Depression potential side effect of hormonal contraceptive use: Wiley
Oral contraceptive pills (OCPs) are the most commonly used contraceptive measure, owing to their effectiveness and practicability. Women in this region were more familiar with oral contraceptive pill use than other ways of contraception. Women often use oral contraceptive pills (OCPs) to prevent pregnancy or address menstrual symptoms. However, many of the women discontinue the use following 6 months for a variety of reasons, including mood changes.
Women are twice more likely to develop depressive disorder than men. Incidentally, the prevalence of depression correlates with hormonal changes in women, especially during puberty, before menstruation, post pregnancy, and at perimenopause, suggesting hormonal fluctuations as a probable trigger for depression.
Female sex hormones have been hypothesized to play a role in causing depression. There are several proposed mechanisms to explain how sex hormones affect mood. The first postulated theory suggests a decrease in catecholamines because of hormonal contraceptives (HCs)-induced monoamine oxidase (MAO) activation. Second, decreased conversion of tryptophan to serotonin was suggested as a contributor to depression. Third, HC is suggested to suppress vitamin B6 and B12 metabolism causing low serotonin and GABA. Finally, HC dysregulates the HPA axis by elevating circulating cortisol levels, which cause effects analogous to chronic psychological stress and depression.
HC has mixed effects on mood, ranging from improved mood to worse mood or having no effect at all. These findings suggest that some women may benefit from HC use, while others do not or even have a negative impact. Most studies have discovered a connection between teenage use of hormonal contraception and an increased risk of developing depression. The impact of hormonal contraception on adult depression risk is less clear; some sources contend there is either no increased risk or a decreased risk in adults.
Few randomized clinical trials revealed that OCP improved depressive symptoms while increasing mood swings and irritability. Literature shows mixed findings about the relationship of HC with depression. Therefore, Sadia Sultan et al. aimed to examine the association between HC use and concurrent depressive symptoms.
A cross-sectional study was conducted on 326 women of the reproductive age group (15–49 years) attending the family planning unit of the obstetrics and gynecology department of a medical college in Saudi Arabia. Their sociodemographic and medical details along with the current use of any contraceptives (hormonal, nonhormonal, or not using any) with duration were collected. Beck depression inventory-II (BDI-II) was applied to the women to assess for depression along with its severity, and a BDI score of >16 was taken to denote clinical depression. Women were stratified by type of contraceptive used, and its association with depression category was assessed.
A total of 326 consenting eligible women in the age group of 15–49 years were enrolled in the study of which 165 (50.6%) were currently using a hormonal contraceptive and 49 (15.0%) were using a nonhormonal contraceptive and the rest 112 (34.4%) were not using any contraceptives. There was no significant difference in the mean BDI scores (p = 0.79) and degrees of depression (p = 0.06) between the HC users and HC nonusers. However, individual symptoms of depression such as sadness (p = 0.01), reduced libido (p = 0.0002), feelings of pessimism (p = 0.02), and failure (p = 0.003) were found to be significantly higher in the HC users than non-HC users.
Future prospective longitudinal studies should systematically document the short- and long-term effects of using different types of OCs (and other forms of hormonal contraceptives) on women’s mental health; this may also help to identify further the specific biochemical mechanisms underlying the observed association.
Authors conclude that there was no significant difference in the mean BDI scores between the HC and non-HC user groups. However, there were significantly increased depressive symptoms such as sadness, decreased libido, and increased feelings of pessimism and failure in HC users. Study findings suggest that depression can be a potential side effect of HC use. Furthermore, longitudinal studies are required to warrant depression as an adverse efect of HC use.
Source: Sadia Sultan et al.; Wiley Obstetrics and Gynecology International Volume 2024, Article ID 7309041, 11 pages https://doi.org/10.1155/2024/7309041
