Summary: A new study exploring the potential impacts of contraceptive pills on mental health reveals an alarming connection to depression, especially in teenage users.
The research, which analyzed data from over a quarter of a million women from the UK Biobank, found that teens initiating contraceptive pill use had a 130% higher incidence of depression symptoms. This incidence decreased with continued usage over the first two years, but an elevated risk persisted even after stopping the pill for teenage users.
This pivotal finding urges the need for increased awareness among healthcare professionals about this potential side effect.
Teenage users initiating contraceptive pill use exhibited a 130% higher incidence of depression symptoms, compared to a 92% increase in adult users.
Even after discontinuing the pill, teenage users still had an increased incidence of depression, a phenomenon not observed in adult users.
Despite these findings, the majority of women tolerate hormonal contraceptives well, with these pills serving as a crucial tool in preventing unplanned pregnancies and potentially reducing the risk of specific cancers.
Source: Uppsala University
In a global perspective, depression is the leading cause of ill health and disability. More than 264 million people are affected and at least 25 percent of all women and 15 percent of all men experience depression that requires treatment at some point during their life.
The possibility that contraceptive pills might have negative effects on mental health and even lead to depression has long been discussed. Although many women choose to stop using contraceptive pills because of the 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, the time at which 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 estrogen.
Progestogen prevents ovulation and thickens the cervical mucus to prevent sperms from entering the uterus, while estrogen thins the uterine lining to hinder the implantation of a fertilized 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 percent higher incidence of symptoms of depression, while the corresponding increase among adult users was 92 percent.
“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 not only to hormonal changes but also to 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 they can also prevent illnesses that affect women, including ovarian cancer 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 who are considering using 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 draw conclusions about other contraceptive options, such as mini pills, contraceptive patches, hormonal spirals, vaginal rings or contraceptive rods. In a future study, we plan to examine different formulations and methods of administration.
“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.
About this psychology and depression research news
Population-based cohort study of oral contraceptive use and risk of depression
Research on the effect of oral contraceptive (OC) use on the risk of depression shows inconsistent findings, especially in adult OC users. One possible reason for this inconsistency is the omission of women who discontinue OCs due to adverse mood effects, leading to healthy user bias. To address this issue, we aim to estimate the risk of depression that is associated with the initiation of OCs as well as the effect of OC use on lifetime risk of depression.
This is a population-based cohort study based on data from 264,557 women from the UK Biobank. Incidence of depression was addressed via interviews, inpatient hospital or primary care data. The hazard ratio (HR) between OC use and incident depression was estimated by multivariable Cox regression with OC use as a time-varying exposure. To validate causality, we examined familial confounding in 7,354 sibling pairs.
We observed that the first 2 years of OC use were associated with a higher rate of depression compared to never users (HR = 1.71, 95% confidence interval [CI]: 1.55–1.88). Although the risk was not as pronounced beyond the first 2 years, ever OC use was still associated with an increased lifetime risk of depression (HR = 1.05, 95% CI: 1.01–1.09). Previous OC use were associated with a higher rate of depression compared to never users, with adolescent OC users driving the increased hazard (HR = 1.18, 95% CI: 1.12–1.25). No significant association were observed among adult OC users who had previously used OCs (HR = 1.00, 95% CI: 0.95–1.04). Notably, the sibling analysis provided further evidence for a causal effect of OC use on the risk of depression.
Our findings suggest that the use of OCs, particularly during the first 2 years, increases the risk of depression. Additionally, OC use during adolescence might increase the risk of depression later in life. Our results are consistent with a causal relationship between OC use and depression, as supported by the sibling analysis. This study highlights the importance of considering the healthy user bias as well as family-level confounding in studies of OC use and mental health outcomes. Physicians and patients should be aware of this potential risk when considering OCs, and individualized risk–benefit assessments should be conducted.