Can Your Mood Stabilizer Interfere With Birth Control?

Drug interactions between oral contraceptives and bipolar medications

Woman holding contraceptive pills
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What do you need to know about drug interactions if you are taking a mood stabilizer for bipolar disorder and could these medications make your birth control less effective?

Mood Stabilizers (Anticonvulsants) for Bipolar Disorder

Anticonvusants (anti-epileptic) 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, calcium channel blockers, and benzodiazepines).

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.

While these medications can be very effective, there are important drug interactions you will need to be aware of that could both increase your risk of pregnancy and increase the risks of pregnancy if you were to become pregnant.

Types of Interactions Between Bipolar Drugs and Birth Control Medications

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, and even those methods which do not contain estrogen may be a problem. 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 effectiveness (unwanted) 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) and Birth Control

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.

Women who are prescribed Tegretol should be instructed to use secondary methods of birth control such as condoms. In some cases, a gynecologist may recommend using a higher dosage of birth control medications as well.

Trileptal (Oxcarbazepine) and Birth Control Pills

Trileptal (oxcarbazepine) may also interfere with contraceptives. Birth control pills containing estrogen and progestin, progestin only birth control pills (the minipill), contraceptive progestin injections (such as Depo-Provera), contraceptive implant forms of progestin (such as Nexplanon), and progestin-containing IUDs,(such as the Mirena IUD and the Skyla IUD) may not work properly if you take them while you are taking oxcarbazepine

Aside from birth control issues, people taking Trileptal should know that it can increase the risk of suicidal thoughts and suicide attempts. In this article we are primarily discussing interactions with birth control methods, but it's important to again point out that there are many potential drug interactions in addition to those involving birth control that can be serious.

Topamax (Topiramate) and Birth Control

Topamax (topiramate) has a risk of decreased contraceptive efficiency as well as carrying a strong risk of birth defects such as cleft lip and palate in those who become pregnant while taking the medication.

Interactions Between Depo-Provera  Injections and Any Anticonvulsant

Depo-Provera contraceptive injections can speed up bone loss, as can some other anti-epileptic drugs (anticonvulsants), which may lead to osteoporosis. Thus, if you take any anticonvulsant and are considering using Depo-Provera injections, seek advice about osteoporosis from your doctor.

Lamictal (Lamotrigine) and Birth Control

In the case of another anticonvulsant, Lamictal (lamotrigine), birth control can affect how well the mood stabilizer works. 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.

Benzodiazepines and Birth Control

Benzodiazepines are another class of drugs used as mood stabilizers for people with bipolar disorder. Birth control pills can increase the concentration of some benzodiazepines, such as Xanax (alprazolam) lead to heightened effects of the drugs (and consequent side effects.)

Calcium Channel Blockers and Pregnancy

Calcium channel blockers are used less frequently for bipolar disorder as they aren't usually as effective and higher doses need to be used. That said, if you are feeling discouraged about the side effects and interactions of your medications, it might be helpful to learn that this is one class of medications which is relatively safe in pregnancy.

Being Your Own Advocate - Awareness of Medication Interactions

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.

It's important to understand that the medications you are using, particularly if you are getting these medications from different providers, have the potential to interact. Pharmacists frequently find interactions, but you can not assume this will occur. One study found that 50 percent of people taking six or more medications daily were taking medications that resulted in an adverse interaction.

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

Tips for Avoiding Drug Interactions

  • Make sure that all of your providers are aware of all of the medications you are using, not just the drugs they are prescribing.
  • Bring all of your medications with you, in their original bottles, to each office visit.
  • Keep in mind 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.

Bottom Line on Mood Stabilizers (Particularly) Mood Stabilizers and Birth Control

The bottom line? 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.

Sources:

Suto, H., Braga, G., Scarpellini, G. et al. Neurologist Knowledge about Interactions Between Antiepileptic Drugs and Contraceptive Methods. International Journal of Gynaecology and Obstetrics. 2016. 134(3):264-7.

Williams, D. Antiepileptic Drugs and Contraception. US Pharmacist. 2014. 39(1):39-42.

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