Antidepressant and Birth Control Interaction Checker
Check Your Medication Combination
Many women take antidepressants and hormonal birth control at the same time. It’s not unusual. About 1 in 10 women between 18 and 39 in the U.S. are on antidepressants, and nearly 9 in 10 women use some form of birth control during their reproductive years. When these two medications overlap, questions arise: Does one make the other less effective? Do side effects get worse? Is it safe? The short answer: For most people, yes-it’s safe. But there are important details you shouldn’t ignore.
Most Antidepressants Don’t Break Birth Control
The good news? The most common antidepressants-SSRIs like sertraline (Zoloft), escitalopram (Lexapro), and fluoxetine (Prozac)-don’t interfere with how birth control works. Multiple studies, including a 2024 review of 15 clinical trials involving nearly 4,000 women, found no meaningful drop in contraceptive effectiveness when these antidepressants were taken with combined pills, patches, or rings. In fact, pregnancy rates among women using both were nearly identical to those using birth control alone.Why does this matter? Because some women worry that if their antidepressant reduces birth control’s effectiveness, they could get pregnant unexpectedly. That fear is understandable, but it’s largely unfounded for SSRIs. The CDC and American College of Obstetricians and Gynecologists (ACOG) both state that these medications don’t reduce the hormonal levels needed to prevent ovulation.
Even when taken together, estrogen and progestin in birth control maintain their normal concentrations in the bloodstream. One study tracking women on fluoxetine and oral contraceptives showed no statistically significant change in depression scores or hormone levels-meaning both treatments worked as expected.
Where the Risk Actually Lies: Tricyclics and Other Antidepressants
Not all antidepressants are created equal. If you’re on a tricyclic antidepressant (TCA) like amitriptyline, nortriptyline, or imipramine, the picture changes. These older medications are metabolized by liver enzymes-specifically CYP1A2 and CYP2C19-that birth control can slow down. When that happens, the antidepressant builds up in your system.That buildup can lead to side effects you didn’t sign up for: dizziness, dry mouth, blurred vision, and, more seriously, heart rhythm changes. A 2019 study found that 12% of women on TCAs with birth control showed signs of QT interval prolongation, a condition that can trigger dangerous heart arrhythmias. This isn’t common, but it’s real enough that doctors now routinely screen for it.
If you’re on a TCA and birth control, your provider should monitor your heart health, especially in the first few months. Blood tests for liver function and EKGs may be recommended. Many women in this situation end up switching to an SSRI-not because the birth control stops working, but because the TCA becomes harder to manage safely.
Bupropion: The Exception That Works Well
If you’re struggling with sexual side effects from SSRIs-something that affects up to 70% of users-bupropion (Wellbutrin) might be your best option. Unlike SSRIs, bupropion doesn’t significantly impact serotonin levels in the same way, which means it’s far less likely to cause low libido, delayed orgasm, or reduced arousal. And the good news? It doesn’t interfere with birth control either.Studies show that when bupropion is taken with hormonal contraceptives, ethinyl estradiol levels stay within 5% of normal. That’s practically negligible. Plus, bupropion doesn’t cause weight gain or emotional blunting like some SSRIs do. For women who want to manage depression without sacrificing sexual health or contraceptive reliability, bupropion is often the top choice.
Birth Control Type Matters Less Than You Think
You might assume that the type of birth control you use changes how it interacts with antidepressants. But the truth is, the difference between combined pills (estrogen + progestin) and progestin-only methods (mini-pill, implant, IUD, injection) is minimal when it comes to antidepressant interactions.Progestin-only methods are often recommended for women who can’t take estrogen-for example, those with migraines with aura, high blood pressure, or a history of blood clots. But they’re also safe with antidepressants. In fact, because they don’t contain estrogen, there’s even less chance of enzyme interference. The Mirena IUD, the implant, and the Depo shot all show no documented interactions with SSRIs or bupropion.
One exception: the copper IUD. It’s non-hormonal, so it doesn’t interact with any medication at all. If you’re worried about side effects piling up-like low mood, low libido, or irregular bleeding-the copper IUD is a solid, long-term alternative that gives you control without adding chemical complexity.
The Real Problem: Overlapping Side Effects
Here’s where things get messy-not because of drug interactions, but because of side effects that overlap and amplify each other.SSRIs are known to cause sexual side effects: reduced desire, trouble getting aroused, delayed or absent orgasm. Hormonal birth control can do the same thing-up to 25% of users report lower libido. When you put them together, it’s not a 50/50 chance of trouble. It’s more like a 70-80% chance that you’ll notice a drop in sexual satisfaction.
A 2022 survey of over 1,200 women taking both medications found that 41% reported compounded sexual dysfunction. That’s not a drug interaction. It’s a double whammy. And it’s often the reason women stop one or both medications-not because they’re unsafe, but because they make life feel duller.
Breakthrough bleeding is another common complaint. About 22% of women in the same survey reported spotting between periods. This isn’t a sign that birth control is failing. It’s often just your body adjusting. But if it lasts more than three months or is heavy, talk to your provider. It could mean you need a different hormone dose or a different antidepressant.
What Your Doctor Should Do (And What They Might Skip)
Ideally, your doctor should review your full medication list before prescribing either antidepressants or birth control. But in practice, that doesn’t always happen. Many women start birth control in their teens and get prescribed antidepressants years later-sometimes by a different provider who doesn’t know their full history.Best practice? Ask for a medication review. Make sure your provider knows:
- What antidepressant you’re on (and why)
- What birth control you’re using (pill, IUD, shot, etc.)
- Any side effects you’ve noticed (mood changes, bleeding, low libido)
- Any history of heart issues or liver disease
Providers at large health systems like Kaiser Permanente now use automated alerts when these two medications are prescribed together. Those alerts cut down on risky combinations by 37%. If your provider doesn’t have that system, it’s up to you to speak up.
What to Do If You’re Already Taking Both
If you’re already on an antidepressant and birth control and feeling fine-no mood crashes, no unusual bleeding, no sexual side effects-you’re probably in the clear. Keep doing what you’re doing.If you’ve noticed new symptoms since starting one or both medications, here’s what to check:
- Did your mood get worse after starting birth control? (Could be hormonal)
- Did your libido drop after starting an SSRI? (Common, but manageable)
- Do you feel dizzy, have heart palpitations, or get headaches? (Could signal TCA buildup)
- Are you bleeding more than usual? (Usually temporary, but worth checking)
Don’t stop either medication on your own. Stopping antidepressants suddenly can cause withdrawal symptoms. Stopping birth control suddenly can lead to ovulation and pregnancy. Talk to your doctor first.
When to Consider Alternatives
You don’t have to stick with a combination that’s making you feel worse. Here are three alternatives to consider:- Switch antidepressants: Move from an SSRI to bupropion if sexual side effects are the main issue.
- Switch birth control: Try a copper IUD if you want to eliminate hormones entirely.
- Try non-hormonal depression treatments: Therapy, exercise, and light therapy can help with mild to moderate depression without medication.
Some women find that combining talk therapy with a low-dose SSRI and a copper IUD gives them the best balance-mental health stability without hormonal side effects.
What’s New in 2025
Research is moving fast. A $2.4 million study launched in late 2024 is looking at how your genes affect how you process antidepressants and birth control. Some people have a genetic variation in the CYP2D6 or CYP2C19 enzymes that makes them metabolize drugs slower or faster. That could explain why one woman has no issues with sertraline and birth control, while another has severe side effects.ACOG is updating its guidelines in early 2025 to include clearer advice on this topic. That means more doctors will be trained to ask the right questions-and more women will get personalized care instead of one-size-fits-all prescriptions.
The bottom line? You don’t have to choose between mental health and reproductive control. With the right information and support, you can manage both safely. But you need to be your own advocate. Track your symptoms. Ask questions. And don’t settle for feeling worse just because you’re told it’s "normal."
Can antidepressants make birth control less effective?
For most commonly prescribed antidepressants like SSRIs (sertraline, escitalopram, fluoxetine) and bupropion, no-they do not reduce birth control effectiveness. Studies show pregnancy rates remain the same as in women taking birth control alone. The only exception is tricyclic antidepressants (like amitriptyline), which can build up in the body when taken with birth control, but even then, it’s not about birth control failing-it’s about the antidepressant becoming too strong.
Do birth control pills make antidepressants less effective?
Birth control pills don’t make antidepressants less effective at treating depression. In fact, some studies suggest they might help stabilize mood in women with premenstrual dysphoric disorder (PMDD). However, birth control can slightly increase levels of tricyclic antidepressants, which may raise the risk of side effects. For SSRIs and bupropion, there’s no meaningful change in how well the antidepressant works.
Why am I bleeding between periods on both birth control and antidepressants?
Breakthrough bleeding is common in the first 3-6 months of starting either birth control or an antidepressant. When taken together, it can happen more often-but it doesn’t mean either medication is failing. It’s usually your body adjusting. If bleeding is heavy, lasts longer than three months, or comes with pain, talk to your provider. You may need a different hormone dose or a different antidepressant.
Is it safe to take Lexapro with birth control?
Yes, it’s safe. Lexapro (escitalopram) has been studied extensively with hormonal birth control, and no clinically significant interactions have been found. The FDA’s prescribing information for Lexapro explicitly states that no dose adjustment is needed when taken with birth control pills. Many women take them together without any issues.
Can birth control make my depression worse?
For some women, yes-especially with progestin-only methods. Hormonal changes can trigger or worsen mood symptoms, particularly in those with a history of depression or PMDD. If you notice your mood dips after starting birth control, don’t assume it’s all in your head. Track your symptoms for 2-3 months, then talk to your provider. You might need to switch to a different type of birth control or adjust your antidepressant.
What’s the best birth control for someone on antidepressants?
The best choice depends on your goals. If you want to avoid side effects like low libido or spotting, a copper IUD is hormone-free and won’t interact with any antidepressant. If you prefer hormonal methods, progestin-only options (implant, mini-pill, Depo shot) have fewer interactions than combined pills. For mood stability, combined pills may help some women with PMDD. Bupropion paired with any hormonal method is often the most balanced combo.
Should I take my antidepressant and birth control at the same time?
There’s no strong evidence that timing matters. Some providers suggest taking them two hours apart to avoid stomach upset, but this isn’t necessary for effectiveness. The most important thing is taking both consistently-same time every day. Use a pill tracker app or set a phone reminder. Missing doses is far riskier than taking them together.
Are there any antidepressants I should avoid with birth control?
Yes-tricyclic antidepressants (TCAs) like amitriptyline and imipramine. These can build up in your system when combined with birth control, increasing the risk of heart rhythm problems. If you’re on a TCA and birth control, your provider should monitor your heart health. Most women in this situation switch to an SSRI or bupropion for safety. Always tell your doctor what you’re taking before starting a new medication.
Final Thoughts: You Have Options
You don’t have to live with low mood or low libido. You don’t have to risk an unintended pregnancy. And you don’t have to accept side effects as "just part of the deal." The science is clear: most antidepressants and birth control methods work well together. But your body is unique. What works for someone else might not work for you. That’s why tracking your symptoms, asking questions, and partnering with a provider who listens matters more than any guideline.If you’re taking both medications and feeling off-whether it’s your mood, your body, or your sex life-don’t wait. Talk to your doctor. Bring your notes. Ask about alternatives. You deserve to feel well in every way.
