Hormonal Contraceptives and Depression: The Latest News

By Erin Orth
Approximately 80% of sexually active young women in the United States use hormonal contraceptives, with additional use seen in pubescent and peri-/post-menopausal women for purposes other than prevention of pregnancy¹. This gives some idea to the substantial scope of this issue, and why any link between hormone-containing contraception and a major health concern is of paramount importance.

Estrogen has profound effects on body systems of than those utilized for reproduction. For example, estrogen receptors are located throughout the brain, including the centers that regulate emotion (amygdala) as well as develop behaviors and personality (prefrontal cortex)². Through these receptors, estrogen regulates a multitude of neurologic pathways and systems, some of which have been seen to influence the development and progression of mood disorders¹.

Recently, a massive study out of Denmark was published which included over one million women using hormonal contraception and followed them for almost 14 years. The researchers were able to encompass so many women ages 15-34, but also able to exclude women that were unable or unfit to participate, such as those with previous history of blood clots or previous psychiatric illness². The study revealed some startling conclusions: women that took the estrogen/progestin-containing birth control pill (BCP) were 23% more likely to use anti-depressant therapy, and demonstrated a positive association between BCP and a depression diagnosis². Additionally, users of the progestin-only pill, the hormone patch, and levonorgestrel intra-uterine device (IUD) as well as adolescent girls (aged 15-19) were particularly susceptible (with higher risk ratios than the BCP users)^2,3.

Moreover, previous research and case studies have been published on this issue in Europe as well as in the United States. One significant example involves a 33-year old woman from England that developed severe depression mid-pregnancy. She began a birth control pill approximately 3 months after birth, and developed severe depression symptoms once again. Her provider encouraged her to discontinue the BCP, and within ONE WEEK, all of her symptoms were eliminated⁴.

So where does that leave us? Should we never prescribe the birth control pill again? Of course not. However, the research cited above will become a part of the thought process for ordering hormonal contraceptives, especially when they are being used for “off-label” uses (those not intended by the manufacturer but found to have benefit in other conditions), and it should make the consumer think twice before agreeing to initiate birth control therapy, especially if susceptible to mood disorders or depression.

References:

1. Keyes, K.M., Cheslack-Postava K., Westhoff C., Heim C.M., Haloossim M., Walsh K., Koenen K. (2013). Association of Hormonal Contraceptive Use with Reduced Levels of Depressive Symptoms: A National Study of Sexually Active Women in the United States. Am J Epidemiol. 2013;178(9):1378-1388.
2. Skovlund C.W., Morch L.S., Kessing LV. (2016). Association of Hormonal Contraception with Depression. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2016.2387
3. Behind the Headlines (2016). Women taking the contraceptive pill ‘more likely to be depressed’. https://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/news/2016-09-30-women-taking-the-contraceptive-pill-more-likely-to-be-depressed/.
4. Andersen N.M., Bech P, Csillag C. (2014). Development and remission of depressive symptoms and treatment with hormonal contraceptives. Oxford Academic; Oxford Medical Case Reports. doi: https://doi.org/10.1093/omcr/omu025