Some evidence does suggest that birth control pills and other forms of hormonal contraceptives (including the IUD, patch, ring, implant and injection) can cause depression. Reportedly, women have been complaining to their doctors for years about mood changes they link to these birth control methods, but it wasn’t until 2016 that we had good evidence for them. That came from a large Danish investigation involving data on more than one million women. Even so, critics have been disputing the conclusions, because the difference in risk of depression among women using hormonal contraceptives and nonusers turned out to be very small.
Here’s the story: Researchers from the University of Copenhagen mined information from Denmark’s national health system, which has medical records on everyone in the country. They focused on women between the ages of 15 and 34, excluding women with preexisting psychiatric conditions, those who couldn’t use hormonal contraceptives for medical reasons, those who were pregnant and recent immigrants.
The researchers looked at particular sets of women – those who had been prescribed birth control, those diagnosed with depression at a psychiatric hospital and those who had filled a prescription for an antidepressant. Results showed that only 2 percent of all the women whose records were reviewed had been diagnosed with depression and that 13 percent were taking antidepressants.
The research team concluded that all forms of hormonal contraception were linked to an increased risk of depression and that the risk was higher with progesterone-only forms, including the IUD. Risk was highest in 15 to 19 year-olds, especially those using the ring, patch and IUD. These risks declined as women got older and peaked about 6 months after they began to use the contraceptives.
The increased risk affected 2.2 out of every 100 women using hormonal birth control methods compared to 1.7 out of 100 women who were prescribed antidepressants but were not using hormonal contraception, a very slim difference of only 0.5 percent. Put another way, this amounts to only one woman in every 200. And while the researchers found an association between hormonal contraceptives and depression, it did not prove cause and effect.
Earlier studies have not found such a link, and in fact, some showed improved mood among women using these contraceptives. However, depression is listed as a side effect on hormonal birth control method package inserts.
Experts who questioned the Danish investigation’s findings pointed out that there are potentially many different causes for depression in women in the age group studied. For example, earlier research showed that sexually active teenage girls have a higher risk for depression (and anxiety) than their non-sexually-active contemporaries.
If you’re using hormonal birth control and are concerned about depression or any of the other potential side effects, be sure to discuss the risks with your physician. And do consider non-pharmacological alternatives. Besides using the calendar method and paying attention to your temperature and the texture of cervical mucus, there are other options. Your partner can chose condoms, either alone or with spermicidal foam, or you can use a contraceptive sponge, a diaphragm or a cervical cap.
Andrew Weil, M.D.
Charlotte Wessel Skovlund et al, “Association of Hormonal Contraception With Depression.” JAMA Psychiatry, November 2016, doi:10.1001/jamapsychiatry.2016.2387