In August of 2009 ABC News did a story on antidepressant use in pregnant women, with one of the sections entitled “Fresh Guidance on Antidepressant Use in Women”. Fresh guidance, indeed. The only thing fresh about it was that a number of the academic psychiatrists who had been receiving large sums of money to serve on various “Women’s Health” consulting boards related to mental health paid for by the pharmaceutical industry, who were also being paid to fan out across the country and give lectures designed to convince psychiatrists to give SSRIs to pregnant and lactating women, were being quoted in the article as stating that antidepressants were safe to give in pregnant and lactating women. That was, in fact, far from the truth. It has been known for quite some time that SSRIs can induce cardiac defects, increase the risk of miscarriage, and cause other problems like Primary Pulmonary Hypertension (PPH). The drugs cross the placental barrier, for Christ’s sake. Would you take a drug that messes with the brain’s serotonin receptors in your unborn baby, willingly? Hopefully not! Why not just use crack cocaine?

Amy Philo, a mom who developed severe psychiatric symptoms as a result of being given Zoloft in the post-partum period, was contacted by ABC News about their story, but she was never put on the air. Instead, ABC went with a mom who took antidepressants during pregnancy.

Amy Philo and son

See Amy Amy Philo Speaks Out on the Mother\’s Act.

Since 80% of the efficacy of antidepressants is purely placebo effect, the much vaunted effects of the mainstream academic psychiatry establisment to get all pregnant women with depressive symptoms on an SSRI, which held the risk of injury or death to their in utero babies, something they would have to live with for the rest of their lives, in exchange for a 4% or so bump over placebo on a depression rating, all of the ranting and raving of mainstream psychiatry over the tragedy of the depressed mom, and this bullshit about how she won’t connect with her baby when it is born, seems a bit overblown, no? The true risks of SSRIs to pregnant and lactating mothers and their babies are now becoming known, thanks to excellent journalist reporting by people like Evelyn Pringle. Hopefully it can save some lives. And babies.

On Thursday an appellate court in New Jersey reversed the decision to let me testify in the case of Palazzolo v Hoffman La Roche, although they upheld the decision to not permit the results of our brain imaging study showing that Accutane affected function of the orbitofrontal cortex. In doing so they correctly noted that the results of the imaging study were just one part of the body of evidence needed to conclude that Accutane can cause depression, not the linchpin of the argument, as the prior judge had noted.

This announcement caused an outpouring of vitriol (e.g. calling my study “faked” and “junk science”), first from lawyers working on behalf of pharma and device makers, writing in the Drug and Device Law blog, then from an MD who works as writer and marketer for pharma and pharma-sponsored CME. I felt I need to set the record straight on a number of points that were made.

First of all, it is not true that the study was “commissioned for the litigation”. Eighty percent of the study was paid for by money donated by Liam Grant of Ireland. Brain scans aren’t free. Roche refused to do a study. In fact, back in 1999, I met personally with John McLane, who unbenownst to me was a senior executive for Roche at the time, who refused to even provide medication for the study. I am not an expert in Liam Grant’s litigation (in Ireland you cannot get more than $50,000 in litigation, so he is hardly doing it for the money). I agreed to be an expert after the study was done, not before. Half of all research is supported by pharma. They “commission” research to serve their marketing goals all the time. The bias that introduces has been well documented. When a study is done that is not controlled by them, they go bananas.

Some of the missing data referred to as “bmax” was actually an erroneous term introduced in the course of the 15 depositions (8 hours each) I went through with Roche over this study. The inability to retrieve the numbers was temporary due to problems accessing old media (not an uncommon problem in imaging research). By the time the data was retrieved a court deadline had passed. But it is inaccurate to imply that they were never retrieved.

The reference to not following the study methodology refers to a questionnaire about satisfaction with skin condition (called the Skindex) that was not part of the original protocol, and that was added late, and was not the primary focus of the study.  The original article stated that it was given before and after treatment, but the after treatment results were not presented. As I wrote in a correction later the questionnaire was not given to all of the subjects after treatment.

Roche spent a lot of time and effort trying to debunk this study, in the course of which some data entry errors were found. A re-analysis of the study with corrected data continued to show a reduction in function of the orbitofrontal brain function, in fact the results were more statistically significant than before. Roche next accused me of fraud and asked the journal to retract the paper, which led to an inquiry at my university where the committee had access to all the data and legal documents, and cleared me of the charges of fraud, recommending a letter of correction based on the corrected data, which led to this single sentence correction published in the journal.

The conclusion that Accutane can cause depression shouldn’t rest on a single study, which it doesn’t, as the evidence that retinoids play a role in affective disorders continues to grow.

After I wrote this post yesterday called “Motherhood is Not a Medical Disorder” about the Mother’s Act, which advocates for widespread screening of moms for post-partum depression (PPD), something I don’t think is a good idea because it medicalizes a normal stage of life, increases the chances that people will be but on antidepressant medications that they may not need and that may have side effects, and represents yet another intrusion into privacy, I got this response from John Grohol at psychcentral (”False Claims by Bremner”).

First he grumbles about my pointing out that the psychiatrist quoted in the Time article, Katherine Wisner, MD (you can follow the link to the Time article in yesterday’s post), was on the speakers bureau for Pfizer and Lilly (something not noted in the article but which I found on my own), makers of Zoloft and Prozac, respectively, which as a commenter pointed out are promoted as the two safest antidepressants for pregnant and lactating women. Being on a speaker’s bureau these days means giving “promotional talks”, which translates into working for the drug company to advertise to other doctors, and is relevant. In addition, the psychcentral website has paid ads, most of them for treatment (which includes medications), while this site has no ads. And don’t say I am trying to profit off my book, which now goes for a nickel on amazon.

Grohol further takes issue with my statement that women without a prior history of anxiety or depression are not at risk for PPD and therefore would not benefit from widespread screening. However in support of that he cites Ross et al 2009, claiming that history of abuse and alcohol or substance abuse are risk factors for PPD as well. However a perusal of Ross et al shows that a history of childhood abuse is not in fact a factor, rather only abuse during pregnancy. In addition, it is alcohol and substance abuse during pregnancy that is a risk factor, on the order of a pregnant woman drinking a six pack a day or actively abusing cocaine. That kind of substance abuse is a risk to the fetus, and needs to be stopped.

If you have a man beating his pregnant wife, or a woman snorting cocaine while pregnant, that it is a situation much more serious than PPD, and should be stopped. These extreme circumstances hardly justify mass screening for PPD.

I still say NO to the MOTHER’S ACT.

This recent article in Time Magazine discusses the Mother’s Act, legislation initiated in response to the story of Melanie Blocker-Stokes, who leaped to her death from her hotel room in Chicago three months after the birth of her daughter. Officially known as the Melanie Blocker-Stokes Post Partum Depression Research and Care Act, but referred to as the Mother’s Act, this legislation would require screening of all women post-partum for depression.

The problem with this is the attitude that being a mother is a risk factor for a psychiatric disorder. First of all, there is no evidence that women without a prior history of anxiety and depression have any increased risk of getting post partum depression. So to screen all moms as if giving birth is a risk factor for depression is ridiculous. And whenever you start screening the general population, you get into problems with over-identification of people and an increase in the number of people that go on antidepressants. I am opposed to mandatory screenings of the population, like Teenscreen, which are bonanzas for the pharmaceutical industry, but a major intrusion into the privacy and autonomy of American citizens. In the case of Melanie Blocker-Stokes, she had already been treated with multiple courses of psychotropic drugs and electro-convulsive therapy, so there is no reason to think that her life would have been saved by “screening”. This legislation is typical of much that comes out of an individual tragedy, that results in an intrusion into the personal lives of individuals and the further relinqueshment of individual freedoms to the government.

The article quotes psychiatrist Katherine Wisner MD as stating ”how can you be opposed to something that will help mothers?” But an examination of the fine print from one of her articles here shows that she is on speakers bureaus for Pfizer and Lilly, makers of Zoloft and Prozac, respectively. 

In it is quoted Amy Philo, a leader of the coalition against the Mother’s Act. Her experience was that after her baby choked on his vomit and needed emergency treatment, she became increasingly anxious about his health. Her doctor gave her Zoloft, telling her that it would make both her and her baby happier. After treatment with Zoloft, she started having alarming suicidal thoughts and thoughts about hurting her baby. When she weaned herself off of Zoloft she felt fine. This experience led her to start the United Non-Profits and Individuals for Truth and Ethics (UNITE), a coalition opposed to the Mother’s Act (click here to sign their petition). Time magazine recently corrected a statement that she had post-partum depression and developed thoughts of harm before taking Zoloft, which wasn’t true.

[update: read more on the debate that arose after this post here at Amy Philo's The Bitter Pill blog and my responses to John Grohol's attack on this post ("Bremner makes false claims...") here and here.]

It’s not bad enough that if you go see a psychiatrist that they may give you medications of questionable efficacy that may be complicated by making it hard for you to get off your couch and other side effects. But as I was discussing at lunch the other day with Charles Whitfield MD, friend and fellow Atlanta MD author and author of The Truth About Mental Illness and other books in the trauma field, psychotherapy can be helpful but can also be a double edged sword. That made me think about my long term psychotherapy supervision as a Yale psychiatry resident. The supervisors were great, I followed a patient for several years and they met with me (two of them) for an hour a week, they were both with the New England Psychoanalytical Institute, which was affiliated with Yale, and both had offices on Trumbull Street in New Haven, CT, which was “therapy row”.

Therapy Row, Trumbull St, in New Haven CT

Their names were Charles Gardner MD and Ira Levine MD. After I graduated I subletted Charlie Gardner’s office for my own small private practice for a while. Then I moved my practice to my house. My five year old daughter liked to talk to the borderline-strippers with total body tatoos in the waiting room. Oddly they seemed to be at a similar level of psychological development.

When I moved from Yale to Emory in 2000, the Director of Clinical Services, Steven Levy MD, who was (is) a psychoanalyst, kind of eyed me funny, as I was a researcher who was primarily focused on brain imaging studies in PTSD. He is now the acting chair of psychiatry at Emory. How ironic. He probably doesn’t know that I was born at the Meninger Clinic in Topeka KS, where my father was a psychiatry resident and whose mentor was the famous American psychoanalyst Karl Menninger MD. One of his jobs was entertaining visitors to the Meninger Clinic, who included Aldous Huxley, the author of the book Brave New World, who had dinner at our house.

We don't need soma, since we have Seroquel

Dr. B. outside Berggasse 19, Vienna

Anyhoo Charlie Gardner gave me a paper by a psychiatrist and analyst named Robert Langs, MD. He wrote several books including Rating Your Psychotherapist which I went back and repurchased. The gist of these books is that there are certain principles that characterize good therapists, including the fact that they start and end on time. Langs discussed the “frame” of therapy as something almost religious, which at the time I thought sounded nuts, but with time I came to appreciate as being very important. He makes these points about what is required for a good therapy:

• A single set fee
• A single, set location
• A set time for and length of sessions
• A soundproof office
• The rule of free association
• The therapist limited to neutral interventions (i.e. not from personal needs of therapist)
• The relative anonymity of the therapist (no self revelation or opinions, work limited to the material from the patient)
• total privacy
• total confidentiality

I don’t think this list is unreasonable. And I don’t think it is unreasonable to request that someone you are paying money to should abide by these rules if that is what you want. And yes dreams are important, in spite of what the Shrink Rap bloggers think, and I recommend this book by Robert Langs called Decoding Your Dreams. He recommends free association from the elements of the dream, identifying the day’s event that triggered the dream, and not writing it down or talking about it with others (to let the dream continue to grow in meaning).

Unfortunately the current generation of psychiatrists was trained by the pharma-bio consortium, and doesn’t always take dreams and therapy seriously, but the ”New Psychiatry” is on the way (stay tuned).

The news about the stop smoking drug Chantix (varenicline) just keeps getting worse. When my sister emailed a while back and said she was thinking of taking the drug to get off the weed, I said make sure you have your suicide hotline number handy. A recent report in JAMA shows an alarming number of suicides and suicide attempts on Chantix, much larger than you would normally expect.

Last year I was sitting in my car dealership waiting to get service on my car and working on my laptop while the television was droning on in front of me. I mean this was one of the rare times when I watch TV without the benefit of Tivo to pause the commercials or otherwise avoid them. And it was like one prescription medication ad after another! They were only punctuated by an ad for a device for diabetics to check their blood sugar at home. All I can say is they better get Ronald McDonald (”Don’t forget to feed the waste baskets…”) back on TV so that they can keep those diabetics rolling in to buy their blood glucose testers (not to mention their Avandia and Actos).

Anyhoo one of the ads that caught my eye was of a woman who droned on about how she needed a cigarette to wake up, one in the car, one at 10 am… Boy I know that drill. I kicked the habit by writing a book that advocated diet, exercise and lifestyle changes over prescription medications for health (works every time! No relapses!).

But enough of my narcissism, back to the “My Time to Quit” campaign by the makers of the anti-smoking drug Chantix, which was gleefully playing across the screen at my auto dealership and interfering with my ability to concentrate on more important things like write a book chapter that noone would ever read.

This drug affects the frontal lobe of the brain, which regulates emotion, and has been associated with depression, psychosis, and suicidality. It made headlines when a famous country music singer from Texas who was on the drug accosted a neighbor in an apparently psychotic state of mind and was shot dead.

Thanks Texas home invasion gun laws!

What’s really annoying is that the clinical trials of Chantix excluded people with mental disorders, but smoking is increased in this population, and these people are obviously at increased risk of suicidality. In spite of this the spokespersons for Chantix say it is fine for people with depression and other mental disorders to go ahead and take Chantix.

When I think of Chantix, in spite of the PR campaign to the contrairy, rather than thinking,

Time To Quit!

The image that comes to mind is of (Governor) Arnold Schwartenagger about to finally eliminate a robot in one of the terminator movies when he says…

Time to die!

I have the best method to quit smoking. DIE!

Oh well, maybe I’ll start humming along with the “life saving drugs” theme song one of these days.

Hat tip to Philip Dawdy.

This month’s American Journal of Psychiatry has a somewhat lame article on conflicts of interest regarding the pharmaceutical industry and psychiatry. Before I delve into this piece I must provide some background information, however. Psychiatry is divided into two sections, maybe three. The first section is the Key Opinion Leader (KOL) group, the guys at the head of our field, a term made up by the drug company guys, not me. We also used to call them “Shining Lights”. These guys rake in hundreds of thousands of dollars per year doing consulting, industry supported talks, and other gigs. This has been going on for thirty years or so, although it was always glossed over with the rationale that it was good for academe and industry to put heads together, and that we were educating the common psychiatrist on updates on drugs. Forget about the slightly slimy feeling it gave you, the fact that the Shining Lights were smart guys was hard to dispute. And who really cared, anyway?

Chemical imbalance? No more!

But to be a Shining Light it is not enough to be just brilliant; you have to grease the wheels a little bit with pharma.

The second group (don’t they have a word for this in France?) are the practising psychiatrist clinicians, who don’t make mega bucks from speaking and consulting gigs with pharma, but who get free pens and dinners, and free parties at the annual meetings, and don’t have to pay for their CME, cuz Pharma Big Brother pays for it for them. And they get their info from the Shining Lights, who say everything is A-OK. The third group I think are the junior academics who aspire to be Shining Lights. They are willing to labor and toil, making their Shining Light mentors look good with their productivity, hoping some day to be “in the lights”!

Fast forward to the present. The public is starting to get fed up with business as usual. And they are seeing that this enormous payoff to leaders in academic psychiatry has tainted them to push prescription medications in cases where they should have known better, to the detriment of treatments like psychotherapy and meditation, which could have helped some patients more.

In other words, evidence of harm.

Which gets me to the editorial, which I will analyze bit by bit.

To many psychiatrists’ dismay, unresolved conflicts of interest between parts of our profession and the pharmaceutical industry continue to be a focus of concern.

Dismay? You mean the guys who are raking in half a mil per year and don’t want the party to stop? And what does unresolved mean? Do they need a COI psychotherapist? Why don’t they just call a spade a spade? Pharma was paying KOLs with the express purpose of influencing them to be favorable to their drugs.

The impact of investigations of conflicts of interest extends beyond their targets and potentially affects the credibility of all psychiatrists.

Yeah, like what I said, Senator Grassley, why don’t you go investigate the cardiologists. Not only are they corrupt, they are also jerks. Unlike us, corrupt but loveable neurotics.

Psychiatry is reexamining its standards and ethical boundaries for interactions with the pharmaceutical industry.

Translation: The KOLs who brought to you this morality play today (who are pretty much all, incidentally, consulting and speaking for pharma) are considering whether to run for cover or keep on playing the same old tunes. I mean, psychiatrist on the street is not reexaming her standards, noo?

Our standards should address not only the conduct of highprofile opinion leaders, but also our responsibility as individual physicians to deliver to our patients the highest-quality evidence-based medicine.

 Translation: We’re thinking about you little guys! Here’s a crumb! 

There is no clearer example of conflict of interest than the participation of prominent psychiatrists in pharmaceutical company speakers bureaus, which supply academic opinion leaders to deliver company-approved presentations that market their drugs to their clinical colleagues in the guise of medical education.

Does that mean no more fees for lectures? Sound like a good idea to me. How about medical ground rounds? Those are typically paid for by pharma. I gave Grand Rounds last year at a university where the pharma sponsors wouldn’t pay for me, so my hosts had to scramble to find funds to cover my trip. They go on: 

Conflicts arise when interests that once seemed congruent begin to diverge. For the pioneers of psychopharmacology, the pharmaceutical companies were invaluable allies.

Yeah, the good ole days of early psychopharmacology at early meetings of the neuropsychopharmacologists. They continue:

As psychopharmacology has matured, education about biological treatment has often narrowed to carefully orchestrated marketing of specific drugs that may have only marginal advantages over other drugs in the same class. As the differences have become smaller, the amount of money involved in marketing has become greater.

 Hmmm. No comment. I’ll have to meditate on that one. Like a Koan. 

Most of us may never receive a check from a pharmaceutical company.

 That means you, little guy clinicians! Kiss kiss! 

The subsidy that each of us has been receiving is part of what has fueled the excesses that are currently under investigation.

So does that mean the party is over guys? I don’t know about you but my attention span has been exceeded. In the future I will post about Dr B.’s perfect Department of Psychiatry.

Cheers for Now.

Kiss kiss! 

More reactions to the editorial here and here and here.

Mrs. Bremner and I played hooky from the American Psychosomatic Society (APS) Meeting on Friday to visit the Chicago Institute of Art, where they had an exhibition on the artist Edvard Munch, which was a real scream. That is one of the perks of our travel intensive lifestyle, is getting to visit art galleries in other cities. Most of us have only seen the painting “The Scream”, which was recently stolen (and then returned) from a museum in Oslo, Norway (sorry! won’t do it again). However he has a number of wonderful paintings. Here is his self portrait.

Didn't anyone tell you that smoking is bad for you, Edvard?

 And I was particularly interested to learn that, like me, his mother died when he was five years old, and also like me, he had occasional bouts of anxiety.

Not a good feeling

His paintings really strike a chord, though, described by a contemporary critic as:

A breath of fresh air from unseen worlds.

Or something like that. He focused on themes like love and death that speak to us all, like this one:

Grief, the eternal condition.

Many of us spend our entire lives grieving, if we are lucky enough to even get to the starting line. Grief, or what is worse not even getting to the point where you can start to grieve, is the cause of much mental health problems today.

In Sicily, where Mrs. Bremner comes from, the women traditionally wore black for a year when someone died. So when you went to the villages in the interior, all of the women were wearing black, cuz someone had always died.

If they were outside, that is (most of the time all day indoors making pasta).

I think the US has something to learn from them. I love cemeteries.

My mom's headstone

Yes, I cry when I see these pictures. But at least I can cry. That is more than I could have said for most of my life.

And that is your mental health Alt CME for the day, boys and girls.

It is interesting how Munch has been interpreted. Called a “neurasthenic” in his day, a psychiatric diagnosis (no longer used) which describes anxiety, depression, psychosomatic concerns, he actually promoted this as a way to market himself as an “alternative artist”, although it is clear he suffered mental torments. A friend and fellow Bohemian Berline cafe sitter, a Polish man named Przybyszewski wrote critiques of his art highlighting the misogynist nature of Munch. He is in this painting in the foreground.

Przybyszewski

He even changed titles of his painting showing a woman kissing a man’s neck to “Vampire” from “Love and Pain”. Munch was a good one on love though. Check this one out:

Madonna

Classic femme fatale. Just like Mrs. Bremner!

I was interested to learn that Munch, like many artists, did not care about the titles of his paintings, and so they were made by dealers or people like his Polish friend. That guy later killed his wife and abandoned his children. Not a very good one to learn about the meaning of Munch’s paintings. I think Munch was expressing the unconscious mind, and the “meaning” of his paintings didn’t really matter.

Kinda like the content of the Drug News and Health Safety Blog.

Oops! This is supposed to be science. I take that back.

Kudos to Philip Dawdy at the Furious Seasons blog for his original reporting on the litigation behind the antipsychotic drug Seroquel (quetiapine). Thousands of people have brought lawsuits against the maker of Seroquel, Astrazenica, because the drug was pushed off label for the treament of conditions other than schizophrenia and bipolar disorder, the conditions it was approved for, without adequate warning that the drug could cause weight gain, which leads to heart disease and diabetes. Not too good for a drug that is associated with only a 10% improvement in depression, while it increases the risk of life threatening diabetes, and is associated with a 25% increase in sedation, based on studies in the American Journal of Psychiatry and Journal of Clinical Psychopharmacology.

Now it comes out that Dr. Wayne MacFadden, who was heading up the group that was performing clinical trials of Seroquel for bipolar, was banging: 1) one of the study investigators; 2) a ghost writer writing manuscripts and preparing posters and presentations about the drug; 3) two other research assistants and/or employees. He also offered sexual favors in return for getting inside scoops from the investigator about other competing drug companies, and tried to intimidate her about reading the literature related to other drug trials. I wonder if he was one of the early members of the ACNP who according to (ill founded, I’m sure) rumour opted to have their annual meeting in Puerto Rico cuz they had cheaper whores? And in the end, it looks like after all that aggravation, the investigator in question who was identified as a doctor at the Institute of Psychiatry in London, apparently didn’t even get her name on the friggin paper!

I’ve been through THAT aggravation!

WE SEL DRUGZ LEZ HAVE SOME WINE!

The funniest part is that Philip emailed the Editors of the American Journal of Psychiatry where one of the studies, with the cheesy name of “Bolder” was published, asking for a comment about whether this affected their opinion of the integrity of the trial results, and one of them responsed “Let’s not respond to this guy anymore.” But then copied Philip on the email! HA HA!

Sometimes these older generation guys are a little clueless on basic use of the computer. So let us digress now for a little lesson. When you get an email and want to respond to it, there are two choices: reply and reply all.

Don't hit the button on the right, unless you are absolutely sure.

More on this story here and here. And original post here.

Bayer announced today that it is going to spend $20 million for an advertising campaign to reverse the effects of its ad campaign promoting the oral birth control pill, Yaz, as effective for the ups and downs of daily life as well as zits and other skin blemishes. This ad campaign was launched after Yaz was approved for birth control with added side benefits of helping premenstrual dysphoric disorder (PDD) and acne, however the ads showed women kicking around balloons that said stuff like “mood swings” and “fatigue” while they played the songs “Good bye to You” or “We’re Not Going to Take It.”

Goodbye to you too, Yaz

Following this they got admonished by the FDA which led to the unusual settlement of being an ad campaign out to UNDO the effects of the advertising. You see, it wasn’t approved to treat PMDD and acne, and in any case not all women have PMDD or untreated acne, even though the makers of Yaz certainly wish that that was the case. They were promoting it as a lifestyle drug, like look good, get laid, and feel good about yourself. What more could women want? Anyhoo in the new ads an actress looks into the camera and says:

You may have seen some Yaz commercials recently that were not clear. The F.D.A. wants us to correct a few points in those ads.

Indeed. Well first of all I really hate it when they take a perfectly good song and associate with some cheesy product. They should make musicians sign a contract that they will never sell out their tunes which run around in our heads. Second, that $20 million is “chump change” as one commenter pointed out, after they have already made their billions promoting a product for something that it wasn’t approved for, something that can be thought of as the cost of doing business, kind of like the billion that Eli Lilly paying as punishment for off label promotion of Zyprexa not being a big deal when they made 20 billion out of the deal. Finally, noone pointed out the fact that Yaz (and is sister pill Yasmin) (as I have written about before in “Is Your Birth Control Pill Driving You Bananas“) is the mosted posted about medication on medications.com, with most of the women complaining about how it makes them MORE depressed and anxious. Yaz also has drospirenone, a type of progesterone that can lead to elevations of potassium and potential heart failure.

How can it be that your birth control pill makes you depressed? Birth control pills (or oral contraceptive pills, or OCPs) are combinations of sex hormones related to estrogen and progesterone. Normally these sex hormones cycle throughout the month. In addition to controlling reproduction they also have effects on the brain, which is why they can cause anxiety and depression.

Taking the pill effectively blunts the normal variation in hormones; it also eliminates ovulation, which also affects sexuality. In fact, one study showed that strippers who were ovulating made $15 more per hour than strippers who were not ovulating,
and that strippers on the pill made significantly less than other strippers.

You can read more about the relative risks of heart disease and cancer in women of different ages and smoking status in my last post on this topic. However, I recommend using an IUD as the safest form of birth control, or a progesterone only pill.