Roe: On the Pill, and on One That Got Away

Dear Roe,

I read a piece going around recently about research about how the pill could be making women depressed. You might have seen it. But the pill has done the opposite for me; it seems to help me with depression. How can it do both?

Dear Letter Writer,

The simple answer is that the pill affects people differently because everyone’s bodies are different; they produce different levels of hormones internally, and react to externally added hormones and medications in different ways.

It’s the same general idea behind why some people have depression and anxiety and some don’t, and why two people with depression could have completely different reactions to the same antidepressant. Our bodies are complicated, and sometimes a goddamn nuisance.

When it comes to the pill, and people who experience menstruation, that glorious mess of hormones can become more calm or more volatile, depending on a range of factors. These include the amount of certain hormones your body produces, as well as how your liver and gut process hormones and medications.

(Just a note before we continue: in this answer, I’m going to just talk about “people” or “AFAB” – assigned female at birth – because not all people who menstruate and/or take the pill identify as women. There are trans men and gender non-binary folk and a whole host of wonderful people who I have no desire to exclude, so let’s eschew gender essentialism and just be sound instead. And no, all ye “this is political correctness gone mad!” types, I do not care an iota about your opinion on this matter.)

For readers unfamiliar with the study you’re referring to, it was published from the University of Copenhagen and studied over 1 million Danish women (the language of the study – it’s unclear whether any people who were AFAB but who don’t identify as women were part of the study), aged between 15 and 34, who were tracked for a total of 13 years.

The study concluded that participants who used hormonal contraception such as the pill were more likely to subsequently be prescribed antidepressants and receive a diagnosis for depression.

The main findings stated that people who take the combined oral contraceptive pill (i.e. pills that contain oestrogen and a progestin) were up to 23 percent more likely to be diagnosed with depression. Meanwhile, for women who used progestin-only pills, their chances of being diagnosed with depression increased to 34 percent.

Adolescents were at the highest risk, as those who took combined pills were 80 percent more likely to be treated for depressive symptoms, while those who took progestin-only pills were twice as likely as their peers to be prescribed an antidepressant.

Now, the study is important, though, as with all studies, there are some caveats and ambiguities to be noted.

People who seek out the pill as a way of regulating moods could be more likely to then try other mood-regulating medications (like antidepressants) than those who do not seek out medication.

Conversely, the emerging symptoms of depression during adolescence may be initially attributed to menstruation-related hormonal problems, and so the pill may be prescribed initially, before antidepressants are tried later.

The authors of the study even say themselves that their work is not the be-all and end-all on this topic, and that the paper acts as a call for more studies to investigate this possible side effect of the pill.

This is not to say that there isn’t a causal relationship between the pill and depression – the thousands of people who self-report experiencing increased depression on the pill, and who responded to the study with a resounding chorus of “I told you so!” demonstrate that there is.

The caveats just indicate that the results are not definitively true for everyone – which we also know by the thousands of others who said “Shitbuzz for you, being on the pill makes me feel as wonderful as the women in tampon ads!” (Though they’re lying – NOBODY is as happy as the women in tampon ads.)

What is clear is that many people do experience an alteration in their moods after going on the pill, both positive and negative, and that the negative aspects have been largely ignored so far.

As to why there could be a link – positive or negative – between the pill and your moods, let’s have a quick class in Periods 101. Most emotional symptoms of PMS are attributed to the increase of progesterone a few days before your period.

Progesterone helps your body make cortisol, the primary stress hormone. As it increases, so may anxiety or depression – and for people who already experience anxiety or depression, an excess of cortisol may be produced, exacerbating their condition.

Taking the progestin-only pill can help keep your levels of progesterone even throughout the month, but for some people, particularly those who already suffer from mental-health issues, the increase in progesterone can elevate their symptoms.

There are also indirect effects to consider. For many people, taking the pill can help alleviate heavy periods, painful cramps, digestive problems, acne and irregular menstrual cycles.

While these aren’t directly related to depression, they could definitely contribute to stress, discomfort and anxiety, and so addressing some of these issues could improve overall physical and mental well-being.

There is also the possibility of a placebo affect, where taking the pill makes you feel like, biologically, your moods are under control – and so they are. Or, on a related but not identical thread, if you do feel any increase in depression or anxiety, you may attribute it to external factors like extra stress, and not attribute it to the pill.

At the end of the day, people react differently to different medications, hormones and methods of contraception. The most important result of this study is the impact it has had on people who have had their side effects ignored or rebuffed by doctors who don’t believe that people with ovaries can be trusted to report their own experiences of their bodies.

If you find that taking the pill helps your moods, that’s great. If others reading this are having adverse side effects, make sure you have a doctor who believes and supports you, and explore other options.

Everyone deserves to feel as good as possible – and to be believed when they don’t.

***

Dear Roe,

I’m a 24-year-old woman and have been close friends with a guy since we were 16. Nothing ever happened, but it was always complicated. All through school and college we were into each other, but never at the same time, or we would tell each other we liked each other, but only when one or both of us was with someone else so we couldn’t do anything.

He went off traveling nearly a year ago and we’ve stayed in touch. We actually traded pretty emotional emails just after he left, saying how much we both liked each other, but that’s calmed down, and we’re now just friendly and definitely flirty. He’s coming home for Christmas, and we’ll finally be single at the same time. I’m no longer obsessed with him the way I used to be, I used to think I was in love with him.

But I do still fancy him and think that after all this time that I want to hook up. Because he’s heading back to New Zealand for at least another six months after Christmas, I don’t think it would cause too many issues, so it seems like the perfect time but none of my friends think it’s a good idea. Is it possible to just have some casual fun after all that serious stuff?

Dear Letter Writer,

Oh, the Ross of it, the Rachel of it, the drama of it all.

As someone who was both prone to writing embarrassingly dramatic feel-filled emails back in the day, and who moved away only to have a few mates come out of the woodwork to make big declarations of feels after years of seeing me every day and never once expressing a feel, I shall let you in on a little secret.

Those big “You’re the one that got away” emails that people send when one of them is leaving the country? They’re usually bullshit.

Not in any kind of malicious or ill-intentioned or dishonest way; they’re usually fuelled by a genuine swell of emotion about someone important leaving, and all the shoulda-woulda-couldas that go along with that big change.

But most of the time, if you really wanted something to happen, you would have made it happen while you were right there beside each other. When one of you is leaving? It’s safe. It’s non-committal.

It’s the drama and excitement of making a big feel-filled declaration, without the responsibility, reality or commitment of following through and actually doing anything about it. “But it wasn’t just when he left!” I hear you dramatically cry! Your declarations of feels have been going on for years!

Exactly. Over six years, you both took part in a calculated dance where you never made declarations of feels when anything could happen. You waited until the other was in a relationship, or uninterested, and only then recited your script.

Now, again, I don’t think either of you did this maliciously (though declaring feels when you or the other person is in a relationship? Not very respectful to your respective partners, don’t be those people).

I don’t even think you did it consciously. Ye obviously have a connection and an attraction, but there is a reason it has never worked out, and I think subconsciously ye both have been ensuring this pattern of bad timing continues so that it never will.

Because it’s kind of perfect, isn’t it? You get to date other people and enjoy the security of relationships, while also having this frisson-fuelled, forbidden attraction that comes with occasional declarations of love and devotion, giving you an extra dose of validation and attention without having to even do anything.

And there’s the beautiful, Tolstoy-worthy romance of it all. Star-crossed lovers, destined to love each other from afar. How beautiful, how tragic, how hopeful. Maybe one day, when all your normal, human relationships prove too mundane, this epic love story of the ages will finally work out.

It’s because of the unattainable nature of it all that you never liked each other when you were both single. Because where’s the fun in that? Once attainable, once less attractive.

Now, there are people who fancy each other in school and college and only get together years later. Could you be those people? Of course you could. Do I think you’re at that stage now? No.

Because you’re still dancing the same dance, my dear girl. You’re not thinking that maybe you can try be together when he’s back home for good; you’re suggesting having a quickie when he’s visiting, before he disappears across the globe for another six months.

And you’re suggesting that this happen when the last time you saw each other was filled with emotion, expressed by email declarations of feels, and has been fuelled by charged flirtatious energy ever since. That’s not causal.

And by hooking up at Christmas, you’re going to transform that not-casual into a glitter-bomb of exploded feels and tension and dramatics that will keep you in the soap-opera-land of overwrought emails for at least another six months until he returns and you’ll have to try glue all the confetti back together.

Maybe I’m wrong. Maybe you really are over him enough to just jump him and enjoy it and send him on his merry way. But you don’t know how he’s feeling.

He could have taken the declarations of feels when he left seriously, and could still be emotionally attached to you. In that case, having a quick roll in the hay would be just playing with his emotions.

Casual sex is one thing, but this isn’t casual, and you need to treat it as such. Whether you’re looking for a quickie or something more long-lasting with this guy, leave it until he comes back home for good.

That way, you can properly assess your reasons for wanting to hook up with him, and do it properly. If you genuinely just want something casual, you can have that conversation free from the “what if this is our last chance!” pressure, and if you want something more serious, you can stick around to see it through.

The good news (for you) is that Christmas is a jackpot for recently dumped people and singles looking to ring in the New Year with a bang, so you’ll have plenty of options for a hook-up – and those will come with less drama.

Do you have a question for Roe? Submit it anonymously at  dublininquirer.com/ask-roe