July 29, 2025 • 22 mins
In this episode of Wellness Unmasked, Dr. Nicole Saphier takes a closer look at the mental health side effects of hormonal birth control—especially in teenage girls. She explains how these commonly prescribed contraceptives may increase the risk of depression and suicidal thoughts in young women, citing research and real-world data.
Dr. Saphier also discusses the role of the pharmaceutical industry in downplaying these risks through aggressive advertising and limited warning labels. This eye-opening conversation raises important questions about how hormonal contraceptives are prescribed and why we need greater awareness around their impact on teen mental health. Wellness Unmasked is part of the Clay Travis & Buck Sexton Podcast Network - new episodes debut every Tuesday & Friday.
Follow Clay & Buck on YouTube: https://www.youtube.com/c/clayandbuck
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
Welcome to Wellness on MASS I'm doctor Nicole Safire, and
we are going to do with something a little different
this week. I had something planned for the podcast episode
to be released this week. However, yesterday I found myself
going down this never ending rabbit hole. Have you ever
done that? Where you start searching one thing and then
you're like, oh, well, that's interesting. I'm going to click
(00:23):
on this length and then this link, and then several
hours later, I have to change our entire week's topic
because I'm still down the rabbit hole, and I'm just
going to bring you guys down with me. So yesterday,
if you saw I do a weekly segment on Fox
and Friends Weekend called Weekend Wellness, and we always talk
about some sort of news of the week or some
wellness topic, usually some social media trend that I think
(00:46):
is totally bogus. This week, though, I was asked to
kind of dive into some of the less common or
less known side effects of contraception use. All right, it
seems pretty straightforward. I've been studying contraception sceptives for I
don't know AIDS, and just as a woman, I knew
about them obviously, But as I was looking for the
(01:07):
more or I should say, less commonly known ones. That's
when I found myself kind of going down this rabbit
hole as a woman. Youwhere from sixty to seventy five
percent of women of child bearing age are all on
contraceptives here in the United States, whether it's oral contraceptives,
implantable devices like rings IDs, surgical contraception where you have
(01:32):
your tubes tubes tied during some sort of surgery. There
are a lot of different contraceptives these days, but the
most common, the overwhelmingly most common, are the hormonal oral
contraceptives or you know, the pill as most people know
it as. So I kind of focused there a bit
and one of the things that really stood out to me. Listen,
(01:54):
I deal in breast cancer every single day, so people
ask me all the time as there arise of cancer
risk when it comes to oral contraceptives. That's not what
we're focusing on today. That's an entirely different conversation. But
I can tell you that there can be a slight
increased risk of breast cancer when it comes to some
of these contraceptive methods. When you stop taking the hormonal contraceptives,
(02:17):
your risk does tend to go back to normal with
some time. So you know, I wouldn't say cancer risk
if you don't already have a known family history of
cancer is necessarily reason not to try them. But again,
that's not what we're going to talk about, because while
that is interested for my daily job, the rabbit hole
that I started going down yesterday which I found extremely alarming,
(02:40):
and I can't believe that I'm not hearing it. I
haven't heard about this more. I guess it's just not
what mainstream media wants to talk about. Is its effect
on mental health, and not just mental health of all women,
but mental health specifically in adolescents and young adults who
take hormonal contraceptives. So let's talk about this. First of all,
(03:02):
we know when it comes to contraceptives, it is wildly advertised.
You can see it. Pharmaceutical companies are now able to
do radio and podcasts and ads and TVs and social
media and all these other things. And usually when you
see the ads, it's female empowerment, doing what's right for you,
(03:22):
kind of all these strong, buzzy, feel good terms. I
guess they don't really want to focus on the negative
side of that. You know, as a teenager myself when
I was having really difficult menses or menstrual cycles, you know,
heavy bleeding, lots of pain. I think a lot of
women deal with it, you know, headaches, you know, some athne,
(03:43):
some of all the stuff that comes with being a teenager,
a kneejer reflex. These days are putting these kids on contraceptives.
I was one of them. I don't even remember having
that conversation. I just, you know, my mom and I
told the doctor, well, these are the symptoms, and the
doctor's like, all right, well, birth control. Well, it's a
very common thing, especially in teen girls. It's not just
(04:04):
for you know, contraceptive, you know, that's like the nice
little thing they say that, like it really can help
with the moods and the acne and all these other things, which,
by the way, it can. You know, contraceptives does decrease eebone,
which can help with acne. I'm not saying it doesn't
have benefits whatsoever. I'm not, but I don't remember having
the conversation about what we're about to talk about. So
(04:27):
one of what I was discovering yesterday in my downward
spiral is the fact that there are I'm going to
be scrolling because I want to reference things because, as
you know, I like to be very fact based. I
love data. I love objective medicine, meaning I like to
take the opinion out of it, and I just like
(04:47):
to report on the facts. So, since I've really only
been studying this for solid twenty four to forty eight hours,
I'm going to reference some things because I wouldn't call
myself an expert, but at this point I am incredibly
more knowledgeable about this topic than I was a week ago,
a year ago, ten years ago, or I guess it
was thirty years ago, homo, And not quite thirty years
ago when I was prescribed these myself as a teen
(05:10):
But the fact that there is a relationship between hormonal
contraceptive use and depression and not just suicide attempt but
suicide completion in teenagers, and I was thinking, all right, well,
maybe there's a few case reports, some anecdotal evidence, you know,
you know, causation correlation. Is there really evidence to suggest
(05:34):
that oral contraceptives or these contra hormonal contraceptives could be
doing this. Well, let me tell you this. There was
not just a couple of case reports. We had these
really big observational meta analysis studies looking at this like,
this is not new, This isn't something that's just popping up.
This is something that's known about. It just really isn't
(05:56):
talked about. I'm going to just throw out some stats
from some of these studies. We're not going to go
into all of these studies. I'm going to spare you
that because I read them. One out of Upsol University
showed at one hundred and thirty percent higher risk of
depressive symptoms in teens who took oral contraceptives the Danish
Registry data. This was the biggest one. It looked at
(06:17):
over a million women over about eight years, and essentially,
Hay said, of the young girls, the teens, young adults
who were taking hormonal contraceptives, they had a seventy percent
higher chance of also being prescribed antidepressed since at the
same time. So it was like it's like this endless cycle.
(06:38):
All right, We're going to prescribe contraceptive hormones, and now
we're going to prescribe antidepressants, and the antidepressants are probably
going to you know, are trying to help the effects
of the hormones. But we're going to keep giving the
hormones and we're going to keep meeting the antidepressants. And
by the way, when you start antidepressants as a teen,
your likelihood of staying on them through adulthood is through
the roof. So it's not like it's a short lived thing. Oh,
(07:00):
we'll just do it for a little bit. Absolutely not.
And there was a clear difference between teens and adult users.
When a teen started oral contraceptives, the risk of depression
and these suicidal thoughts was significantly more than that in
adult users. And it also varied a little bit by
the type of contraceptives. Interestingly, most common associated or the
(07:22):
hormonal IUDs as well as the oral contraceptives. So I
kind of took a pause at this point. I'm like, wow,
I'm seeing a lot of evidence. They're certainly talking about it,
but I really want to know is it true. Were
there really really documented data on suicide and all of that.
(07:43):
And the answer was yes, it's not just oh well
there was a risk of depression, Oh it was more
than that. So there's this study out of Denmark looked
at nearly half a million women age over fifteen. Again,
the follow up was about eight years. This was part
of that Danish registry that I was already talking about
(08:04):
They found hormonal contraceptive use doubled the risk of suicide attempts.
Doubled the risk. By the way, if that's not bad,
it tripled the risk of completed suicide, meaning they didn't
just attempt suicide, they killed themselves. They tripled the risk.
Those who were on the contraceptives had a threefold risk
(08:27):
of completing suicide, of killing themselves then those who never
were on the oral contraceptives. Now you can say, well,
how do we know that they didn't have mental illness?
How did they we know that they weren't predisposed to it?
All good questions, all good questions. Okay, we always have
to look deeper at the data. But they did account
for this. If those if anyone had a known history
(08:49):
of mental illness, known history of depression, they were already
removed from this study. Now, again, science is imperfect, but
I'm telling you that these numbers are not equivocal. We're
talking major increased risk of depression, suicide, attempt suicide completion
being prescribed antidepressants. All when kids, I call them kids,
(09:11):
I mean I have a twenty five year old, yes,
a sixteen year old girl, A fifteen year old girl
is a kid. To me, when we are prescribing kids
these medications, they are heavy consequences with this. Another study
came out of Sweden. This was a big Swedish registry.
It looked I mean it was a less populated about
two hundred and sixteen thousand women looked at fifteen to
(09:32):
twenty two year olds. The combined oral contraceptive users had
almost a two times suicidal behavior in the first month
compared to those without oral contraceptives. And they actually said
that they said the suicidal ideations and attempts were more
likely within the first two months, but it didn't actually
(09:52):
go back down to normal with time. And if it
was a progestion only pill like the mini pill, I
think it's referred to the cool world, it was even higher.
Another one Finland analysis of almost six hundred thousand women
ages fifteen to forty nine over a couple year period.
They said that they found no increase of attempted suicide. However,
(10:15):
it certainly did it increase depression. I mean, so take
it what you will. Depression can lead to suicide if
you have an increased risk of depression. I'm going to
say at some point people with depression contemplate if not
complete suicide. So nine studies total looked at some of
this stuff, three on suicide attempts, five on completed suicides,
(10:40):
and the majority of these showed an increased risk. Some
of them were equivocal, some just said, well, we can't
really say for sure that there's an increased risk of
suicide attempt or completion, but they certainly there was not
a question that it could increase the risk of depression
and people who do not have a history of depression.
You're listening to wellness and we'll be right back with more.
(11:05):
Why would teenagers be more vulnerable to these you know,
why isn't it the same for teens versus adult women. Well,
I mean common sense kind of comes in right here.
The reality is the teenager's brain, their body, it's still forming.
I know, I know, fifteen sixteen year olds think they
know it all and that they're already adults, but the
reality is they're not. And in fact, adolescence is a
(11:27):
critical period for brain development and hormonal regulation that is puberty.
It doesn't just happen overnight. It takes time, and there's
something called the HPA axis. And without getting into the
granular detail, there's a little gland in your brain called
the hypothalamus. Then you have the pituitary another one, and
then you go down to your adrenal glands, which are
(11:47):
two glands. That's it's hard for way to do with
my shoulder pointing to my back. Your two little drainal
glands sit on top of your kidneys. Now, this is
your HPA access and this is important for you your
stress response, so your fight or flight it's part of that,
your cortisol levels. And so there have been many studies
(12:08):
showing how synthetic hormones like oral contraceptives may disregulate this
cycle and disregulate your mood resilience, you know, your ability
to deal with stress, and particularly oral contraceptives based on
this science, not just because it's my opinion, have shown
that it can significantly affect this HPA axis again, which
(12:31):
regulates the body's stress response. So this impact can lead
to altered cortisol dynamics, including blunted cortisol response to stress.
So if you're stressed out, your body is like, well,
I just don't know how to deal with it, and
that internalizes and that can lead to depression and just
mood and emotional reactivities that are abnormal for you, not
(12:52):
the way that they're meant to be. So there have
been several studies that have looked at that cortisol levels
women on and off oral inceptives and the other hormonal contraceptives,
and it does show there's variations in the cortisol and
their response to certain stimuli. They've actually done imaging studies.
I mean as a radiologist, of course, I love the
imaging studies. They looked at functional MRI, and they looked
(13:15):
at MRI and they showed on women who have been
on hormonal contraceptives compared to those who are not on
hormonal contraceptives, their brains look different. There are certain areas
in their brain where their cortices are thinner. They react
differently to traumatic stimuli, like if they were to be
(13:35):
seen a picture that should invoke some sort of reaction.
It's your visual pathway, so you see it, it registers
in your brain, and then your brain said, all right,
let's send out these hormones. We got to deal with
this stress that actually happens in your brain. Well, oral
contraceptive view, there's sometimes it's a blunted response. They don't
respond the same way to stimuli that they should. It's
(13:57):
all very interesting. Again, this was part of that deep
I was kind of going into and I think I
could continue to go, but we had to record because
I have to get this out for you guys. But
you know, I just got really concerned about this because listen,
there's so many stories about teens who you know, have acne,
who are being bullied, and so they go on prescription
(14:21):
you know, hormonal contraceptives and it's the only thing that
works for them. You know. I don't think anyone here
is saying no one should be on medications, especially if
it's helping them, because I can tell you if a
teen is not feeling good about their physical appearance and
they're being bullied or they're just that can also lead
to depression. That can also lead to suicidal ideations and
(14:42):
suicide completion. I just am saying that I think that
the risks of these contraceptives in younger girls is not
talked about enough, and in fact, we have black box
warnings on SSRIs, which is a very common antidepressant, which
ironically is like what some of these girls are being
put on because their contraceptives are giving them depression. There
(15:05):
are black box warnings on ssririse warning that there's increase
risk of suicidal thoughts and completion with the use of
these medications. And okay, so then the question is, all right, well,
if there's already a black box warning on SSRIs, obviously
the data on that showing a direct not just correlation
(15:29):
but causation exists. I mean, you'd think so, right, I
thought so too. Again, that was another level of that
rabbit hole that I went down. Let's talk about why
did the SSRIs get their black box warning. Well, in
two thousand and four, when they were being prescribed like candy,
(15:50):
there's started to be all these case reports and parents
were saying, hey, specifically in kids under twenty five, they're
not doing well. They're talking of being institutionalized suicide. Really
just all started with some of these anecdotal reports, which
you know it often does. So in two thousand and four,
when SSRIs were starting to be prescribed like they are candy,
(16:13):
especially in young adults and teens less than twenty five,
there were a lot of reports. I wouldn't say a
lot of reports considering how many was being prescribed, but
there were reports of increased suicidal attempts and completion of
people who had just been put on these medications. Well,
aren't these medications supposed to help the depression, not escalate it. Well,
(16:36):
so the FDA said, all right, let's we're going to
take a break. Because again FDA not always the first.
In fact, Europe said we need to take a look
at these a little bit closer. Europe started doing a
little deeper dive. They started putting warnings out. So the
FDA is like, well, I guess we have to look
at these now. Shocking. So the FDA decided to conduct
(16:58):
a big meta analysis looking at over one hundred thousand people,
and the analysis revealed that the risk of just suicidal
thoughts or behavior was twice as high in those taking
antidepressants compared to those on the placebo, twice as high
suicidal thoughts when taking the medication compared to those that weren't. Gosh,
(17:20):
I just don't know where I've heard that before. Oh right,
oral contraceptives twice as high suicidal thoughts, three times as
high suicidal completion. I didn't even see suicidal completion in
the FDA's meta analysis that resulted in their black box
warning on SSRIs, So why not black box warning on
oral contraceptives. I don't know. I find it concerning when
(17:43):
I googled the Google machine, why is there a black
box warning for SSRIs and not for oral contraceptives when
it comes to suicidal thoughts? It came back, well, all
the evidence is clear because of randomized control trials. The
evidence is less clear for oral contraceptives because it's based
(18:06):
on meta analyzes and observational studies and blah blah blah
blah blah, and kind of everything else that we hear.
Yet no one's doing the studies. There are enough signals
here that the conversation is significantly warranted. And maybe I'm
going to need to give a call over to the HHS.
Some of my buddies over there. You know Marty McCarey,
(18:28):
who was the commissioner of the new Commissioner of FDA.
He was on Wellness d Mass last month talking about
some things and how they're going to be cutting through
the red tape and they are going to reassess the
data because they're tired of settled science. They were just
talking about hormone replacement therapy and black box warning that's
scaring women away from HRT. Well, maybe we can talk
(18:49):
about oral contraceptives and teams seems like a good idea
to me. We don't have a CDC director right now,
so I can't reach out to anybody there. It would
be nice to have one to kind of help guide us,
seeing as the SEA gives formal recommendations about things I
don't know. I guess the question I have from an
ethical and regulatory question. Mind you, I'm not a gynecologist,
(19:10):
I'm not a psychiatrist. I'm not going to have these
conversations with my patients. And I have three sons, so
I'm not having these with my daughters either. But if
we are obligated as physicians to inform teens about the
suicidal risk with antidepressants, is there not a parallel obligation
to do the same thing with birth control. I mean,
maybe this warning could help girls and parents monitor mood
(19:33):
symptoms earlier. Maybe people would be less inclined to medicate
as quickly as we do, knowing that there are legitimate risks.
I personally think we are an over medicated society. I
think far too many young girls are started on birth control.
Do I get it, we want to avoid unwanted pregnancies.
I get it. For some it's helpful with ACNE. I
(19:54):
just think that this perpetual cycle of hormones, antidepressants, hormones, antidepressants, antibiotics,
and all these other things that we just keep throwing
at our kids, like, no wonder, we're a messed up society,
no wonder we have gut issues, No wonder we're overweight
and have metabolic issues and infertility issues and all the
other things that we're dealing with. I don't know. Again,
(20:15):
you can see my little hole that I keep going down.
I guess the important thing is I want to make
sure that people are being told of these risks. Whether
that is in the form of a black box warning,
I don't really know. You know, one thing that I
find incredibly interesting is that if you look in Europe,
like several European countries forbid or severely curtailed pharmaceutical advertising
(20:38):
to children, yet here in the United States selling the
children is just like business as usual. Whether it's the vaping,
I mean, we're finally getting control on that and the
bubblegum flavors of vaping, whether it's birth control, just medications
like whatever it is. I mean, there's anti HIV medications,
(20:59):
just showing people like frolicking at parties, like hey, we
can have a good time again. There's a pill Like
I am so turned off by all of this. I
just think we have gone so far from our moral
compass and what is right when it comes to our
pharmaceutical advertising and all of the other things that we
need to really rein it in RFK Junior has talked about, Hey,
(21:22):
we're going to pull back on pharmaceutical advertising. Hasn't happened.
Pharmaceutical companies, I think pay like thirty billion dollars globally
and advertising. Maybe that's part of the reason why. I
don't know. I just think that I think that we
need to have a bigger conversation when it comes to
contraceptive use in kids. And I think that as a
(21:45):
medical society, we need to take a pause, take a
step back, and say are we doing too much? Are
we not acknowledging the risks because we're trying to push
this mainstream agenda, and the mainstream agenda is reducing unintended pregnancies,
But with that is a cast gate of perpetual medication
and hormone use, which you're not benign. They have very
(22:05):
significant risks, and those risks are not being talked about
nearly enough. I'm doctor Nipole, Sofire. Thanks for listening to
Wellness on MASS on America's number one podcast network. iHeart.
Follow Wellness on MASS with doctor Napole, soptfhire and start
listening on the free iHeartRadio app wherever you get your podcasts,
and we will catch you next time.
Welcome to Wellness on MASS I'm doctor Nicole Safire, and
we are going to do with something a little different
this week. I had something planned for the podcast episode
to be released this week. However, yesterday I found myself
going down this never ending rabbit hole. Have you ever
done that? Where you start searching one thing and then
you're like, oh, well, that's interesting. I'm going to click
(00:23):
on this length and then this link, and then several
hours later, I have to change our entire week's topic
because I'm still down the rabbit hole, and I'm just
going to bring you guys down with me. So yesterday,
if you saw I do a weekly segment on Fox
and Friends Weekend called Weekend Wellness, and we always talk
about some sort of news of the week or some
wellness topic, usually some social media trend that I think
(00:46):
is totally bogus. This week, though, I was asked to
kind of dive into some of the less common or
less known side effects of contraception use. All right, it
seems pretty straightforward. I've been studying contraception sceptives for I
don't know AIDS, and just as a woman, I knew
about them obviously, But as I was looking for the
(01:07):
more or I should say, less commonly known ones. That's
when I found myself kind of going down this rabbit
hole as a woman. Youwhere from sixty to seventy five
percent of women of child bearing age are all on
contraceptives here in the United States, whether it's oral contraceptives,
implantable devices like rings IDs, surgical contraception where you have
(01:32):
your tubes tubes tied during some sort of surgery. There
are a lot of different contraceptives these days, but the
most common, the overwhelmingly most common, are the hormonal oral
contraceptives or you know, the pill as most people know
it as. So I kind of focused there a bit
and one of the things that really stood out to me. Listen,
(01:54):
I deal in breast cancer every single day, so people
ask me all the time as there arise of cancer
risk when it comes to oral contraceptives. That's not what
we're focusing on today. That's an entirely different conversation. But
I can tell you that there can be a slight
increased risk of breast cancer when it comes to some
of these contraceptive methods. When you stop taking the hormonal contraceptives,
(02:17):
your risk does tend to go back to normal with
some time. So you know, I wouldn't say cancer risk
if you don't already have a known family history of
cancer is necessarily reason not to try them. But again,
that's not what we're going to talk about, because while
that is interested for my daily job, the rabbit hole
that I started going down yesterday which I found extremely alarming,
(02:40):
and I can't believe that I'm not hearing it. I
haven't heard about this more. I guess it's just not
what mainstream media wants to talk about. Is its effect
on mental health, and not just mental health of all women,
but mental health specifically in adolescents and young adults who
take hormonal contraceptives. So let's talk about this. First of all,
(03:02):
we know when it comes to contraceptives, it is wildly advertised.
You can see it. Pharmaceutical companies are now able to
do radio and podcasts and ads and TVs and social
media and all these other things. And usually when you
see the ads, it's female empowerment, doing what's right for you,
(03:22):
kind of all these strong, buzzy, feel good terms. I
guess they don't really want to focus on the negative
side of that. You know, as a teenager myself when
I was having really difficult menses or menstrual cycles, you know,
heavy bleeding, lots of pain. I think a lot of
women deal with it, you know, headaches, you know, some athne,
(03:43):
some of all the stuff that comes with being a teenager,
a kneejer reflex. These days are putting these kids on contraceptives.
I was one of them. I don't even remember having
that conversation. I just, you know, my mom and I
told the doctor, well, these are the symptoms, and the
doctor's like, all right, well, birth control. Well, it's a
very common thing, especially in teen girls. It's not just
(04:04):
for you know, contraceptive, you know, that's like the nice
little thing they say that, like it really can help
with the moods and the acne and all these other things, which,
by the way, it can. You know, contraceptives does decrease eebone,
which can help with acne. I'm not saying it doesn't
have benefits whatsoever. I'm not, but I don't remember having
the conversation about what we're about to talk about. So
(04:27):
one of what I was discovering yesterday in my downward
spiral is the fact that there are I'm going to
be scrolling because I want to reference things because, as
you know, I like to be very fact based. I
love data. I love objective medicine, meaning I like to
take the opinion out of it, and I just like
(04:47):
to report on the facts. So, since I've really only
been studying this for solid twenty four to forty eight hours,
I'm going to reference some things because I wouldn't call
myself an expert, but at this point I am incredibly
more knowledgeable about this topic than I was a week ago,
a year ago, ten years ago, or I guess it
was thirty years ago, homo, And not quite thirty years
ago when I was prescribed these myself as a teen
(05:10):
But the fact that there is a relationship between hormonal
contraceptive use and depression and not just suicide attempt but
suicide completion in teenagers, and I was thinking, all right, well,
maybe there's a few case reports, some anecdotal evidence, you know,
you know, causation correlation. Is there really evidence to suggest
(05:34):
that oral contraceptives or these contra hormonal contraceptives could be
doing this. Well, let me tell you this. There was
not just a couple of case reports. We had these
really big observational meta analysis studies looking at this like,
this is not new, This isn't something that's just popping up.
This is something that's known about. It just really isn't
(05:56):
talked about. I'm going to just throw out some stats
from some of these studies. We're not going to go
into all of these studies. I'm going to spare you
that because I read them. One out of Upsol University
showed at one hundred and thirty percent higher risk of
depressive symptoms in teens who took oral contraceptives the Danish
Registry data. This was the biggest one. It looked at
(06:17):
over a million women over about eight years, and essentially,
Hay said, of the young girls, the teens, young adults
who were taking hormonal contraceptives, they had a seventy percent
higher chance of also being prescribed antidepressed since at the
same time. So it was like it's like this endless cycle.
(06:38):
All right, We're going to prescribe contraceptive hormones, and now
we're going to prescribe antidepressants, and the antidepressants are probably
going to you know, are trying to help the effects
of the hormones. But we're going to keep giving the
hormones and we're going to keep meeting the antidepressants. And
by the way, when you start antidepressants as a teen,
your likelihood of staying on them through adulthood is through
the roof. So it's not like it's a short lived thing. Oh,
(07:00):
we'll just do it for a little bit. Absolutely not.
And there was a clear difference between teens and adult users.
When a teen started oral contraceptives, the risk of depression
and these suicidal thoughts was significantly more than that in
adult users. And it also varied a little bit by
the type of contraceptives. Interestingly, most common associated or the
(07:22):
hormonal IUDs as well as the oral contraceptives. So I
kind of took a pause at this point. I'm like, wow,
I'm seeing a lot of evidence. They're certainly talking about it,
but I really want to know is it true. Were
there really really documented data on suicide and all of that.
(07:43):
And the answer was yes, it's not just oh well
there was a risk of depression, Oh it was more
than that. So there's this study out of Denmark looked
at nearly half a million women age over fifteen. Again,
the follow up was about eight years. This was part
of that Danish registry that I was already talking about
(08:04):
They found hormonal contraceptive use doubled the risk of suicide attempts.
Doubled the risk. By the way, if that's not bad,
it tripled the risk of completed suicide, meaning they didn't
just attempt suicide, they killed themselves. They tripled the risk.
Those who were on the contraceptives had a threefold risk
(08:27):
of completing suicide, of killing themselves then those who never
were on the oral contraceptives. Now you can say, well,
how do we know that they didn't have mental illness?
How did they we know that they weren't predisposed to it?
All good questions, all good questions. Okay, we always have
to look deeper at the data. But they did account
for this. If those if anyone had a known history
(08:49):
of mental illness, known history of depression, they were already
removed from this study. Now, again, science is imperfect, but
I'm telling you that these numbers are not equivocal. We're
talking major increased risk of depression, suicide, attempt suicide completion
being prescribed antidepressants. All when kids, I call them kids,
(09:11):
I mean I have a twenty five year old, yes,
a sixteen year old girl, A fifteen year old girl
is a kid. To me, when we are prescribing kids
these medications, they are heavy consequences with this. Another study
came out of Sweden. This was a big Swedish registry.
It looked I mean it was a less populated about
two hundred and sixteen thousand women looked at fifteen to
(09:32):
twenty two year olds. The combined oral contraceptive users had
almost a two times suicidal behavior in the first month
compared to those without oral contraceptives. And they actually said
that they said the suicidal ideations and attempts were more
likely within the first two months, but it didn't actually
(09:52):
go back down to normal with time. And if it
was a progestion only pill like the mini pill, I
think it's referred to the cool world, it was even higher.
Another one Finland analysis of almost six hundred thousand women
ages fifteen to forty nine over a couple year period.
They said that they found no increase of attempted suicide. However,
(10:15):
it certainly did it increase depression. I mean, so take
it what you will. Depression can lead to suicide if
you have an increased risk of depression. I'm going to
say at some point people with depression contemplate if not
complete suicide. So nine studies total looked at some of
this stuff, three on suicide attempts, five on completed suicides,
(10:40):
and the majority of these showed an increased risk. Some
of them were equivocal, some just said, well, we can't
really say for sure that there's an increased risk of
suicide attempt or completion, but they certainly there was not
a question that it could increase the risk of depression
and people who do not have a history of depression.
You're listening to wellness and we'll be right back with more.
(11:05):
Why would teenagers be more vulnerable to these you know,
why isn't it the same for teens versus adult women. Well,
I mean common sense kind of comes in right here.
The reality is the teenager's brain, their body, it's still forming.
I know, I know, fifteen sixteen year olds think they
know it all and that they're already adults, but the
reality is they're not. And in fact, adolescence is a
(11:27):
critical period for brain development and hormonal regulation that is puberty.
It doesn't just happen overnight. It takes time, and there's
something called the HPA axis. And without getting into the
granular detail, there's a little gland in your brain called
the hypothalamus. Then you have the pituitary another one, and
then you go down to your adrenal glands, which are
(11:47):
two glands. That's it's hard for way to do with
my shoulder pointing to my back. Your two little drainal
glands sit on top of your kidneys. Now, this is
your HPA access and this is important for you your
stress response, so your fight or flight it's part of that,
your cortisol levels. And so there have been many studies
(12:08):
showing how synthetic hormones like oral contraceptives may disregulate this
cycle and disregulate your mood resilience, you know, your ability
to deal with stress, and particularly oral contraceptives based on
this science, not just because it's my opinion, have shown
that it can significantly affect this HPA axis again, which
(12:31):
regulates the body's stress response. So this impact can lead
to altered cortisol dynamics, including blunted cortisol response to stress.
So if you're stressed out, your body is like, well,
I just don't know how to deal with it, and
that internalizes and that can lead to depression and just
mood and emotional reactivities that are abnormal for you, not
(12:52):
the way that they're meant to be. So there have
been several studies that have looked at that cortisol levels
women on and off oral inceptives and the other hormonal contraceptives,
and it does show there's variations in the cortisol and
their response to certain stimuli. They've actually done imaging studies.
I mean as a radiologist, of course, I love the
imaging studies. They looked at functional MRI, and they looked
(13:15):
at MRI and they showed on women who have been
on hormonal contraceptives compared to those who are not on
hormonal contraceptives, their brains look different. There are certain areas
in their brain where their cortices are thinner. They react
differently to traumatic stimuli, like if they were to be
(13:35):
seen a picture that should invoke some sort of reaction.
It's your visual pathway, so you see it, it registers
in your brain, and then your brain said, all right,
let's send out these hormones. We got to deal with
this stress that actually happens in your brain. Well, oral
contraceptive view, there's sometimes it's a blunted response. They don't
respond the same way to stimuli that they should. It's
(13:57):
all very interesting. Again, this was part of that deep
I was kind of going into and I think I
could continue to go, but we had to record because
I have to get this out for you guys. But
you know, I just got really concerned about this because listen,
there's so many stories about teens who you know, have acne,
who are being bullied, and so they go on prescription
(14:21):
you know, hormonal contraceptives and it's the only thing that
works for them. You know. I don't think anyone here
is saying no one should be on medications, especially if
it's helping them, because I can tell you if a
teen is not feeling good about their physical appearance and
they're being bullied or they're just that can also lead
to depression. That can also lead to suicidal ideations and
(14:42):
suicide completion. I just am saying that I think that
the risks of these contraceptives in younger girls is not
talked about enough, and in fact, we have black box
warnings on SSRIs, which is a very common antidepressant, which
ironically is like what some of these girls are being
put on because their contraceptives are giving them depression. There
(15:05):
are black box warnings on ssririse warning that there's increase
risk of suicidal thoughts and completion with the use of
these medications. And okay, so then the question is, all right, well,
if there's already a black box warning on SSRIs, obviously
the data on that showing a direct not just correlation
(15:29):
but causation exists. I mean, you'd think so, right, I
thought so too. Again, that was another level of that
rabbit hole that I went down. Let's talk about why
did the SSRIs get their black box warning. Well, in
two thousand and four, when they were being prescribed like candy,
(15:50):
there's started to be all these case reports and parents
were saying, hey, specifically in kids under twenty five, they're
not doing well. They're talking of being institutionalized suicide. Really
just all started with some of these anecdotal reports, which
you know it often does. So in two thousand and four,
when SSRIs were starting to be prescribed like they are candy,
(16:13):
especially in young adults and teens less than twenty five,
there were a lot of reports. I wouldn't say a
lot of reports considering how many was being prescribed, but
there were reports of increased suicidal attempts and completion of
people who had just been put on these medications. Well,
aren't these medications supposed to help the depression, not escalate it. Well,
(16:36):
so the FDA said, all right, let's we're going to
take a break. Because again FDA not always the first.
In fact, Europe said we need to take a look
at these a little bit closer. Europe started doing a
little deeper dive. They started putting warnings out. So the
FDA is like, well, I guess we have to look
at these now. Shocking. So the FDA decided to conduct
(16:58):
a big meta analysis looking at over one hundred thousand people,
and the analysis revealed that the risk of just suicidal
thoughts or behavior was twice as high in those taking
antidepressants compared to those on the placebo, twice as high
suicidal thoughts when taking the medication compared to those that weren't. Gosh,
(17:20):
I just don't know where I've heard that before. Oh right,
oral contraceptives twice as high suicidal thoughts, three times as
high suicidal completion. I didn't even see suicidal completion in
the FDA's meta analysis that resulted in their black box
warning on SSRIs, So why not black box warning on
oral contraceptives. I don't know. I find it concerning when
(17:43):
I googled the Google machine, why is there a black
box warning for SSRIs and not for oral contraceptives when
it comes to suicidal thoughts? It came back, well, all
the evidence is clear because of randomized control trials. The
evidence is less clear for oral contraceptives because it's based
(18:06):
on meta analyzes and observational studies and blah blah blah
blah blah, and kind of everything else that we hear.
Yet no one's doing the studies. There are enough signals
here that the conversation is significantly warranted. And maybe I'm
going to need to give a call over to the HHS.
Some of my buddies over there. You know Marty McCarey,
(18:28):
who was the commissioner of the new Commissioner of FDA.
He was on Wellness d Mass last month talking about
some things and how they're going to be cutting through
the red tape and they are going to reassess the
data because they're tired of settled science. They were just
talking about hormone replacement therapy and black box warning that's
scaring women away from HRT. Well, maybe we can talk
(18:49):
about oral contraceptives and teams seems like a good idea
to me. We don't have a CDC director right now,
so I can't reach out to anybody there. It would
be nice to have one to kind of help guide us,
seeing as the SEA gives formal recommendations about things I
don't know. I guess the question I have from an
ethical and regulatory question. Mind you, I'm not a gynecologist,
(19:10):
I'm not a psychiatrist. I'm not going to have these
conversations with my patients. And I have three sons, so
I'm not having these with my daughters either. But if
we are obligated as physicians to inform teens about the
suicidal risk with antidepressants, is there not a parallel obligation
to do the same thing with birth control. I mean,
maybe this warning could help girls and parents monitor mood
(19:33):
symptoms earlier. Maybe people would be less inclined to medicate
as quickly as we do, knowing that there are legitimate risks.
I personally think we are an over medicated society. I
think far too many young girls are started on birth control.
Do I get it, we want to avoid unwanted pregnancies.
I get it. For some it's helpful with ACNE. I
(19:54):
just think that this perpetual cycle of hormones, antidepressants, hormones, antidepressants, antibiotics,
and all these other things that we just keep throwing
at our kids, like, no wonder, we're a messed up society,
no wonder we have gut issues, No wonder we're overweight
and have metabolic issues and infertility issues and all the
other things that we're dealing with. I don't know. Again,
(20:15):
you can see my little hole that I keep going down.
I guess the important thing is I want to make
sure that people are being told of these risks. Whether
that is in the form of a black box warning,
I don't really know. You know, one thing that I
find incredibly interesting is that if you look in Europe,
like several European countries forbid or severely curtailed pharmaceutical advertising
(20:38):
to children, yet here in the United States selling the
children is just like business as usual. Whether it's the vaping,
I mean, we're finally getting control on that and the
bubblegum flavors of vaping, whether it's birth control, just medications
like whatever it is. I mean, there's anti HIV medications,
(20:59):
just showing people like frolicking at parties, like hey, we
can have a good time again. There's a pill Like
I am so turned off by all of this. I
just think we have gone so far from our moral
compass and what is right when it comes to our
pharmaceutical advertising and all of the other things that we
need to really rein it in RFK Junior has talked about, Hey,
(21:22):
we're going to pull back on pharmaceutical advertising. Hasn't happened.
Pharmaceutical companies, I think pay like thirty billion dollars globally
and advertising. Maybe that's part of the reason why. I
don't know. I just think that I think that we
need to have a bigger conversation when it comes to
contraceptive use in kids. And I think that as a
(21:45):
medical society, we need to take a pause, take a
step back, and say are we doing too much? Are
we not acknowledging the risks because we're trying to push
this mainstream agenda, and the mainstream agenda is reducing unintended pregnancies,
But with that is a cast gate of perpetual medication
and hormone use, which you're not benign. They have very
(22:05):
significant risks, and those risks are not being talked about
nearly enough. I'm doctor Nipole, Sofire. Thanks for listening to
Wellness on MASS on America's number one podcast network. iHeart.
Follow Wellness on MASS with doctor Napole, soptfhire and start
listening on the free iHeartRadio app wherever you get your podcasts,
and we will catch you next time.
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