Depression is the most common mental health disorder in the United States. According to the National Institutes of Health, over 16 million adults in the U.S. experienced at least one episode of clinical depression in the year 2015. And it is likely underestimated given that many with this medical condition sadly never seek help. Studies show that only about 50% of those with depression actually seek help from their doctor.
Contraceptives, on the other hand, have been used by nearly all women living in the United States at some point during their reproductive years. According to the Centers for Disease Control and Prevention, between 2011 and 2013, almost 62% of women between the ages of 15 and 44 were using some type of contraception. Hormonal contraceptives are still the most popular method of contraception, with the pill still remaining as the most widely used type.
Is there a link between depression and contraception? For many years, women have been reporting changes in mood swings with certain hormonal contraceptives. But to this date, there have been few studies that show good evidence to support it.
Now, a recent study that was just published in the Journal of American Medical Association Psychiatry has gained attention by suggesting a potential link between hormonal contraceptives and depression. The purpose of the study was to discover the risk of first time antidepressant use in women who used various types of hormonal contraceptives.
If you are prone towards depression, the results of the study may be useful the next time you discuss your contraceptive options with your doctor. Let’s learn about this study that has been in the forefront of media coverage lately—plus, how to interpret and apply it to your own health.
The 14-year study took place in Denmark beginning with the year 2000, where over 1 million females between the ages of 15 and 34 were grouped depending on the type of contraception they were using, tracked through time, and then compared to a group of non-hormonal contraceptive users.
All patients who were previously diagnosed with depression or had taken antidepressants for any reason were excluded from the study. The scientists specifically tracked the first time people were diagnosed with depression after initiating contraception and their likelihood of taking an antidepressant for the first time afterwards. They then measured this increase in risk of being prescribed an antidepressant after the use of the following methods of birth control when compared to the non-user group (in increasing order):
Combined estrogen and progesterone pill users had an increased risk of 23% over non-users
Progesterone only pill (the "mini pill"): 34%
Progesterone Intrauterine Device (IUD): 40%
Vaginal Ring: 60%
Patch: 200%
The most vulnerable to the mood changing effects of these hormones were actually adolescents. Their risk of being prescribed an antidepressant while on a combined pill was 80% higher than those who didn’t take it. And it was 120% higher with the progestin only pills.
So how can you interpret these results appropriately so that you can make a sound judgement when deciding your family planning health options? Just because you are prone to depression or experience mood changes while taking contraception, does that mean you should nix the birth control and risk getting pregnant? Like with all medical treatment, the risks and benefits must be weighed against each other before making such an important health decision, including the risk of unwanted pregnancies.
Here are some essential take home points to remember:
1. Estrogen-containing methods seem to be more protective against depression.
2. The progesterone component seems to be the main mood-changing culprit—therefore even changing the progesterone component from one type to another may be a worthwhile effort before throwing in the towel.
3. It is not a perfect study (no study is). This was a "cohort study," which is really an observational study where patients are simply observed passively through time. And although still useful information, cohort studies do have their drawbacks. Studies that are "double-blind" (meaning neither the patients nor the physicians know which patient is taking what medication) and "placebo-controlled" studies (those with the administration of a placebo without knowing they are taking a placebo) are features of more well-accepted studies.
4. The study also measured the use of prescribed antidepressants. But not everyone taking an antidepressant is being treated for depression. Examples of other uses of medications in the antidepressant category include: Anxiety disorders, PMS, smoking cessation, hot flashes, and ADHD.
5. It's important to make certain your mood changes aren't due to numerous other causes as well.
6. Lastly, adolescents already have mood swings—that’s almost a defining feature of this age group in the first place. This population is already more vulnerable to depression, so it makes sense that they are the most susceptible towards anything that can impose on their mood.
As a physician, will this change the way I practice? Well, for patients whom i know have suffered from significant depression, the combined pill may be a more preferable option, but this is only taking the patient's preferences into consideration and only if there are no contraindication to estrogen use. And for others who initiate hormonal contraception and then report mood changes, the pros and cons of all other available methods may be worthwhile to revisit. Overall, the study has caused me to keep my antennas up and simply be more aware.
The wonderful thing about birth control nowadays is this: there are numerous options. If one doesn't work well for you, it doesn't mean something else won't.
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Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.
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