According to a 2017 report from the CDC, between the years 2011-2014, 12.7% of Americans aged 12 and over were on antidepressant medications [1]. Notably, adult women are 2.5 times more likely to take antidepressant drugs than adult men. While well-intentioned doctors prescribe these medications to help patients, little attention is paid to how antidepressants can affect a woman’s fertility and overall health.
It is crucial to informed consent that women understand the impact psychiatric drugs have on their reproductive system. Further, they ought to be informed about healthy alternatives to antidepressants that preserve or may even enhance their natural fertility. Charting one’s cycle with what’s known in the medical community as a Fertility Awareness-Based Method (FABM), more informally called fertility awareness methods (FAM) or natural family planning (NFP), allows a woman to know some of the hidden dysfunctions her body may have, through the signs of her menstrual cycle. Charting with a fertility awareness method can be a vital part of the process of achieving mental and reproductive health and healing.
Not everyone on an antidepressant may actually be depressed
Shockingly, a New York Times editorial reported in 2013 that one in four women are taking psychiatric drugs [1], but up to 2/3 of those taking them do not fit the criteria for major depression disorder as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM5) [2]. These women may experience symptoms of fatigue, anxiety, or depression, and primary care doctors (who originate the highest number of anxiety medication prescriptions) may use these drugs to help patients with the temporary option of antidepressants, to allow them some daily life functioning.
More recent studies have found similar trends in the prescription of antidepressants. For example, a 2016 study published in JAMA found that only 55% of antidepressant prescriptions written by primary care providers in Quebec, Canada, were indicated for depression [3]; this led to a Time headline boldly declaring “Half of the People Taking Antidepressants Aren’t Depressed [4].” Likewise, a study published in 2018 in the journal Health Services Research evaluated the data collected by the 2006-2015 National Ambulatory Medical Care Survey, and found that “Altogether, at 60.4% of visits at which a new psychotropic prescription was initiated, no psychiatric diagnosis was recorded for the visit [5].”
The concerning side effects of antidepressants
The prescription of antidepressant medications for non-psychiatric diagnoses is troubling given the unintended effects of these drugs, especially when they are used long–term. For example, research from 2018 found a “robust association” between the use of anticholinergic drugs (a drug class which includes some antidepressants) and future dementia [6]; research published in 2020 likewise found that adults who use anticholinergic drugs have a 47% higher risk of developing mild cognitive impairment, which is a known precursor to dementia and Alzheimer’s disease [7].
As evidenced by the increased investigation into birth control drugs, medication side effects are to be expected—and antidepressant drugs are obviously no different. Any drug entering the body has an effect because the chemicals contained in the drug are designed to alter a believed malfunction occurring within a body part or body system. That is what pharmaceutical drugs are supposed to do, right? But because brain functions control and help balance the performance of other body systems, the effects of antidepressant drugs (and other drugs that have a direct effect on the brain, like hormonal birth control) tend to reach even further beyond the intended outcome—even to the point of affecting fertility.
How antidepressants can affect fertility
For instance, we know that anti-depressants and some anti-psychotic drugs interfere with the hormonal regulation of ovulation and a brain-produced hormone called prolactin. A 2013 study showed that women taking antidepressants in the form of selective serotonin reuptake inhibitors (SSRIs) took significantly longer to conceive. SSRIs were also shown to reduce the efficacy of infertility treatments and were linked to miscarriage and preterm birth [8]. In an article from Parents.com, Dr. Alan Copperman, M.D., director of reproductive endocrinology at the Icahn School of Medicine at Mount Sinai in New York City, explains the reasons for these effects well: “Because a woman’s menstrual cycle is tightly controlled by the interaction between the brain, ovaries, and uterus, any health problem or medication that disrupts this communication could adversely affect ovulation and make it challenging for women to achieve a pregnancy.”
And the fertility-altering effects of certain antidepressants may not be limited to women. After all, the hypothalamus and pituitary gland (both of which are structures in the brain) are responsible for spermatogenesis and testosterone production in men [9]. So, yet another critical consideration for couples who are trying to achieve pregnancy is this: a review of the available research shows that SSRIs (a common class of antidepressants) “exert a harmful effect on semen quality and rates of DNA fragmentation, as well as increase oxidative stress within reproductive organs [10].”
How fertility awareness can be an important part of improving your mental health and fertility—naturally
Fertility awareness methods (FAM) of charting the menstrual cycle offer important benefits for women who experience emotional or mental health symptoms and want to preserve their fertility. Fertility awareness teaches a woman to recognize simple biomarkers of her body so that she can know the distinct stages of her cycles.
First, FAMs can be used instead of hormonal birth control, which is now proven to increase the risk of depression among women who use them. Second, fertility awareness can help women and their doctors understand any hormonal imbalances that may be at the root of their emotional or psychological symptoms, such as depression, PMS, or low energy. Finally, FAMs help couples to achieve or space pregnancies in a more natural and emotionally fulfilling way.
Weighing the benefits of antidepressants against the potential effects on your fertility
For women who are not suffering from clinically diagnosed depression, it is important to carefully weigh the benefits of antidepressant drugs and their possible affects on fertility, especially if they are trying to become pregnant, or hope to become pregnant in the future. It is also important to know that there are other proven ways to evaluate and treat anxiety, depression, and other mild to moderate emotional/mental conditions that do not require psychiatric drugs. Cognitive Behavioral Therapy (CBT), talk therapy, health coaching, and Functional & Integrative Medicine are excellent options to consider for mental health treatment, as they work to understand the body-mind connection, the gut-brain relationship, and other health imbalances that may be rooted in detrimental diet and lifestyle habits.
In some situations (as with severe depression), psychiatric drugs can truly be a lifesaver. However, as a health coach and corporate wellness consultant, I am convinced that too often, psychiatric drugs not only mask other problems, but they have far too many detrimental, unintended effects—which certainly seems to be the case with fertility.
References:
[1] Products – Data Briefs – Number 283 – August 2017. Cdc.gov. https://www.cdc.gov/nchs/products/databriefs/db283.htm. Published 2021. Accessed May 19, 2021.[2] Moore T, Mattison D. Adult Utilization of Psychiatric Drugs and Differences by Sex, Age, and Race. JAMA Intern Med. 2017;177(2):274. doi:10.1001/jamainternmed.2016.7507
[3] Takayanagi Y, Spira A, Bienvenu O et al. Antidepressant Use and Lifetime History of Mental Disorders in a Community Sample. J Clin Psychiatry. 2014;76(01):40-44. doi:10.4088/jcp.13m08824
[4] Wong J, Motulsky A, Eguale T, Buckeridge D, Abrahamowicz M, Tamblyn R. Treatment Indications for Antidepressants Prescribed in Primary Care in Quebec, Canada, 2006-2015. JAMA. 2016;315(20):2230. doi:10.1001/jama.2016.3445
[5] Half of the People Taking Antidepressants Aren’t Depressed: Study. Time. https://time.com/4345517/antidepressants-depression-insomnia-depression-migraine/. Published 2020. Accessed October 16, 2020.
[6] Rhee T, Rosenheck R. Initiation of new psychotropic prescriptions without a psychiatric diagnosis among US adults: Rates, correlates, and national trends from 2006 to 2015. Health Serv Res. 2018;54(1):139-148. doi:10.1111/1475-6773.13072
[7] Richardson K, Fox C, Maidment I et al. Anticholinergic drugs and risk of dementia: case-control study. BMJ. 2018:k1315. doi:10.1136/bmj.k1315
[8] LaFee S. Common Class of Drugs Linked to Increased Risk of Alzheimer’s Disease. UC Health – UC San Diego. https://health.ucsd.edu/news/releases/Pages/2020-09-04-common-class-of-drugs-linked-to-increased-risk-of-alzheimers.aspx. Published 2020. Accessed October 16, 2020.
[9] Domar A, Moragianni V, Ryley D, Urato A. The risks of selective serotonin reuptake inhibitor use in infertile women: a review of the impact on fertility, pregnancy, neonatal health and beyond. Human Reproduction. 2012;28(1):160-171. doi:10.1093/humrep/des383
[10] Clavijo R, Hsiao W. Update on male reproductive endocrinology. Transl Androl Urol. 2018;7(S3):S367-S372. doi:10.21037/tau.2018.03.25
[11] Beeder L, Samplaski M. Effect of antidepressant medications on semen parameters and male fertility. International Journal of Urology. 2019;27(1):39-46. doi:10.1111/iju.14111
This article was originally published on September 18, 2017 as written by Virginia Schoenfeld. It has since been updated by Natural Womanhood to offer more resources. Last updated October 16, 2020.
Additional Reading:
The Powerful Link Between Fertility Awareness and Mental Health
4 Ways Fertility Awareness Methods Can Improve Mental Health
How I Overcame Postpartum Depression with Bioidentical Progesterone
