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Women taking the contraceptive pill 'more likely to be depressed'
Contraceptive methods were categorised by oestrogen type and dose, progesterone type and the method of contraception. Data was collected from the National Prescription Register.
Data for the use of antidepressants was collected using two outcome measures:
- collecting a prescription for antidepressants
- being diagnosed with depression at any inpatient or outpatient psychiatric department in Denmark
Non-users were defined as those who never used hormonal contraceptives, plus former users.
What were the basic results?
The analysis included 1,061,997 women, with an average age of 24 years. During follow-up, 55.5% of women were current or recent users of hormonal contraception. A total of 133,178 first prescriptions of antidepressants and 23,077 first diagnoses of depression were detected during follow-up.
The researchers compared users of hormonal contraception with non- users and found more users had been prescribed antidepressants or diagnosed with depression.
They calculated the increase in risk of using antidepressants according to contraceptive method as:
- oral contraceptives - 23% (relative risk [RR] 1.23 (95% confidence interval [CI], 1.22 to 1.25))
- progestogen-only pill - 34% (RR 1.34 (95% CI, 1.27 to 1.40))
- contraceptive patch (norgestrolmin) - 100%, (RR 2.0 (95% CI, 1.76 to 2.18))
- vaginal ring (etonogestrel) - 60% 1.6 (RR (95% CI, 1.55 to 1.69))
- levonorgestrel intrauterine system (IUS) - 40% (RR 1.4 (95% CI, 1.31 to 1.42))
Similar figures were found for depression diagnoses.
The researchers also found the risk of depression decreased with age. Adolescents using combined oral contraceptives had an 80% increased risk of antidepressant use (RR 1.8 (95% CI, 1.75 to 1.84)) and those using progesterone-only pills a 120% higher risk (RR 2.2 (95% CI, 1.99 to 2.52)).
How did the researchers interpret the results?
The researchers concluded that the "use of hormonal contraception, especially among adolescents, was associated with subsequent use of antidepressants and a first diagnosis of depression, suggesting depression as a potential adverse effect of hormonal contraceptive use."
This was a large prospective cohort study which aimed to investigate whether using hormonal contraception is associated with the future use of antidepressants and a diagnosis of depression.
The researchers compared users of hormonal contraception with non-users and found users were more likely to be prescribed antidepressants and diagnosed with depression.
However, there are a few important points to consider about the results, such as:
- this study is not able to prove that the contraceptive methods are responsible for the depression - only to find possible links to investigate further
- some of the associations are based on a comparatively small number of events
- the risk of using antidepressants and being diagnosed with depression peaks at approximately two to three months of contraceptive use, but then begins to fall
The researchers tested for a range of other things that might explain the results. For example, they looked at whether doctors were more likely to prescribe hormonal contraception to women who were already low in mood, or whether the initiation of a sexual relationship might influence the risk of depression. They found nothing that could easily explain the link that was shown across all age groups and types of contraception.
Further studies are required to prove this link. If the link is proven in future studies, depression may have to be added as a possible side effect of hormonal contraception.
"Are you on the Pill? You're more likely to be depressed: Women who use contraception are up to 70% more likely to be on antidepressants," reports the Mail Online. The news is based on a study by researchers in Denmark...
Links to Headlines
Women taking pill more likely to be treated for depression, study finds. The Guardian, September 28 2016
Is the contraceptive Pill making you feel depressed? The Daily Telegraph, September 29 2016
Links to Science
Skovlund CW, Mørch LS, Kessing LV, et al. Association of Hormonal Contraception With Depression. JAMA Psychiatry. Published online September 28 2016
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