Oral contraceptives depression with

Estazolam potentiates the CNS depressant effects of phenothiazines, narcotics, antihistamines, MAOIs, barbiturates, alcohol, general anesthetics, and TCAs. Use with cimetidine, disulfiram, oral contraceptives, and isoniazid may diminish hepatic metabolism and result in increased plasma concentrations of estazolam and increased CNS depressant effects. Fleavy smoking (more than 20 cigarettes/day) accelerates estazolam s clearance. Theophylline antagonizes estazolam s pharmacological effects. 

A 28-year-old woman took an extract of C. sativum for 7 days to augment lactation while breastfeeding. She developed severe stomach pain and diarrhea and 15 days later resented with dark skin, depression, dehydration, and amenorrhea. A diagnosis of adrenal dysfunction was made, the herbal remedy was withdrawn, and she was treated with dexamethasone, prednisolone, and an oral contraceptive. Her symptoms resolved within 10 days. 

St. John s wort Mild to moderate depression Gastrointestinal upset, photo-sensitivity. Mild serotonin syndrome with the following medications paroxetine, trazodone, sertraline, and nefazodone. May decrease digoxin levels. May decrease cyclosporine serum concentrations. Combined oral contraceptives—breakthrough bleeding. 

Under the headline Still time for rational debate about vitamin Bs the controversial debate on the safety of pyridoxine has been revived (8). Pyridoxine is marketed for stress in general, for depression associated with premenstrual syndrome and oral contraceptives, and for carpal tunnel syndrome, although it is doubtful that it has more than a placebo effect. It is legitimately prescribed in general deficiency states in doses starting at 150 mg/day. Adverse events include sensory neuropathy at oral doses about 2-3 g/day or more. 

Decreased levels with enzyme inducers (rifampin). Increased levels wHh VPA. increased sedation with other CNS depressants. Decreased effectiveness of warfarin, CBZ, metronidazole, oral contraceptives. 

Some women suffer from mental deprc.ssion when taking estrogen-containing oral contraceptives, and this depression could be due to another malfunction in tryptophan metabolism, leading to S-hydroxytryptamine (serotonin). Some evidence indicates that the decarboxylation of S-hydroxytrypto-phan is inhibited (in vitro) by estfogen conjugates competing with pyridoxal phosphate for the decarboxylase apoenzyme. 

Interpretation In normal subjects, serum cortisol concentration is suppressed to 2 pg/dL or less after administration of 1 mg of dexamethasone. Most patients with Cushing s syndrome do not show adequate suppression, and 0800 hours cortisol concentrations are usually >10pg/dL. Serum cortisol >2pg/dL may also be seen in cases of stress, obesity, infection, acute or chronic illness, alcohol abuse, severe depression, oral contraceptive use, pregnancy, estrogen therapy, failure to take the dexamethasone, or treatment with phenytoin or phenobarbital (enhancement of dexamethasone metabolism). 

Thalidomide s interactions with other dmgs have not been systematically addressed, except for lack of significant interaction with oral contraceptives and thalidomide s effect in enhancing the sedative effects of barbitnrates and alcohol and the catatoiuc effects of chlorpromazine and reserpine. Conversely, CNS stimnlants (snch as metham-phetamine and methylphenidate) connteract the depressant effects of thalidomide. 

Anticonvulsive drugs in general have additive depressive effects when used with other depressant drugs, cause a precipitation of seizures upon abrupt withdrawal, and decrease the efficiency of oral contraceptives. 

Depression has been described in women taking oral contraceptives (Al, Bl, H9, L6, W8) although a causal relationship has not been convincingly demonstrated (L3, W5). There has been interest lately in depression in OCA-users because these women often manifest abnormalities in tryptophan metabolism and because depressive illnesses may be associated with abnormal brain neuroamine metabolism. 

Al. Adams, P. W., Rose, D. P., Folkard, J., Wymi, V., Seed, M., and Strong, R., Effect of pyridoxine hydrochloride (Vitamin Bo) upon depression associated with oral contraception. Lancet 1, 897-904 (1973). 

There is little doubt that combination products often relieve some of the symptoms associated with premenstrual tension [295, 119]. At the same time, there is little doubt that depression is the most distressing side effect encountered on oral contraceptive medication [296] and may affect up to 20 per cent of women [297-299]. 

Pill-induced depression is frequently associated with frigidity [302]. Evidence concerning the effect of oral contraceptives upon libido is contradictory [303], but the medication does appear to erase the depression in libido that frequently occurs during the luteal phase of the menstrual cycle [304]. 

Rose [305] reported the excretion of grossly increased amounts of xanthurenic acid in the urine of women taking combination products. A similar increase in tryptophan metabolites occurs in pregnancy and has been interpreted as indicating pyridoxine deficiency [306]. Dewhurst [307] subsequently postulated a causal connection between dysfunction of trytophan metabolism and certain types of depression. Winston [308] developed the concept further by suggesting that depression from oral contraceptive medication be treated with pyridoxine. Price and Toseland [309] have proposed routine inclusion of pyridoxine in oral contraceptive preparations. Developments will be awaited with interest. 

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