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Psychodynamic Aspects of Oral Contraception: Title and subTitle BreakA Review FREE

Edward E. Wallach, MD; Celso-Ramon Garcia, MD
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JAMA. 1968;203(11):927-931. doi:10.1001/jama.1968.03140110019005
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Emotional response to use of oral contraceptives results from numerous factors, basic among them are the attitudes of patient and husband towards (1) contraception, (2) pregnancy, and (3) sexuality. Concerns over potential side effects, subsequent fertility, and use of any medication are significant, as well as information received from the patient's physician, peers, and news media. The estrogenic and progestogenic components of oral contraceptives have been implicated in emotional alterations. Varied cyclic changes occurring throughout the menstrual cycle depend greatly upon metabolic effects and fluctuating levels of estrogens and progesterone. Therapeutic value has been attributed to oral contraceptives in management of psychiatric conditions, although depression has also been described in association with their use. Libido does not appear to be affected by these drugs.

REFERENCES

Himes, N.E.: Medical History of Contraception , New York: Gamut Press, Inc, 1963;, pp 3-330.
Kroger, W.S., and Freed, S.C.: Psychosomatic Gynecology , Hollywood, Calif: Wiltshire Book Co., 1962;. pp 274, 268-269. 273.
Ryder. N.B., and Westoff, C.F.:  Use of Oral Contraception in the United States, 1965 , Science 153:1199-1205 ( (Sept 9) ) 1966;.
Rainwater, L.: And the Poor Get Children , Chicago: Quadrangle Books, 1960;, pp 55-56, 85.
Whitelaw, M.J.; Nola, V.F.; and Kalman, C.F.:  Irregular Menses. Amenorrhea. and Infertility Following Synthetic Progestational Agents , JAMA 195:780-782 ( (Feb 28) ) 1966;.
Heffernan, R.J.:  Female Infertility , JAMA 128:613 ( (June 23) ) 1945;.
Mead, M.: Male and Female , New York: William Morrow & Co., 1949;, p 225.
Michael, R.P.; Herbert, J.; and Welegalla, J.:  Ovarian Hormones and Grooming Behavior in the Rhesus Monkey (Macaca mulata) Under Laboratory Conditions . J Endocr 36:263-279 ( (Nov) ) 1966;.
Schick, M.:  On Premenstrual Depression , Amer J Psychother 7:664-671 ( (Oct) ) 1953;.
Pierson, W.R., and Lockhart, A.:  Effect of Menstruation on Simple Reaction and Movement Time , Brit Med J 1:796-797 ( (March 23) ) 1963;.
Benedek, T., and Rubenstein, B.B.:  The Correlations Between Ovarian Activity and Psychodynamic Processes: I. The Ovulative Phase , Psychosom Med 1:245-270 ( (April) ) 1939;.
Saunders, F.J.:  The Effects of Several Steroids on Mating Behavior, Ovulation and Pregnancy in Female Rats , Endocrinology 63:566-569 ( (Nov) ) 1958;.
Bower. W.H., and Altschule, M.D.:  Use of Progesterone in the Treatment of Post-partum Psychosis , New Eng J Med 254: 157-160 ( (Jan 26) ) 1956;.
Keeler, M.H.; Kane, F.; and Daly, R.:  An Acute Schizophrenic Episode Following Abrupt Withdrawal of Enovid in a Patient With Previous Post-partum Psychiatric Disorder , Amer J Psychiat 120:1123-1124 ( (May) ) 1964;.
Kane. F.J., Jr., and Keeler, M.H.:  The Use of Enovid in Postpartum Mental Disorders , Southern Med J 58:1089-1092 ( (Sept) ) 1965;.
Idestrom, C.M.:  Reaction to Norethisterone Withdrawal , Lancet 1:718 ( (March 26) ) 1966;.
Swanson, D.W., et al:  The Use of Norethynodrel in Psychotic Females , Amer J Psychiat 120:1101-1103 ( (May) ) 1964;.
Friedman, J.H.:  The Attitude of the Psychoneurotic Toward Scientific Contraceptive Advice , J Nerv Ment Dis 89:672-681 ( (May) ) 1939;.
Solomon, L.L.:  A Physician Dares Raise His Voice in Opposition to Birth Control , Int J Med Surg 45:286-290 ( (June) ) 1932;.
Kaye, B.M.:  Oral Contraceptives and Depression , JAMA 186:522 ( (Nov 2) ) 1963;.
Meldman, M.J.:  Behavioral Changes in the Husbands of Women Treated With Oral Contraceptives , Psychosomatics 5:188-189 ( (May) -June) 1964;.
Glick, I.D.:  Mood and Behavioral Changes Associated With the Use of the Oral Contraceptive Agents , Psychopharmacologia 10:363-374, 1967;.
Pincus, G., et al:  Effectiveness of an Oral Contraceptive , Science 130:81-83 ( (July 10) ) 1959;.
Ringrose, C.A.D.:  The Emotional Responses of Married Women Receiving Oral Contraceptives , Canad Med Assoc J 92: 1207-1209 ( (June 5) ) 1965;.
Bakker, C.B., and Dightman, C.R.:  Side Effects of Oral Contraceptives , Obstet Gynec 28:373-379 ( (Sept) ) 1966;.
Richter, R.H.H.: " Planning of Clinical Trials With Oral Contraceptives ," in Social and Medical Aspects of Oral Contraception , M. N. G. Dukes (ed.), Amsterdam: Excerpta Medica Foundation, 1966;, pp 53-62.
Wallach, E.E.; Watson, F.M., Jr.; and Garcia, C.R.:  Patient Acceptance of Oral Contraceptives: II. The Private Patient , Amer J Obstet Gynec 98:1071-1079 ( (Aug 15) ) 1967;.
Ziegler, F.J., and Rodgers, D.A.:  Vasectomy Ovulation Suppressors, and Sexual Behavior , read before the American Orthopsychiatric Meeting, April 15, 1966 .
Zell, J.R., and Crisp, W.E.:  A Psychiatric Evaluation of the Use of Oral Contraceptives: A Study of 250 Private Patients , Obstet Gynec 23:657-661 ( (May) ) 1964;.
Bakker, C.B., and Dightman, C.R.:  Psychological Factors in Fertility Control , Fertil Steril 15:559-567 ( (Sept) -Oct) 1964;.
Wallach, E.E.; Beer, A.E.; and Garcia, C.-R.:  Patient Acceptance of Oral Contraceptives: I. The American Indian , Amer J Obstet Gynec 97:984-991 ( (April 1) ) 1967;.
Pincus, G.:  Control of Conception by Hormonal Steroids , Science 153:493-500 ( (July 29) ) 1966;.
Puddy, E.: " The Difficulty of Assessing Subjective Symptoms Relative to Ovulation Inhibition ," in Recent Advances in Ovarian and Synthetic Steroids and the Control of Ovarian Function , R. P. Shearman (ed.), Sydney, Australia: Globe Commercial, 1965;, pp 233-241.

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Himes, N.E.: Medical History of Contraception , New York: Gamut Press, Inc, 1963;, pp 3-330.
Kroger, W.S., and Freed, S.C.: Psychosomatic Gynecology , Hollywood, Calif: Wiltshire Book Co., 1962;. pp 274, 268-269. 273.
Ryder. N.B., and Westoff, C.F.:  Use of Oral Contraception in the United States, 1965 , Science 153:1199-1205 ( (Sept 9) ) 1966;.
Rainwater, L.: And the Poor Get Children , Chicago: Quadrangle Books, 1960;, pp 55-56, 85.
Whitelaw, M.J.; Nola, V.F.; and Kalman, C.F.:  Irregular Menses. Amenorrhea. and Infertility Following Synthetic Progestational Agents , JAMA 195:780-782 ( (Feb 28) ) 1966;.
Heffernan, R.J.:  Female Infertility , JAMA 128:613 ( (June 23) ) 1945;.
Mead, M.: Male and Female , New York: William Morrow & Co., 1949;, p 225.
Michael, R.P.; Herbert, J.; and Welegalla, J.:  Ovarian Hormones and Grooming Behavior in the Rhesus Monkey (Macaca mulata) Under Laboratory Conditions . J Endocr 36:263-279 ( (Nov) ) 1966;.
Schick, M.:  On Premenstrual Depression , Amer J Psychother 7:664-671 ( (Oct) ) 1953;.
Pierson, W.R., and Lockhart, A.:  Effect of Menstruation on Simple Reaction and Movement Time , Brit Med J 1:796-797 ( (March 23) ) 1963;.
Benedek, T., and Rubenstein, B.B.:  The Correlations Between Ovarian Activity and Psychodynamic Processes: I. The Ovulative Phase , Psychosom Med 1:245-270 ( (April) ) 1939;.
Saunders, F.J.:  The Effects of Several Steroids on Mating Behavior, Ovulation and Pregnancy in Female Rats , Endocrinology 63:566-569 ( (Nov) ) 1958;.
Bower. W.H., and Altschule, M.D.:  Use of Progesterone in the Treatment of Post-partum Psychosis , New Eng J Med 254: 157-160 ( (Jan 26) ) 1956;.
Keeler, M.H.; Kane, F.; and Daly, R.:  An Acute Schizophrenic Episode Following Abrupt Withdrawal of Enovid in a Patient With Previous Post-partum Psychiatric Disorder , Amer J Psychiat 120:1123-1124 ( (May) ) 1964;.
Kane. F.J., Jr., and Keeler, M.H.:  The Use of Enovid in Postpartum Mental Disorders , Southern Med J 58:1089-1092 ( (Sept) ) 1965;.
Idestrom, C.M.:  Reaction to Norethisterone Withdrawal , Lancet 1:718 ( (March 26) ) 1966;.
Swanson, D.W., et al:  The Use of Norethynodrel in Psychotic Females , Amer J Psychiat 120:1101-1103 ( (May) ) 1964;.
Friedman, J.H.:  The Attitude of the Psychoneurotic Toward Scientific Contraceptive Advice , J Nerv Ment Dis 89:672-681 ( (May) ) 1939;.
Solomon, L.L.:  A Physician Dares Raise His Voice in Opposition to Birth Control , Int J Med Surg 45:286-290 ( (June) ) 1932;.
Kaye, B.M.:  Oral Contraceptives and Depression , JAMA 186:522 ( (Nov 2) ) 1963;.
Meldman, M.J.:  Behavioral Changes in the Husbands of Women Treated With Oral Contraceptives , Psychosomatics 5:188-189 ( (May) -June) 1964;.
Glick, I.D.:  Mood and Behavioral Changes Associated With the Use of the Oral Contraceptive Agents , Psychopharmacologia 10:363-374, 1967;.
Pincus, G., et al:  Effectiveness of an Oral Contraceptive , Science 130:81-83 ( (July 10) ) 1959;.
Ringrose, C.A.D.:  The Emotional Responses of Married Women Receiving Oral Contraceptives , Canad Med Assoc J 92: 1207-1209 ( (June 5) ) 1965;.
Bakker, C.B., and Dightman, C.R.:  Side Effects of Oral Contraceptives , Obstet Gynec 28:373-379 ( (Sept) ) 1966;.
Richter, R.H.H.: " Planning of Clinical Trials With Oral Contraceptives ," in Social and Medical Aspects of Oral Contraception , M. N. G. Dukes (ed.), Amsterdam: Excerpta Medica Foundation, 1966;, pp 53-62.
Wallach, E.E.; Watson, F.M., Jr.; and Garcia, C.R.:  Patient Acceptance of Oral Contraceptives: II. The Private Patient , Amer J Obstet Gynec 98:1071-1079 ( (Aug 15) ) 1967;.
Ziegler, F.J., and Rodgers, D.A.:  Vasectomy Ovulation Suppressors, and Sexual Behavior , read before the American Orthopsychiatric Meeting, April 15, 1966 .
Zell, J.R., and Crisp, W.E.:  A Psychiatric Evaluation of the Use of Oral Contraceptives: A Study of 250 Private Patients , Obstet Gynec 23:657-661 ( (May) ) 1964;.
Bakker, C.B., and Dightman, C.R.:  Psychological Factors in Fertility Control , Fertil Steril 15:559-567 ( (Sept) -Oct) 1964;.
Wallach, E.E.; Beer, A.E.; and Garcia, C.-R.:  Patient Acceptance of Oral Contraceptives: I. The American Indian , Amer J Obstet Gynec 97:984-991 ( (April 1) ) 1967;.
Pincus, G.:  Control of Conception by Hormonal Steroids , Science 153:493-500 ( (July 29) ) 1966;.
Puddy, E.: " The Difficulty of Assessing Subjective Symptoms Relative to Ovulation Inhibition ," in Recent Advances in Ovarian and Synthetic Steroids and the Control of Ovarian Function , R. P. Shearman (ed.), Sydney, Australia: Globe Commercial, 1965;, pp 233-241.
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