Can Your Mood Stabilizer Interfere With Birth Control?

Mood stabilizers are psychiatric medications that are prescribed to treat mental health conditions such as bipolar disorder, depression, borderline personality disorder, and schizoaffective disorder. Some types of mood stabilizers can interact with oral contraceptives, which may affect the effectiveness of either or both medications. 

If you are taking a mood stabilizer, it is important to talk to your doctor about how it might affect your birth control method to avoid unintended pregnancy or other drug interactions. It is also important to consider whether hormonal birth control might make your mood stabilizer less effective.

Overview of Mood Stabilizers

Anticonvulsants (antiepileptic) drugs are commonly used for people with bipolar disorder and are one of several classes of medications considered to be mood stabilizers (along with lithium and certain antipsychotics). While these drugs were devised for controlling seizures, they are often very effective in stabilizing mood and have been called mood stabilizers for this reason.

Interactions Between Mood Stabilizers and Hormonal Birth Control

There are several different ways in which mood stabilizers can interact with hormonal methods of birth control such as birth control pills. Keep in mind that there are several different types of hormonal birth control, of which birth control pills are only one type. Some possible pregnancy prevention and related interactions include:

• Decreased effectiveness of birth control pills related to the mood stabilizer
• Decreased effectiveness of the mood stabilizer among those who take birth control pills
• Increased levels and side effects of the bipolar drug in those who used birth control pills
• Potential for birth defects related to the drug if you become pregnant

Let's look at a few of the specific mood stabilizers and how they may interact with birth control (or pregnancy.)

Tegretol (Carbamazepine)

Tegretol (carbamazepine) is especially known for causing contraceptive failures among those using birth control pills (oral contraceptives). In addition, for those who do become pregnant while taking Tegretol there is an increased risk of birth defects in the fetus.

In some cases, a gynecologist may recommend using a higher dosage of birth control medications as well.

Trileptal (Oxcarbazepine)

Trileptal (oxcarbazepine) may also interfere with contraceptives. Birth control pills that may not work properly if you take them while you are taking oxcarbazepine include those:

• Containing estrogen and progestin
• Progestin-only birth control pills (the mini pill)
• Contraceptive progestin injections (such as Depo-Provera)
• Contraceptive implant forms of progestin (such as Nexplanon)
• Progestin-containing IUDs, (such as the Mirena IUD and the Skyla IUD)

Topamax (Topiramate)

Topamax (topiramate) has a risk of decreased contraceptive efficiency. However, some research suggests that taking low-dose topiramate with oral contraceptives may not increase the risk of unintended pregnancy.

Topiramate also carries a big risk of birth defects, such as cleft lip and palate, in those who become pregnant while taking the medication.

Lamictal (Lamotrigine)

Another anticonvulsant, Lamictal (lamotrigine), can be affected by some birth control. This can increase the metabolism of the mood stabilizer and affect its effectiveness. Conversely, higher doses of Lamictal can decrease the effectiveness of certain birth control.

If you are starting to take lamotrigine, make sure to tell your doctor if you are taking birth control medication; if you are already taking Lamictal, tell your doctor right away if you start—or stop—taking birth control.

Be Your Own Advocate

Be aware that your healthcare provider may not know every interaction between every specific medication off the top of their head. You should make sure they know all the medications, supplements, and substances you are taking and check for specific interactions before prescribing any medication.

A 2016 study found that while many physicians are aware that there can be drug interactions between anticonvulsants and birth control, they were less familiar with the adverse effects and interactions related to specific drugs.

We have listed a few of the potential drug interactions between commonly used bipolar medications (mood stabilizers) and birth control medications, but there are many more interactions not listed here.

Pharmacists frequently find interactions, but you can not assume this will occur. Evidence suggests that 50% of people taking five or more medications daily experience an adverse drug interaction.

How to Avoid Drug Interactions

There are strategies that can help you minimize the risk of experiencing drug interactions between your mood stabilizers and oral contraceptives (as well as other medications):

• Bring all of your medications with you, in their original bottles, to each office visit.
• Remind your doctor of other conditions you have that other specialists are treating.
• Remember that over-the-counter medications and nutritional supplements may also interact with some drugs, and your doctors should be aware of any herbal treatments or vitamin supplements you are taking.
  

Keep in Mind

The bottom line is that if you are taking or want to take contraceptives, always make sure the doctor who prescribes your bipolar medications knows about it, and that the doctor prescribing the contraceptive knows about your bipolar medications. It's also worthwhile to talk to your pharmacist about possible drug interactions as well.