Risk of Depression May Increase During First Two Years of Oral Contraceptive Use

The first two years of oral contraceptive use may raise the risk of depression in women and adolescents compared with their peers who have never used oral contraceptives, a study in Epidemiology and Psychiatric Sciences has found.

Mikael Wallerstedt

“While oral contraceptives have been widely used and studied for their effectiveness in preventing unwanted pregnancies and managing various health conditions, the relationship between oral contraceptive use and depression has been a subject of debate and inconclusive findings in the past,” study researcher Therese Johansson, M.S., told Psychiatric News. She is a doctoral student and researcher in the Department of Immunology, Genetics, and Pathology at Uppsala University in Sweden. “We felt it was essential to investigate this topic further to provide more clarity and insights into the potential risks associated with oral contraceptive use and its impact on mental health, particularly focusing on depression.”

Johansson and colleagues analyzed data from 264,557 women from the UK Biobank, a population-based cohort that recruited participants aged 37 to 71 years from across the United Kingdom between 2006 and 2010. Among the women in the current study, 80.6% had used oral contraceptives. The median time from first initiation to last use of oral contraceptives was 10 years, and the median age at initiating and discontinuing use was 21 and 32 years, respectively. The incidence of depression was determined via interviews, inpatient hospital data, or primary care data.

Women who used oral contraceptives had a 79% increased risk of depression during their first two years of oral contraceptive use compared with their peers who had never used oral contraceptives. Adolescents—those who began using oral contraceptives at or before the age of 20 years—had a 95% increased risk of depression during their first two years of oral contraceptive use compared with their peers who had never used oral contraceptives. The increased risk of depression associated with oral contraceptive use declined over time, and the lifetime risk of depression was only 5% higher in women who had ever used oral contraceptives compared with those who had never used oral contraceptives.

To capture data from women with symptoms of depression that might not have come to clinical attention, the researchers analyzed data from a subcohort of 82,232 women who completed the online UK Biobank mental health questionnaire. In this secondary analysis, women who used oral contraceptives had twice the risk of having depressive symptoms in the first two years of oral contraceptive use compared with women who had never used oral contraceptives. Women who had begun using oral contraceptives at or before the age of 20 years had 130% higher risk of depressive symptoms during the first two years of oral contraceptive use. Women who began oral contraceptives at age 21 or older had a 92% increased risk of depressive symptoms.

“While prior studies have presented mixed and sometimes contradictory results, our study strengthens the studies suggesting an increased risk of depression among women using oral contraceptives and especially in adolescent users,” Johansson said.

Johansson added that it is crucial for psychiatrists to be aware of the potential link between oral contraceptive use and depression.

“[Psychiatrists] should consider discussing this potential risk with their patients and closely monitor any changes in mood or mental well-being during contraceptive use. Open communication with patients about the possible side effects can help women make informed decisions about their contraceptive choices and, if necessary, explore alternative contraceptive methods or additional mental health support,” she said. “It’s essential for health professionals and patients to work together to strike a balance between the benefits of oral contraceptives and potential mental health considerations. This study underscores the need for continued research and dialogue in this area, with the ultimate goal of providing better care and support to women in managing their reproductive health while safeguarding their mental well-being.”

Beware of Creating Fear

Nada Stotland, M.D., M.P.H., past APA president and an expert in reproductive psychiatry who was not involved in the research, said that it is imperative for psychiatrists to get to the root of their patient’s depression because depression has many causes that are unrelated to taking oral contraceptives. For example, intimate partner violence is linked to depression, and an unwanted pregnancy may be further detrimental to the woman’s health and well-being. “If they’re depressed because they’re being abused, I wouldn’t want them to stop taking oral contraceptives out of fear and then get pregnant by their oppressor,” Stotland said.

She added that oral contraceptives can be “life changing” for many women. “This method of contraception is so very important to women’s lives and to women having lives where they can realize their education, pursue their careers, and take care of the children they may already have, so we need to be careful about making them afraid of it. To know you are protected [from unwanted pregnancy] is so important to women, and right now, with all the attacks on abortion, it’s even more important.”

Psychiatrists should carefully discuss each patient’s depression, including when the symptoms started and what the patient’s life circumstances are, Stotland said. She added that if it appears that oral contraceptives are contributing to a patient’s depression, a discussion with an obstetrician/gynecologist is in order because the solution may lie in changing the dose or formulation.

Stotland stressed that there is no excuse for not trying to find out exactly what is causing a woman’s depression. “There are so many reasons for it that psychiatrists and their patients really need to work together to tease it out.”

This study was funded by the Swedish Research Council, the Swedish Brain Foundation, and the Uppsala University Center for Women’s Mental Health During the Reproductive Lifespan. ■