User talk:BC07

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[edit] COCP edits

I'm very impressed with your edits to the "Mechanism of action" section of Combined oral contraceptive pill. I've been hoping someone would improve that section for a long time - thank you!

I was non-plussed by your comment "COCP users have no increased risk (and may have a decreased risk) of clinical depression compared to women not using COCPs." It implies my experience was all in my head. I'm much more open to statements of small risk, unlikely effect, etc. I obviously have a preference for believing I was part of an unlucky 1% or 0.5% of women than that my experiences were all in my head.

Weight gain - I agree it appears to be a myth about the pill that it causes weight gain. But it is a very common myth, so I do not believe a section discussing the evidence against weight gain is undue weight. I agree the section needs to be updated with new references, but not deleted entirely.

I really appreciate all the time you have spent researching for this article. It looks like you've done some preparation for more editing and I look forward to the Wikipedia article being better because of it! Lyrl^Talk _C 01:51, 17 July 2007 (UTC)

Thank you for your thoughtful and considerate comments.

I did not mean to imply that your depression while taking Yasmin was not real.

The opening sentence of the subsection "Mood swings, depression" in the section "Managing side effects" in Hatcher & Nelson (2004) "Combined Hormonal Contraceptive Methods" in Hatcher et al. (eds.), Contraceptive Technology, 18th ed. ISBN 0966490258 is:

Multiple studies have demonstrated no increase in the risk of clinical depression in women using OCs.

The fourth and fifth sentences are:

Some women do report an increase in depressive symptoms, moodiness, and other emotional states while on OCs. This may represent an idiosyncratic response to hormones, which may warrant a decrease in hormone doses or pill cessation.

It would be reasonable for the COCP article to incorporate the first sentence and the fourth and fifth sentences, but wrong to alter the meaning of the first sentence by changing "no increase in the risk of" to "a small increase in the risk of".

The first paragraph of the "Managing side effects" section in Hatcher & Nelson (2004) says:

A double-blind trial showed no difference in the incidence of any of the traditionally "hormonally related" side effects during the 6-month comparison of OC users and placebo pills users. Similar percentages of women in each group developed headaches, nausea, vomiting, mastalgia, weight gain, etc. This finding differs from the impression given by the pill package labeling, because the side effect numbers in labeling come from clinical trials and reflect events that women had while they use pills that could possibly be related to pill use, not events that occur because of the pill. Similarly, when women with "pill side effects" such as nausea, headache, irritability, fatigue, weight gain, breast tenderness and breakthrough bleeding were treated in another study with either Vitamin B6 or sugar pill, both groups improved on all symptoms.

The "Mood and Depression" subsection of the "Metabolic Effects" subsection of the "Oral Steroid Contraceptives" section in Mishell (2004) "Contraception" in Strauss & Barbieri (eds.), Yen & Jaffe's Reproductive Endocrinology, 5th ed. ISBN 0721695469 says:

Analysis of the data from the Royal College of General Practitioners (RCGP) cohort study indicated that OC use was positively correlated with the incidence of depression, which in turn was directly related to the dose of estrogen in the formulation. In this study, an increased incidence of depression was not found to occur among users of OCs containing less than 50 µg of estrogen.

citing:

Kay CR (1984). The Royal College of General Practitioners' Oral Contraception Study: some recent observations. Clin Obstet Gynaecol. 11(3):759-86. PMID 6509858 :

Depression and Attempted Suicide

There is a marked contrast between the lack of scientific evidence that the Pill causes reactive or neurotic depression—the subject of the present communication—and the experience of most clinicians, who cannot fail to have been impressed by the common complaint of their patients that OCs have made them depressed. Frequently these women have recovered when they stopped the Pill, only to relapse when another course was begun. Of course, such a history could be consistent with a psychological rather than a pharmacological effect of OCs. Depression is extremely common, and it is easy for any concurrent circumstances (including OC use) to become the scapegoat to which the condition is attributed.

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Conclusions

The literature on this subject is vast. An excellent review by Glick and Bennett (1981) cites 166 references, and they conclude, 'Whether OCs cause depression is unknown at this time, but our interpretation of the data in the literature does not support such an association.' I agree with this view, but our data provide some explanation for the conflicting evidence, since if the oestrogen dose response is correct (and it requires confirmation) the results will vary with the type of OC used by the women studied. On present-day brands containing oestrogen doses of 35 µg or less, we show no increased risk of depression. However, we cannot exclude the possibility that an over-reporting bias has concealed a true reduction of depression in these low-dose users.

(The RCGP study was the first very large prospective study of the health effects of oral contraceptives. Low-estrogen-dose (30 or 35 µg) OC users had a relative risk of 1.00 of depression compared to non-users.)

BC07 07:14, 20 July 2007 (UTC)