Case of a Girl on Psychotropic Medications Seeking Birth Control

For patients with mental health disorders treated with psychotropic medications, contraceptive management can be challenging for the primary care provider. Effectiveness of the combined oral contraceptive may decrease with concomitant use of certain psychotropic medications, although notably SSRIs do not have this interaction. Certain psychotropic medications may convey sexual side effects or hormonal effects such as elevated prolactin levels, elevated androgen levels, and decreased sex hormone-binding globulin, which may lead to clinical symptoms. The lack of effective contraception in patients on psychotropic medications may lead to teratogenic effects in the event of an unplanned pregnancy. Long-acting reversible contraceptives may be a preferred contraceptive method in these patients for improved rate of pregnancy prevention and the avoidance of pharmacologic interactions.