From a global perspective, depression is the leading cause of disease and disability. More than 264 million people are affected, and at least 25% of all women and 15% of all men experience depression that requires treatment at some point in their lives.
The possibility that contraceptive pills could have negative effects on mental health and even lead to depression has long been debated. Although many women choose to stop using the contraceptive pill due to the affect on their mood, the picture emerging from the research so far has not been straightforward. This study is one of the largest and most far-reaching to date, following more than a quarter of a million UK Biobank women from birth to menopause.
The researchers collected data on 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 contraceptive method studied was combined contraceptive pills, which contain progestin, a compound similar to the hormone progesterone, and estrogen. Progestin prevents ovulation and thickens cervical mucus to prevent sperm from entering the uterus, while estrogen thins the uterine lining to prevent implantation of a fertilized egg.
“Although contraception has many benefits for women, both doctors and patients should be educated about the side effects identified in this and previous research,” says Therese Johansson of Uppsala University’s Department of Immunology, Genetics and Pathology, a of female researchers conducting the study.
According to the study, women who started using contraceptive pills as teenagers had a 130% higher incidence of symptoms of depression, while the corresponding increase among adult users was 92%.
“The powerful influence of contraceptive pills on adolescents can be attributed to the hormonal changes caused by puberty. Because women in that age group have already experienced substantial hormonal changes, they may be more receptive to not only hormonal changes but other life experiences as well,” says Johansson.
The researchers were also able to see that the increase in the incidence of depression decreased when women continued to use contraceptive pills after the first two years. However, adolescent contraceptive pill users still had a higher incidence of depression even after they stopped using the pill, which was not seen in adult contraceptive pill users.
“Importantly, most women tolerate external hormones well, without experiencing any adverse effects on their mood, so combined contraceptive pills are a great option for many women. Contraceptive pills allow women to avoid unplanned pregnancies and can also prevent diseases that affect women, including ovarian cancer and uterine cancer. However, some women may have an increased risk of depression after they start using contraceptive pills.
The study findings point to the need for healthcare professionals to be more aware of possible links between different body systems, such as depression and the use of contraceptive pills. The researchers conclude that it is important for healthcare professionals to inform women who are considering the use of contraceptive pills of the potential risk of depression as a side effect of the medicine.
“Because we only looked at combined contraceptive pills in this study, we cannot draw any conclusions about other contraceptive options, such as mini pills, contraceptive patches, hormonal coils, vaginal rings or contraceptive sticks. In a future study, we plan to look at different formulations and methods of administration. Our ambition in comparing different contraceptive methods is to provide women with even more information to help them make well-informed decisions about their contraceptive options,” says Johansson.
Reference: T. Johansson, et al., S. Vinther Larsen, M. Bui, W.E. Ek, T. Karlsson, and Å. Johansson. Population-based cohort study of oral contraceptive use and risk of depression [published online June 12, 2023]. Epidemiology and psychiatric sciences. 2023; doi: https://doi.org/10.1017/S2045796023000525
For more information:
Therese Johansson, PhD candidate in the Department of Immunology, Genetics and Pathology and WOMHER, Uppsala University, email@example.com, telephone: 073-810 52 58 or +61 484 721 453 (Australia)
Epidemiology and psychiatric sciences
Population-based cohort study of oral contraceptive use and risk of depression
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