Use of oral contraceptives tied to increased risk of depression: Study

Sweden: A recent study published in Epidemiology and Psychiatric Sciences suggests that using oral contraceptives, particularly during the first two years, increases the risk of depression. Moreover, the use of oral contraceptives during adolescence was shown to increase the risk of depression later in life.

"Patients and physicians should be aware of this potential risk when considering oral contraceptives, and individualized risk–benefit assessments should be conducted,' the authors wrote in their study.

From a global perspective, depression is the leading cause of ill health and disability. More than 264 million people are affected, and at least 25 per cent of all women and 15 per cent of all men experience depression that requires treatment at some point.

The possibility that contraceptive pills might negatively affect mental health and even lead to depression has long been discussed. Although many women choose to stop using contraceptive pills because of their influence on their mood, until now, the picture emerging from research has not been straightforward. This study is one of the largest and widest-ranging to date, following more than a quarter of a million women from UK Biobank from birth to menopause.

The researchers collected data about women’s use of contraceptive pills, when they were first diagnosed with depression and when they first experienced symptoms of depression without receiving a diagnosis. The method of contraception studied was combined contraceptive pills, which contain progestogen, a compound resembling the hormone progesterone, and oestrogen. Progestogen prevents ovulation and thickens the cervical mucus to prevent sperms from entering the uterus, while oestrogen thins the uterine lining to hinder the implantation of a fertilised egg.

“Although contraception has many advantages for women, both medical practitioners and patients should be informed about the side-effects identified in this and previous research,” says Therese Johansson of the Department of Immunology, Genetics and Pathology at Uppsala University, one of the researchers leading the study.

According to the study, women who began to use contraceptive pills as teenagers had a 130 per cent higher incidence of symptoms of depression, while the corresponding increase among adult users was 92 per cent.

“The powerful influence of contraceptive pills on teenagers can be ascribed to the hormonal changes caused by puberty. As women in that age group have already experienced substantial hormonal changes, they can be more receptive to hormonal changes and other life experiences,” Johansson says.

The researchers were also able to see that the increased incidence of depression declined when the women continued to use contraceptive pills after the first two years. However, teenage users of contraceptive pills still had an increased incidence of depression even after stopping using the pill, which was not observed in adult users of contraceptive pills.

“It is important to emphasise that most women tolerate external hormones well, without experiencing negative effects on their mood, so combined contraceptive pills are an excellent option for many women. Contraceptive pills enable women to avoid unplanned pregnancies and prevent illnesses that affect women, including ovarian and uterine cancer. However, certain women may have an increased risk of depression after starting to use contraceptive pills.”

The findings of the study point to a need for healthcare professionals to be more aware of possible links between different systems in the body, such as depression and the use of contraceptive pills. The researchers conclude that it is important for care providers to inform women considering contraceptive pills of the potential risk of depression as a side-effect of the medicine.

“Since we only investigated combined contraceptive pills in this study, we cannot conclude other contraceptive options, such as mini-pills, contraceptive patches, hormonal spirals, vaginal rings or contraceptive rods. We plan to examine different formulations and administration methods in a future study. Our ambition in comparing different contraceptive methods is to give women even more information to help them take well-informed decisions about their contraceptive options,” Johansson says.

Reference:

Johansson, T., Vinther Larsen, S., Bui, M., Ek, W., Karlsson, T., & Johansson, Å. (2023). Population-based cohort study of oral contraceptive use and risk of depression. Epidemiology and Psychiatric Sciences, 32, E39. doi:10.1017/S2045796023000525.