Many women take both antidepressants and birth control at the same time. It’s not unusual. About 10.4% of women between 18 and 39 in the U.S. are on antidepressants, and nearly all 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 can’t ignore.
The biggest fear? That your antidepressant will make your birth control fail. The good news: For the most common antidepressants - especially SSRIs like sertraline (Zoloft), escitalopram (Lexapro), and fluoxetine (Prozac) - there’s no strong evidence this happens. A 2024 review of 15 studies involving over 3,800 women found no significant drop in contraceptive effectiveness when these drugs were taken together. In fact, pregnancy rates were nearly identical between women taking SSRIs and those who weren’t.
Why? Because SSRIs don’t interfere with how your body processes the hormones in birth control. They don’t speed up or slow down the liver enzymes (like CYP3A4) that break down estrogen and progestin. That means your pill, patch, or ring stays just as effective as it would be on its own.
Not all antidepressants are the same. Tricyclics like amitriptyline, nortriptyline, and imipramine are older drugs still used for chronic pain or severe depression. But they come with a hidden risk when paired with hormonal birth control.
Birth control pills can block the liver enzymes (CYP1A2 and CYP2C19) that break down tricyclics. That means these antidepressants build up in your blood - by 30% to 50%. Higher levels raise the risk of side effects like dizziness, dry mouth, blurred vision, and, more seriously, heart rhythm changes. A 2019 study found that 12% of women taking amitriptyline with birth control showed signs of QT prolongation on EKGs - a condition that can lead to dangerous arrhythmias.
If you’re on a tricyclic and birth control, your doctor should monitor you closely. Blood tests for drug levels and heart function may be needed, especially in the first few weeks. Many providers will switch you to an SSRI instead - not just for safety, but because SSRIs often work better for mood disorders tied to hormonal cycles, like PMDD or postpartum depression.
Bupropion (Wellbutrin) stands out for two reasons. First, it doesn’t interact with birth control at all. Studies show less than 5% change in estrogen levels when taken together. Second, it’s one of the few antidepressants that doesn’t cause sexual side effects - and may even help with low libido.
That’s important. About 30% to 70% of women on SSRIs report reduced sexual desire, trouble reaching orgasm, or vaginal dryness. Hormonal birth control can add to that - up to 25% of users experience lowered libido. When you combine them, the effect isn’t just additive; it’s compounding. One woman on Reddit wrote: “I was fine on Zoloft until I started the pill. Then I lost all interest in sex - and it lasted months.” Switching to bupropion helped her regain her sex drive without losing mood stability.
If sexual side effects are a major concern, bupropion is often the best alternative. It’s not perfect - it can cause insomnia or anxiety in some - but for many, it’s the clear winner.
Not all birth control is made equal. Combined methods (estrogen + progestin) like the pill, patch, or ring have more potential for interaction simply because estrogen affects liver enzymes. Progestin-only options - the mini-pill, implant (Nexplanon), or IUD (Mirena, Kyleena) - are less likely to interfere with antidepressants.
Why? No estrogen means fewer changes to protein binding and liver metabolism. That’s why many doctors recommend progestin-only methods for women on antidepressants, especially if they have a history of blood clots, migraines with aura, or high blood pressure. The Mirena IUD, for example, releases progestin locally in the uterus, so very little enters the bloodstream. That minimizes any possible interaction.
One woman on a fertility forum shared: “I was on Loestrin and felt like I was drowning in mood swings. My doctor switched me to Mirena and I felt like myself again - no more crying over spilled coffee.”
It’s not just antidepressants. Some antibiotics can wreck your birth control. Rifampin, used for tuberculosis, cuts estrogen levels by 60%. That’s why you need backup contraception while taking it - and for a month after.
But don’t panic about amoxicillin or azithromycin. Those don’t interfere. A 2021 study confirmed: common antibiotics are safe. The myth that all antibiotics reduce birth control effectiveness is just that - a myth.
Other drugs to watch: Seizure meds like carbamazepine, some HIV drugs, and St. John’s Wort. These all speed up how fast your body breaks down hormones. If you’re on any of these, talk to your doctor before starting birth control.
Even if your birth control and antidepressant don’t interfere chemically, their side effects can pile up. Nausea, fatigue, weight gain, and mood swings? Common to both. One study of 1,243 women found that 22% experienced more breakthrough bleeding when taking SSRIs with birth control. Another 10% said their sexual side effects got worse.
That’s not a drug interaction - it’s a symptom overlap. But it feels like one. And it can make you think your treatment isn’t working. The key is tracking. Keep a simple log: mood, bleeding, sleep, libido. Bring it to your doctor. You might need a lower dose, a different birth control, or a switch to bupropion.
Good care means more than just writing a prescription. Your provider should:
Many private practices skip these steps. Planned Parenthood’s patient guides on this topic scored 4.7/5 in a 2023 survey. Private clinics? Only 3.2/5. Don’t assume your doctor knows this stuff. Be prepared to ask.
You don’t need to panic over every little change. But call if you notice:
These aren’t normal. They’re signals. Don’t ignore them. Your body is telling you something needs adjusting.
Research is catching up. The American College of Obstetricians and Gynecologists is updating its guidelines in early 2025 to include clearer advice on antidepressant-birth control use. A new $2.4 million study is looking at how your genes affect how you metabolize these drugs. That means in a few years, we might be able to test your DNA and know - before you even start - whether you’re at risk for interactions.
For now, the best approach is simple: Be informed. Track your symptoms. Speak up. And work with a provider who listens.
For most common antidepressants like SSRIs (Zoloft, Lexapro, Prozac) and bupropion (Wellbutrin), no - they don’t reduce birth control effectiveness. The only exception is tricyclic antidepressants like amitriptyline, which can build up in your system when taken with birth control, potentially increasing side effects but not causing pregnancy. Always check with your doctor if you’re on an older antidepressant.
Birth control doesn’t make antidepressants less effective at treating depression. But it can worsen side effects like nausea, fatigue, or low libido - especially if you’re on an SSRI. This isn’t because the drugs interfere with each other, but because both can cause similar side effects. If you feel worse after starting birth control, talk to your doctor about switching to a different method or antidepressant.
Yes. Lexapro (escitalopram) has no known interaction with combined hormonal birth control. The FDA-approved prescribing information states no dose adjustment is needed. Studies show no change in either the antidepressant’s effectiveness or the pill’s ability to prevent pregnancy. Many women take them together safely for years.
Progestin-only methods are often the safest choice: the implant (Nexplanon), the hormonal IUD (Mirena, Kyleena), or the progestin-only pill. They have fewer hormone-related side effects and less potential for interaction. If you’re on a tricyclic antidepressant, avoid combined pills (estrogen + progestin) and consider switching to a non-hormonal option like the copper IUD.
You’re not imagining it. Both antidepressants (especially SSRIs) and hormonal birth control can cause overlapping side effects: low energy, weight gain, low sex drive, mood swings. When taken together, these effects can feel stronger. It’s not a drug interaction - it’s symptom stacking. Try tracking your symptoms for a month, then talk to your doctor about switching to bupropion or switching birth control to a progestin-only method.
There’s no proven benefit to spacing them out. Some providers suggest taking them 2 hours apart to avoid stomach upset, but studies show this doesn’t affect absorption or effectiveness. Take them when it’s easiest for you - as long as you’re consistent. The key is not timing, but sticking to your schedule every day.
