1 00:00:02,120 --> 00:00:05,120 Speaker 1: Welcome to Wellness on MASS I'm doctor Nicole Safire, and 2 00:00:05,320 --> 00:00:07,480 Speaker 1: we are going to do with something a little different 3 00:00:07,520 --> 00:00:11,479 Speaker 1: this week. I had something planned for the podcast episode 4 00:00:11,560 --> 00:00:15,160 Speaker 1: to be released this week. However, yesterday I found myself 5 00:00:15,240 --> 00:00:18,640 Speaker 1: going down this never ending rabbit hole. Have you ever 6 00:00:18,680 --> 00:00:21,600 Speaker 1: done that? Where you start searching one thing and then 7 00:00:21,640 --> 00:00:23,840 Speaker 1: you're like, oh, well, that's interesting. I'm going to click 8 00:00:23,880 --> 00:00:26,640 Speaker 1: on this length and then this link, and then several 9 00:00:26,640 --> 00:00:29,720 Speaker 1: hours later, I have to change our entire week's topic 10 00:00:29,960 --> 00:00:32,040 Speaker 1: because I'm still down the rabbit hole, and I'm just 11 00:00:32,120 --> 00:00:34,800 Speaker 1: going to bring you guys down with me. So yesterday, 12 00:00:34,840 --> 00:00:37,360 Speaker 1: if you saw I do a weekly segment on Fox 13 00:00:37,400 --> 00:00:39,959 Speaker 1: and Friends Weekend called Weekend Wellness, and we always talk 14 00:00:40,000 --> 00:00:42,680 Speaker 1: about some sort of news of the week or some 15 00:00:42,720 --> 00:00:46,080 Speaker 1: wellness topic, usually some social media trend that I think 16 00:00:46,159 --> 00:00:49,519 Speaker 1: is totally bogus. This week, though, I was asked to 17 00:00:49,600 --> 00:00:52,760 Speaker 1: kind of dive into some of the less common or 18 00:00:52,840 --> 00:00:56,520 Speaker 1: less known side effects of contraception use. All right, it 19 00:00:56,520 --> 00:01:01,120 Speaker 1: seems pretty straightforward. I've been studying contraception sceptives for I 20 00:01:01,120 --> 00:01:03,960 Speaker 1: don't know AIDS, and just as a woman, I knew 21 00:01:04,000 --> 00:01:06,959 Speaker 1: about them obviously, But as I was looking for the 22 00:01:07,360 --> 00:01:11,080 Speaker 1: more or I should say, less commonly known ones. That's 23 00:01:11,120 --> 00:01:14,480 Speaker 1: when I found myself kind of going down this rabbit 24 00:01:14,520 --> 00:01:18,280 Speaker 1: hole as a woman. Youwhere from sixty to seventy five 25 00:01:18,360 --> 00:01:21,600 Speaker 1: percent of women of child bearing age are all on 26 00:01:21,720 --> 00:01:25,600 Speaker 1: contraceptives here in the United States, whether it's oral contraceptives, 27 00:01:26,480 --> 00:01:32,360 Speaker 1: implantable devices like rings IDs, surgical contraception where you have 28 00:01:32,440 --> 00:01:37,200 Speaker 1: your tubes tubes tied during some sort of surgery. There 29 00:01:37,200 --> 00:01:39,600 Speaker 1: are a lot of different contraceptives these days, but the 30 00:01:39,600 --> 00:01:44,080 Speaker 1: most common, the overwhelmingly most common, are the hormonal oral 31 00:01:44,120 --> 00:01:47,280 Speaker 1: contraceptives or you know, the pill as most people know 32 00:01:47,400 --> 00:01:50,400 Speaker 1: it as. So I kind of focused there a bit 33 00:01:50,640 --> 00:01:53,760 Speaker 1: and one of the things that really stood out to me. Listen, 34 00:01:54,200 --> 00:01:57,440 Speaker 1: I deal in breast cancer every single day, so people 35 00:01:57,520 --> 00:02:00,559 Speaker 1: ask me all the time as there arise of cancer 36 00:02:00,640 --> 00:02:03,920 Speaker 1: risk when it comes to oral contraceptives. That's not what 37 00:02:03,920 --> 00:02:06,920 Speaker 1: we're focusing on today. That's an entirely different conversation. But 38 00:02:07,000 --> 00:02:09,760 Speaker 1: I can tell you that there can be a slight 39 00:02:09,840 --> 00:02:12,280 Speaker 1: increased risk of breast cancer when it comes to some 40 00:02:12,320 --> 00:02:17,440 Speaker 1: of these contraceptive methods. When you stop taking the hormonal contraceptives, 41 00:02:17,520 --> 00:02:19,800 Speaker 1: your risk does tend to go back to normal with 42 00:02:19,880 --> 00:02:23,560 Speaker 1: some time. So you know, I wouldn't say cancer risk 43 00:02:23,639 --> 00:02:26,120 Speaker 1: if you don't already have a known family history of 44 00:02:26,160 --> 00:02:29,440 Speaker 1: cancer is necessarily reason not to try them. But again, 45 00:02:29,600 --> 00:02:31,679 Speaker 1: that's not what we're going to talk about, because while 46 00:02:31,680 --> 00:02:34,639 Speaker 1: that is interested for my daily job, the rabbit hole 47 00:02:34,680 --> 00:02:39,640 Speaker 1: that I started going down yesterday which I found extremely alarming, 48 00:02:40,080 --> 00:02:42,560 Speaker 1: and I can't believe that I'm not hearing it. I 49 00:02:42,560 --> 00:02:44,920 Speaker 1: haven't heard about this more. I guess it's just not 50 00:02:44,960 --> 00:02:50,079 Speaker 1: what mainstream media wants to talk about. Is its effect 51 00:02:50,240 --> 00:02:53,480 Speaker 1: on mental health, and not just mental health of all women, 52 00:02:53,560 --> 00:02:57,720 Speaker 1: but mental health specifically in adolescents and young adults who 53 00:02:57,800 --> 00:03:02,120 Speaker 1: take hormonal contraceptives. So let's talk about this. First of all, 54 00:03:02,200 --> 00:03:07,440 Speaker 1: we know when it comes to contraceptives, it is wildly advertised. 55 00:03:07,760 --> 00:03:10,520 Speaker 1: You can see it. Pharmaceutical companies are now able to 56 00:03:10,600 --> 00:03:14,800 Speaker 1: do radio and podcasts and ads and TVs and social 57 00:03:14,880 --> 00:03:17,480 Speaker 1: media and all these other things. And usually when you 58 00:03:17,520 --> 00:03:21,639 Speaker 1: see the ads, it's female empowerment, doing what's right for you, 59 00:03:22,280 --> 00:03:25,880 Speaker 1: kind of all these strong, buzzy, feel good terms. I 60 00:03:25,880 --> 00:03:28,679 Speaker 1: guess they don't really want to focus on the negative 61 00:03:28,720 --> 00:03:32,519 Speaker 1: side of that. You know, as a teenager myself when 62 00:03:32,560 --> 00:03:37,280 Speaker 1: I was having really difficult menses or menstrual cycles, you know, 63 00:03:37,360 --> 00:03:39,800 Speaker 1: heavy bleeding, lots of pain. I think a lot of 64 00:03:39,880 --> 00:03:43,000 Speaker 1: women deal with it, you know, headaches, you know, some athne, 65 00:03:43,240 --> 00:03:45,560 Speaker 1: some of all the stuff that comes with being a teenager, 66 00:03:46,200 --> 00:03:51,720 Speaker 1: a kneejer reflex. These days are putting these kids on contraceptives. 67 00:03:51,760 --> 00:03:53,440 Speaker 1: I was one of them. I don't even remember having 68 00:03:53,440 --> 00:03:55,960 Speaker 1: that conversation. I just, you know, my mom and I 69 00:03:56,000 --> 00:03:58,360 Speaker 1: told the doctor, well, these are the symptoms, and the 70 00:03:58,400 --> 00:04:00,400 Speaker 1: doctor's like, all right, well, birth control. Well, it's a 71 00:04:00,520 --> 00:04:04,680 Speaker 1: very common thing, especially in teen girls. It's not just 72 00:04:04,800 --> 00:04:07,320 Speaker 1: for you know, contraceptive, you know, that's like the nice 73 00:04:07,320 --> 00:04:09,160 Speaker 1: little thing they say that, like it really can help 74 00:04:09,240 --> 00:04:12,240 Speaker 1: with the moods and the acne and all these other things, which, 75 00:04:12,280 --> 00:04:16,240 Speaker 1: by the way, it can. You know, contraceptives does decrease eebone, 76 00:04:16,240 --> 00:04:18,599 Speaker 1: which can help with acne. I'm not saying it doesn't 77 00:04:18,640 --> 00:04:22,000 Speaker 1: have benefits whatsoever. I'm not, but I don't remember having 78 00:04:22,080 --> 00:04:26,720 Speaker 1: the conversation about what we're about to talk about. So 79 00:04:27,279 --> 00:04:31,200 Speaker 1: one of what I was discovering yesterday in my downward 80 00:04:31,279 --> 00:04:35,839 Speaker 1: spiral is the fact that there are I'm going to 81 00:04:35,839 --> 00:04:38,560 Speaker 1: be scrolling because I want to reference things because, as 82 00:04:38,600 --> 00:04:41,719 Speaker 1: you know, I like to be very fact based. I 83 00:04:41,760 --> 00:04:45,440 Speaker 1: love data. I love objective medicine, meaning I like to 84 00:04:45,480 --> 00:04:47,359 Speaker 1: take the opinion out of it, and I just like 85 00:04:47,400 --> 00:04:50,279 Speaker 1: to report on the facts. So, since I've really only 86 00:04:50,400 --> 00:04:53,440 Speaker 1: been studying this for solid twenty four to forty eight hours, 87 00:04:53,440 --> 00:04:55,600 Speaker 1: I'm going to reference some things because I wouldn't call 88 00:04:55,640 --> 00:04:58,400 Speaker 1: myself an expert, but at this point I am incredibly 89 00:04:58,400 --> 00:05:01,560 Speaker 1: more knowledgeable about this topic than I was a week ago, 90 00:05:01,600 --> 00:05:04,520 Speaker 1: a year ago, ten years ago, or I guess it 91 00:05:04,560 --> 00:05:07,120 Speaker 1: was thirty years ago, homo, And not quite thirty years 92 00:05:07,120 --> 00:05:09,720 Speaker 1: ago when I was prescribed these myself as a teen 93 00:05:10,680 --> 00:05:13,880 Speaker 1: But the fact that there is a relationship between hormonal 94 00:05:13,920 --> 00:05:19,200 Speaker 1: contraceptive use and depression and not just suicide attempt but 95 00:05:19,320 --> 00:05:24,320 Speaker 1: suicide completion in teenagers, and I was thinking, all right, well, 96 00:05:24,839 --> 00:05:29,360 Speaker 1: maybe there's a few case reports, some anecdotal evidence, you know, 97 00:05:30,160 --> 00:05:34,480 Speaker 1: you know, causation correlation. Is there really evidence to suggest 98 00:05:34,720 --> 00:05:38,680 Speaker 1: that oral contraceptives or these contra hormonal contraceptives could be 99 00:05:38,760 --> 00:05:42,000 Speaker 1: doing this. Well, let me tell you this. There was 100 00:05:42,040 --> 00:05:44,320 Speaker 1: not just a couple of case reports. We had these 101 00:05:44,360 --> 00:05:50,760 Speaker 1: really big observational meta analysis studies looking at this like, 102 00:05:50,839 --> 00:05:53,920 Speaker 1: this is not new, This isn't something that's just popping up. 103 00:05:53,960 --> 00:05:56,080 Speaker 1: This is something that's known about. It just really isn't 104 00:05:56,120 --> 00:05:58,440 Speaker 1: talked about. I'm going to just throw out some stats 105 00:05:58,440 --> 00:06:00,000 Speaker 1: from some of these studies. We're not going to go 106 00:06:00,360 --> 00:06:02,159 Speaker 1: into all of these studies. I'm going to spare you 107 00:06:02,200 --> 00:06:05,520 Speaker 1: that because I read them. One out of Upsol University 108 00:06:05,839 --> 00:06:09,080 Speaker 1: showed at one hundred and thirty percent higher risk of 109 00:06:09,160 --> 00:06:14,760 Speaker 1: depressive symptoms in teens who took oral contraceptives the Danish 110 00:06:14,800 --> 00:06:17,680 Speaker 1: Registry data. This was the biggest one. It looked at 111 00:06:17,720 --> 00:06:22,000 Speaker 1: over a million women over about eight years, and essentially, 112 00:06:22,160 --> 00:06:26,320 Speaker 1: Hay said, of the young girls, the teens, young adults 113 00:06:26,760 --> 00:06:30,800 Speaker 1: who were taking hormonal contraceptives, they had a seventy percent 114 00:06:30,960 --> 00:06:35,760 Speaker 1: higher chance of also being prescribed antidepressed since at the 115 00:06:35,800 --> 00:06:38,840 Speaker 1: same time. So it was like it's like this endless cycle. 116 00:06:38,839 --> 00:06:42,120 Speaker 1: All right, We're going to prescribe contraceptive hormones, and now 117 00:06:42,120 --> 00:06:45,719 Speaker 1: we're going to prescribe antidepressants, and the antidepressants are probably 118 00:06:45,760 --> 00:06:48,640 Speaker 1: going to you know, are trying to help the effects 119 00:06:48,680 --> 00:06:50,240 Speaker 1: of the hormones. But we're going to keep giving the 120 00:06:50,240 --> 00:06:52,440 Speaker 1: hormones and we're going to keep meeting the antidepressants. And 121 00:06:52,480 --> 00:06:55,159 Speaker 1: by the way, when you start antidepressants as a teen, 122 00:06:55,520 --> 00:06:58,080 Speaker 1: your likelihood of staying on them through adulthood is through 123 00:06:58,080 --> 00:07:00,520 Speaker 1: the roof. So it's not like it's a short lived thing. Oh, 124 00:07:00,560 --> 00:07:02,520 Speaker 1: we'll just do it for a little bit. Absolutely not. 125 00:07:02,920 --> 00:07:06,400 Speaker 1: And there was a clear difference between teens and adult users. 126 00:07:06,680 --> 00:07:10,200 Speaker 1: When a teen started oral contraceptives, the risk of depression 127 00:07:10,440 --> 00:07:13,880 Speaker 1: and these suicidal thoughts was significantly more than that in 128 00:07:13,960 --> 00:07:16,920 Speaker 1: adult users. And it also varied a little bit by 129 00:07:16,920 --> 00:07:22,760 Speaker 1: the type of contraceptives. Interestingly, most common associated or the 130 00:07:22,840 --> 00:07:27,680 Speaker 1: hormonal IUDs as well as the oral contraceptives. So I 131 00:07:27,760 --> 00:07:29,760 Speaker 1: kind of took a pause at this point. I'm like, wow, 132 00:07:30,120 --> 00:07:33,160 Speaker 1: I'm seeing a lot of evidence. They're certainly talking about it, 133 00:07:33,680 --> 00:07:36,920 Speaker 1: but I really want to know is it true. Were 134 00:07:36,920 --> 00:07:42,760 Speaker 1: there really really documented data on suicide and all of that. 135 00:07:43,200 --> 00:07:46,480 Speaker 1: And the answer was yes, it's not just oh well 136 00:07:46,480 --> 00:07:49,679 Speaker 1: there was a risk of depression, Oh it was more 137 00:07:49,760 --> 00:07:54,120 Speaker 1: than that. So there's this study out of Denmark looked 138 00:07:54,160 --> 00:07:58,239 Speaker 1: at nearly half a million women age over fifteen. Again, 139 00:07:58,320 --> 00:08:00,720 Speaker 1: the follow up was about eight years. This was part 140 00:08:00,760 --> 00:08:04,120 Speaker 1: of that Danish registry that I was already talking about 141 00:08:04,320 --> 00:08:10,000 Speaker 1: They found hormonal contraceptive use doubled the risk of suicide attempts. 142 00:08:10,280 --> 00:08:13,560 Speaker 1: Doubled the risk. By the way, if that's not bad, 143 00:08:13,840 --> 00:08:18,960 Speaker 1: it tripled the risk of completed suicide, meaning they didn't 144 00:08:18,960 --> 00:08:23,080 Speaker 1: just attempt suicide, they killed themselves. They tripled the risk. 145 00:08:23,440 --> 00:08:27,640 Speaker 1: Those who were on the contraceptives had a threefold risk 146 00:08:27,840 --> 00:08:31,640 Speaker 1: of completing suicide, of killing themselves then those who never 147 00:08:31,720 --> 00:08:34,960 Speaker 1: were on the oral contraceptives. Now you can say, well, 148 00:08:35,280 --> 00:08:37,600 Speaker 1: how do we know that they didn't have mental illness? 149 00:08:37,640 --> 00:08:40,240 Speaker 1: How did they we know that they weren't predisposed to it? 150 00:08:40,360 --> 00:08:43,280 Speaker 1: All good questions, all good questions. Okay, we always have 151 00:08:43,360 --> 00:08:46,040 Speaker 1: to look deeper at the data. But they did account 152 00:08:46,040 --> 00:08:49,160 Speaker 1: for this. If those if anyone had a known history 153 00:08:49,200 --> 00:08:53,080 Speaker 1: of mental illness, known history of depression, they were already 154 00:08:53,160 --> 00:08:56,600 Speaker 1: removed from this study. Now, again, science is imperfect, but 155 00:08:56,679 --> 00:09:00,600 Speaker 1: I'm telling you that these numbers are not equivocal. We're 156 00:09:00,600 --> 00:09:06,440 Speaker 1: talking major increased risk of depression, suicide, attempt suicide completion 157 00:09:06,920 --> 00:09:11,000 Speaker 1: being prescribed antidepressants. All when kids, I call them kids, 158 00:09:11,000 --> 00:09:13,040 Speaker 1: I mean I have a twenty five year old, yes, 159 00:09:13,280 --> 00:09:15,400 Speaker 1: a sixteen year old girl, A fifteen year old girl 160 00:09:15,520 --> 00:09:17,800 Speaker 1: is a kid. To me, when we are prescribing kids 161 00:09:17,800 --> 00:09:23,079 Speaker 1: these medications, they are heavy consequences with this. Another study 162 00:09:23,400 --> 00:09:26,120 Speaker 1: came out of Sweden. This was a big Swedish registry. 163 00:09:26,200 --> 00:09:28,360 Speaker 1: It looked I mean it was a less populated about 164 00:09:28,400 --> 00:09:32,120 Speaker 1: two hundred and sixteen thousand women looked at fifteen to 165 00:09:32,120 --> 00:09:36,640 Speaker 1: twenty two year olds. The combined oral contraceptive users had 166 00:09:37,040 --> 00:09:41,120 Speaker 1: almost a two times suicidal behavior in the first month 167 00:09:41,440 --> 00:09:44,960 Speaker 1: compared to those without oral contraceptives. And they actually said 168 00:09:44,960 --> 00:09:49,600 Speaker 1: that they said the suicidal ideations and attempts were more 169 00:09:49,720 --> 00:09:52,400 Speaker 1: likely within the first two months, but it didn't actually 170 00:09:52,400 --> 00:09:55,560 Speaker 1: go back down to normal with time. And if it 171 00:09:55,600 --> 00:09:59,000 Speaker 1: was a progestion only pill like the mini pill, I 172 00:09:59,000 --> 00:10:02,880 Speaker 1: think it's referred to the cool world, it was even higher. 173 00:10:03,040 --> 00:10:07,000 Speaker 1: Another one Finland analysis of almost six hundred thousand women 174 00:10:07,080 --> 00:10:09,959 Speaker 1: ages fifteen to forty nine over a couple year period. 175 00:10:10,280 --> 00:10:15,320 Speaker 1: They said that they found no increase of attempted suicide. However, 176 00:10:15,640 --> 00:10:19,480 Speaker 1: it certainly did it increase depression. I mean, so take 177 00:10:19,520 --> 00:10:22,240 Speaker 1: it what you will. Depression can lead to suicide if 178 00:10:22,240 --> 00:10:24,560 Speaker 1: you have an increased risk of depression. I'm going to 179 00:10:24,600 --> 00:10:28,080 Speaker 1: say at some point people with depression contemplate if not 180 00:10:28,200 --> 00:10:34,720 Speaker 1: complete suicide. So nine studies total looked at some of 181 00:10:34,760 --> 00:10:39,160 Speaker 1: this stuff, three on suicide attempts, five on completed suicides, 182 00:10:40,000 --> 00:10:43,080 Speaker 1: and the majority of these showed an increased risk. Some 183 00:10:43,160 --> 00:10:45,640 Speaker 1: of them were equivocal, some just said, well, we can't 184 00:10:45,640 --> 00:10:48,280 Speaker 1: really say for sure that there's an increased risk of 185 00:10:48,400 --> 00:10:52,840 Speaker 1: suicide attempt or completion, but they certainly there was not 186 00:10:52,920 --> 00:10:56,040 Speaker 1: a question that it could increase the risk of depression 187 00:10:56,040 --> 00:10:58,680 Speaker 1: and people who do not have a history of depression. 188 00:10:58,720 --> 00:11:01,680 Speaker 1: You're listening to wellness and we'll be right back with more. 189 00:11:05,040 --> 00:11:08,480 Speaker 1: Why would teenagers be more vulnerable to these you know, 190 00:11:08,520 --> 00:11:12,120 Speaker 1: why isn't it the same for teens versus adult women. Well, 191 00:11:12,240 --> 00:11:14,400 Speaker 1: I mean common sense kind of comes in right here. 192 00:11:14,480 --> 00:11:19,120 Speaker 1: The reality is the teenager's brain, their body, it's still forming. 193 00:11:19,240 --> 00:11:21,520 Speaker 1: I know, I know, fifteen sixteen year olds think they 194 00:11:21,559 --> 00:11:23,600 Speaker 1: know it all and that they're already adults, but the 195 00:11:23,640 --> 00:11:27,000 Speaker 1: reality is they're not. And in fact, adolescence is a 196 00:11:27,000 --> 00:11:31,320 Speaker 1: critical period for brain development and hormonal regulation that is puberty. 197 00:11:31,320 --> 00:11:34,520 Speaker 1: It doesn't just happen overnight. It takes time, and there's 198 00:11:34,520 --> 00:11:37,920 Speaker 1: something called the HPA axis. And without getting into the 199 00:11:37,920 --> 00:11:41,160 Speaker 1: granular detail, there's a little gland in your brain called 200 00:11:41,160 --> 00:11:44,560 Speaker 1: the hypothalamus. Then you have the pituitary another one, and 201 00:11:44,600 --> 00:11:47,319 Speaker 1: then you go down to your adrenal glands, which are 202 00:11:47,360 --> 00:11:49,959 Speaker 1: two glands. That's it's hard for way to do with 203 00:11:50,000 --> 00:11:54,880 Speaker 1: my shoulder pointing to my back. Your two little drainal 204 00:11:54,880 --> 00:11:56,880 Speaker 1: glands sit on top of your kidneys. Now, this is 205 00:11:56,880 --> 00:12:00,240 Speaker 1: your HPA access and this is important for you your 206 00:12:00,320 --> 00:12:03,880 Speaker 1: stress response, so your fight or flight it's part of that, 207 00:12:04,320 --> 00:12:08,480 Speaker 1: your cortisol levels. And so there have been many studies 208 00:12:08,520 --> 00:12:14,000 Speaker 1: showing how synthetic hormones like oral contraceptives may disregulate this 209 00:12:14,120 --> 00:12:18,040 Speaker 1: cycle and disregulate your mood resilience, you know, your ability 210 00:12:18,120 --> 00:12:23,240 Speaker 1: to deal with stress, and particularly oral contraceptives based on 211 00:12:23,280 --> 00:12:26,400 Speaker 1: this science, not just because it's my opinion, have shown 212 00:12:26,440 --> 00:12:30,920 Speaker 1: that it can significantly affect this HPA axis again, which 213 00:12:31,000 --> 00:12:34,480 Speaker 1: regulates the body's stress response. So this impact can lead 214 00:12:34,520 --> 00:12:39,880 Speaker 1: to altered cortisol dynamics, including blunted cortisol response to stress. 215 00:12:39,920 --> 00:12:42,400 Speaker 1: So if you're stressed out, your body is like, well, 216 00:12:42,400 --> 00:12:44,040 Speaker 1: I just don't know how to deal with it, and 217 00:12:44,080 --> 00:12:48,440 Speaker 1: that internalizes and that can lead to depression and just 218 00:12:48,640 --> 00:12:52,920 Speaker 1: mood and emotional reactivities that are abnormal for you, not 219 00:12:52,960 --> 00:12:55,520 Speaker 1: the way that they're meant to be. So there have 220 00:12:55,559 --> 00:12:58,320 Speaker 1: been several studies that have looked at that cortisol levels 221 00:12:58,360 --> 00:13:02,360 Speaker 1: women on and off oral inceptives and the other hormonal contraceptives, 222 00:13:02,360 --> 00:13:05,200 Speaker 1: and it does show there's variations in the cortisol and 223 00:13:05,280 --> 00:13:09,040 Speaker 1: their response to certain stimuli. They've actually done imaging studies. 224 00:13:09,120 --> 00:13:11,520 Speaker 1: I mean as a radiologist, of course, I love the 225 00:13:11,559 --> 00:13:15,160 Speaker 1: imaging studies. They looked at functional MRI, and they looked 226 00:13:15,200 --> 00:13:18,719 Speaker 1: at MRI and they showed on women who have been 227 00:13:18,840 --> 00:13:22,080 Speaker 1: on hormonal contraceptives compared to those who are not on 228 00:13:22,400 --> 00:13:27,120 Speaker 1: hormonal contraceptives, their brains look different. There are certain areas 229 00:13:27,160 --> 00:13:32,160 Speaker 1: in their brain where their cortices are thinner. They react 230 00:13:32,160 --> 00:13:35,320 Speaker 1: differently to traumatic stimuli, like if they were to be 231 00:13:35,520 --> 00:13:38,880 Speaker 1: seen a picture that should invoke some sort of reaction. 232 00:13:39,440 --> 00:13:42,679 Speaker 1: It's your visual pathway, so you see it, it registers 233 00:13:42,679 --> 00:13:44,679 Speaker 1: in your brain, and then your brain said, all right, 234 00:13:44,760 --> 00:13:46,679 Speaker 1: let's send out these hormones. We got to deal with 235 00:13:46,679 --> 00:13:50,280 Speaker 1: this stress that actually happens in your brain. Well, oral 236 00:13:50,280 --> 00:13:54,240 Speaker 1: contraceptive view, there's sometimes it's a blunted response. They don't 237 00:13:54,240 --> 00:13:57,400 Speaker 1: respond the same way to stimuli that they should. It's 238 00:13:57,440 --> 00:13:59,840 Speaker 1: all very interesting. Again, this was part of that deep 239 00:14:00,080 --> 00:14:01,680 Speaker 1: I was kind of going into and I think I 240 00:14:01,720 --> 00:14:04,680 Speaker 1: could continue to go, but we had to record because 241 00:14:04,679 --> 00:14:06,160 Speaker 1: I have to get this out for you guys. But 242 00:14:08,280 --> 00:14:11,840 Speaker 1: you know, I just got really concerned about this because listen, 243 00:14:12,080 --> 00:14:15,960 Speaker 1: there's so many stories about teens who you know, have acne, 244 00:14:16,080 --> 00:14:20,920 Speaker 1: who are being bullied, and so they go on prescription 245 00:14:21,840 --> 00:14:24,760 Speaker 1: you know, hormonal contraceptives and it's the only thing that 246 00:14:24,800 --> 00:14:27,520 Speaker 1: works for them. You know. I don't think anyone here 247 00:14:27,640 --> 00:14:31,120 Speaker 1: is saying no one should be on medications, especially if 248 00:14:31,160 --> 00:14:33,280 Speaker 1: it's helping them, because I can tell you if a 249 00:14:33,400 --> 00:14:36,200 Speaker 1: teen is not feeling good about their physical appearance and 250 00:14:36,240 --> 00:14:38,680 Speaker 1: they're being bullied or they're just that can also lead 251 00:14:38,680 --> 00:14:42,480 Speaker 1: to depression. That can also lead to suicidal ideations and 252 00:14:42,680 --> 00:14:45,600 Speaker 1: suicide completion. I just am saying that I think that 253 00:14:45,640 --> 00:14:50,000 Speaker 1: the risks of these contraceptives in younger girls is not 254 00:14:50,120 --> 00:14:53,360 Speaker 1: talked about enough, and in fact, we have black box 255 00:14:53,440 --> 00:14:58,240 Speaker 1: warnings on SSRIs, which is a very common antidepressant, which 256 00:14:58,440 --> 00:15:01,280 Speaker 1: ironically is like what some of these girls are being 257 00:15:01,280 --> 00:15:05,440 Speaker 1: put on because their contraceptives are giving them depression. There 258 00:15:05,440 --> 00:15:11,800 Speaker 1: are black box warnings on ssririse warning that there's increase 259 00:15:12,400 --> 00:15:16,480 Speaker 1: risk of suicidal thoughts and completion with the use of 260 00:15:16,480 --> 00:15:21,080 Speaker 1: these medications. And okay, so then the question is, all right, well, 261 00:15:21,200 --> 00:15:25,040 Speaker 1: if there's already a black box warning on SSRIs, obviously 262 00:15:25,360 --> 00:15:29,160 Speaker 1: the data on that showing a direct not just correlation 263 00:15:29,480 --> 00:15:33,200 Speaker 1: but causation exists. I mean, you'd think so, right, I 264 00:15:33,320 --> 00:15:37,200 Speaker 1: thought so too. Again, that was another level of that 265 00:15:37,320 --> 00:15:41,640 Speaker 1: rabbit hole that I went down. Let's talk about why 266 00:15:41,680 --> 00:15:44,960 Speaker 1: did the SSRIs get their black box warning. Well, in 267 00:15:45,000 --> 00:15:49,040 Speaker 1: two thousand and four, when they were being prescribed like candy, 268 00:15:50,320 --> 00:15:53,320 Speaker 1: there's started to be all these case reports and parents 269 00:15:53,400 --> 00:15:57,680 Speaker 1: were saying, hey, specifically in kids under twenty five, they're 270 00:15:57,680 --> 00:16:02,880 Speaker 1: not doing well. They're talking of being institutionalized suicide. Really 271 00:16:02,920 --> 00:16:06,240 Speaker 1: just all started with some of these anecdotal reports, which 272 00:16:06,320 --> 00:16:08,760 Speaker 1: you know it often does. So in two thousand and four, 273 00:16:08,800 --> 00:16:12,200 Speaker 1: when SSRIs were starting to be prescribed like they are candy, 274 00:16:13,480 --> 00:16:18,160 Speaker 1: especially in young adults and teens less than twenty five, 275 00:16:18,480 --> 00:16:20,760 Speaker 1: there were a lot of reports. I wouldn't say a 276 00:16:20,800 --> 00:16:23,400 Speaker 1: lot of reports considering how many was being prescribed, but 277 00:16:23,440 --> 00:16:28,760 Speaker 1: there were reports of increased suicidal attempts and completion of 278 00:16:28,760 --> 00:16:30,760 Speaker 1: people who had just been put on these medications. Well, 279 00:16:30,800 --> 00:16:36,400 Speaker 1: aren't these medications supposed to help the depression, not escalate it. Well, 280 00:16:36,520 --> 00:16:40,160 Speaker 1: so the FDA said, all right, let's we're going to 281 00:16:40,200 --> 00:16:44,640 Speaker 1: take a break. Because again FDA not always the first. 282 00:16:44,840 --> 00:16:47,640 Speaker 1: In fact, Europe said we need to take a look 283 00:16:47,640 --> 00:16:49,880 Speaker 1: at these a little bit closer. Europe started doing a 284 00:16:49,920 --> 00:16:53,800 Speaker 1: little deeper dive. They started putting warnings out. So the 285 00:16:53,840 --> 00:16:55,400 Speaker 1: FDA is like, well, I guess we have to look 286 00:16:55,400 --> 00:16:58,640 Speaker 1: at these now. Shocking. So the FDA decided to conduct 287 00:16:58,680 --> 00:17:01,960 Speaker 1: a big meta analysis looking at over one hundred thousand people, 288 00:17:02,120 --> 00:17:05,520 Speaker 1: and the analysis revealed that the risk of just suicidal 289 00:17:05,600 --> 00:17:09,399 Speaker 1: thoughts or behavior was twice as high in those taking 290 00:17:09,440 --> 00:17:13,680 Speaker 1: antidepressants compared to those on the placebo, twice as high 291 00:17:14,240 --> 00:17:20,359 Speaker 1: suicidal thoughts when taking the medication compared to those that weren't. Gosh, 292 00:17:20,480 --> 00:17:23,320 Speaker 1: I just don't know where I've heard that before. Oh right, 293 00:17:24,000 --> 00:17:28,680 Speaker 1: oral contraceptives twice as high suicidal thoughts, three times as 294 00:17:28,760 --> 00:17:33,240 Speaker 1: high suicidal completion. I didn't even see suicidal completion in 295 00:17:33,320 --> 00:17:36,760 Speaker 1: the FDA's meta analysis that resulted in their black box 296 00:17:36,800 --> 00:17:40,359 Speaker 1: warning on SSRIs, So why not black box warning on 297 00:17:40,440 --> 00:17:43,880 Speaker 1: oral contraceptives. I don't know. I find it concerning when 298 00:17:43,920 --> 00:17:49,040 Speaker 1: I googled the Google machine, why is there a black 299 00:17:49,080 --> 00:17:54,240 Speaker 1: box warning for SSRIs and not for oral contraceptives when 300 00:17:54,280 --> 00:17:58,160 Speaker 1: it comes to suicidal thoughts? It came back, well, all 301 00:17:58,200 --> 00:18:01,919 Speaker 1: the evidence is clear because of randomized control trials. The 302 00:18:02,000 --> 00:18:06,080 Speaker 1: evidence is less clear for oral contraceptives because it's based 303 00:18:06,080 --> 00:18:09,120 Speaker 1: on meta analyzes and observational studies and blah blah blah 304 00:18:09,160 --> 00:18:11,120 Speaker 1: blah blah, and kind of everything else that we hear. 305 00:18:11,600 --> 00:18:16,640 Speaker 1: Yet no one's doing the studies. There are enough signals 306 00:18:16,640 --> 00:18:23,080 Speaker 1: here that the conversation is significantly warranted. And maybe I'm 307 00:18:23,080 --> 00:18:25,320 Speaker 1: going to need to give a call over to the HHS. 308 00:18:25,400 --> 00:18:28,880 Speaker 1: Some of my buddies over there. You know Marty McCarey, 309 00:18:28,960 --> 00:18:31,520 Speaker 1: who was the commissioner of the new Commissioner of FDA. 310 00:18:31,640 --> 00:18:34,960 Speaker 1: He was on Wellness d Mass last month talking about 311 00:18:35,000 --> 00:18:36,719 Speaker 1: some things and how they're going to be cutting through 312 00:18:36,760 --> 00:18:38,919 Speaker 1: the red tape and they are going to reassess the 313 00:18:39,040 --> 00:18:42,760 Speaker 1: data because they're tired of settled science. They were just 314 00:18:42,800 --> 00:18:46,760 Speaker 1: talking about hormone replacement therapy and black box warning that's 315 00:18:46,760 --> 00:18:49,840 Speaker 1: scaring women away from HRT. Well, maybe we can talk 316 00:18:49,840 --> 00:18:53,240 Speaker 1: about oral contraceptives and teams seems like a good idea 317 00:18:53,280 --> 00:18:55,680 Speaker 1: to me. We don't have a CDC director right now, 318 00:18:55,720 --> 00:18:57,480 Speaker 1: so I can't reach out to anybody there. It would 319 00:18:57,480 --> 00:18:59,280 Speaker 1: be nice to have one to kind of help guide us, 320 00:18:59,280 --> 00:19:04,600 Speaker 1: seeing as the SEA gives formal recommendations about things I 321 00:19:04,600 --> 00:19:07,000 Speaker 1: don't know. I guess the question I have from an 322 00:19:07,040 --> 00:19:10,600 Speaker 1: ethical and regulatory question. Mind you, I'm not a gynecologist, 323 00:19:10,680 --> 00:19:13,440 Speaker 1: I'm not a psychiatrist. I'm not going to have these 324 00:19:13,480 --> 00:19:17,439 Speaker 1: conversations with my patients. And I have three sons, so 325 00:19:17,480 --> 00:19:19,960 Speaker 1: I'm not having these with my daughters either. But if 326 00:19:20,000 --> 00:19:24,080 Speaker 1: we are obligated as physicians to inform teens about the 327 00:19:24,160 --> 00:19:27,919 Speaker 1: suicidal risk with antidepressants, is there not a parallel obligation 328 00:19:28,119 --> 00:19:30,280 Speaker 1: to do the same thing with birth control. I mean, 329 00:19:30,359 --> 00:19:33,400 Speaker 1: maybe this warning could help girls and parents monitor mood 330 00:19:33,400 --> 00:19:37,400 Speaker 1: symptoms earlier. Maybe people would be less inclined to medicate 331 00:19:37,720 --> 00:19:41,520 Speaker 1: as quickly as we do, knowing that there are legitimate risks. 332 00:19:41,760 --> 00:19:45,080 Speaker 1: I personally think we are an over medicated society. I 333 00:19:45,080 --> 00:19:48,080 Speaker 1: think far too many young girls are started on birth control. 334 00:19:48,440 --> 00:19:52,040 Speaker 1: Do I get it, we want to avoid unwanted pregnancies. 335 00:19:52,280 --> 00:19:54,720 Speaker 1: I get it. For some it's helpful with ACNE. I 336 00:19:54,840 --> 00:20:00,720 Speaker 1: just think that this perpetual cycle of hormones, antidepressants, hormones, antidepressants, antibiotics, 337 00:20:00,720 --> 00:20:02,879 Speaker 1: and all these other things that we just keep throwing 338 00:20:02,920 --> 00:20:06,960 Speaker 1: at our kids, like, no wonder, we're a messed up society, 339 00:20:07,119 --> 00:20:10,320 Speaker 1: no wonder we have gut issues, No wonder we're overweight 340 00:20:10,320 --> 00:20:13,399 Speaker 1: and have metabolic issues and infertility issues and all the 341 00:20:13,440 --> 00:20:15,800 Speaker 1: other things that we're dealing with. I don't know. Again, 342 00:20:15,880 --> 00:20:18,720 Speaker 1: you can see my little hole that I keep going down. 343 00:20:19,119 --> 00:20:21,280 Speaker 1: I guess the important thing is I want to make 344 00:20:21,320 --> 00:20:24,200 Speaker 1: sure that people are being told of these risks. Whether 345 00:20:24,280 --> 00:20:26,080 Speaker 1: that is in the form of a black box warning, 346 00:20:26,240 --> 00:20:28,800 Speaker 1: I don't really know. You know, one thing that I 347 00:20:28,840 --> 00:20:32,200 Speaker 1: find incredibly interesting is that if you look in Europe, 348 00:20:32,680 --> 00:20:38,639 Speaker 1: like several European countries forbid or severely curtailed pharmaceutical advertising 349 00:20:38,640 --> 00:20:41,879 Speaker 1: to children, yet here in the United States selling the 350 00:20:41,960 --> 00:20:46,400 Speaker 1: children is just like business as usual. Whether it's the vaping, 351 00:20:46,680 --> 00:20:48,879 Speaker 1: I mean, we're finally getting control on that and the 352 00:20:48,880 --> 00:20:54,879 Speaker 1: bubblegum flavors of vaping, whether it's birth control, just medications 353 00:20:54,920 --> 00:20:59,160 Speaker 1: like whatever it is. I mean, there's anti HIV medications, 354 00:20:59,200 --> 00:21:02,800 Speaker 1: just showing people like frolicking at parties, like hey, we 355 00:21:02,840 --> 00:21:05,240 Speaker 1: can have a good time again. There's a pill Like 356 00:21:05,480 --> 00:21:08,800 Speaker 1: I am so turned off by all of this. I 357 00:21:09,000 --> 00:21:12,200 Speaker 1: just think we have gone so far from our moral 358 00:21:12,240 --> 00:21:14,879 Speaker 1: compass and what is right when it comes to our 359 00:21:14,920 --> 00:21:18,320 Speaker 1: pharmaceutical advertising and all of the other things that we 360 00:21:18,400 --> 00:21:22,760 Speaker 1: need to really rein it in RFK Junior has talked about, Hey, 361 00:21:22,960 --> 00:21:26,800 Speaker 1: we're going to pull back on pharmaceutical advertising. Hasn't happened. 362 00:21:27,560 --> 00:21:31,680 Speaker 1: Pharmaceutical companies, I think pay like thirty billion dollars globally 363 00:21:31,760 --> 00:21:34,800 Speaker 1: and advertising. Maybe that's part of the reason why. I 364 00:21:34,840 --> 00:21:38,000 Speaker 1: don't know. I just think that I think that we 365 00:21:38,040 --> 00:21:40,119 Speaker 1: need to have a bigger conversation when it comes to 366 00:21:40,480 --> 00:21:45,000 Speaker 1: contraceptive use in kids. And I think that as a 367 00:21:45,040 --> 00:21:46,879 Speaker 1: medical society, we need to take a pause, take a 368 00:21:46,880 --> 00:21:49,720 Speaker 1: step back, and say are we doing too much? Are 369 00:21:49,760 --> 00:21:52,600 Speaker 1: we not acknowledging the risks because we're trying to push 370 00:21:52,680 --> 00:21:58,240 Speaker 1: this mainstream agenda, and the mainstream agenda is reducing unintended pregnancies, 371 00:21:58,680 --> 00:22:02,360 Speaker 1: But with that is a cast gate of perpetual medication 372 00:22:02,560 --> 00:22:05,280 Speaker 1: and hormone use, which you're not benign. They have very 373 00:22:05,320 --> 00:22:08,000 Speaker 1: significant risks, and those risks are not being talked about 374 00:22:08,119 --> 00:22:10,960 Speaker 1: nearly enough. I'm doctor Nipole, Sofire. Thanks for listening to 375 00:22:10,960 --> 00:22:14,520 Speaker 1: Wellness on MASS on America's number one podcast network. iHeart. 376 00:22:14,560 --> 00:22:17,440 Speaker 1: Follow Wellness on MASS with doctor Napole, soptfhire and start 377 00:22:17,480 --> 00:22:21,040 Speaker 1: listening on the free iHeartRadio app wherever you get your podcasts, 378 00:22:21,040 --> 00:22:22,320 Speaker 1: and we will catch you next time.