Hormonal contraception and depression: what now?

No doubt you’ve heard the news from Denmark in the past week relating hormonal contraception methods to an increase in antidepressant usage. The study, carried out by Professor Øjvind Lidegaard and colleagues at the University of Copenhagen, monitored more than a million Danish women between the ages of 15-34 with no prior history of depression, and revealed that those taking the combined contraceptive pill were 23% more likely to be prescribed antidepressants or diagnosed with depression by a psychiatric expert. Unfortunately, it doesn’t get better from there where other forms of hormonal contraception are concerned.

For progestogen-only pill takers (the mini-pill), the risk increased to 34%, for IUS coil (Mirena or Jaydess coil), depression diagnoses were up by 40%, for the vaginal ring (NuvaRing), the risk went up to 60%, and the contraceptive patch showed the strongest possible link to depression, with a 100% increase in diagnoses. More concerning still, teenage girls taking hormonal contraceptives fared worse when it came to depression risk, with adolescents using the combined contraceptive pill facing an 80% risk, and those prescribed the mini-pill looking at a 120% higher risk of developing depression.

While the researchers emphasise that the cohort study doesn’t demonstrate cause and effect, only a potential link to be further investigated, and that the stats look more hopeful after three months or more of contraceptive use in terms of depression risk, they do admit that there are few other obvious factors to explain the correlation. In the words of Professor Lidegaard, ‘if the risk is increasing by 80% it is not a trivial finding, it’s something women should be fully informed about.’ Quite.

For some, the pill is pure magic, but clearly, as this study suggests, altering natural hormone balance isn’t an easy, or healthy, ride for every woman

With one in four women in the UK taking the contraceptive pill, there’s no doubt that it’s a popular birth control option, and for good reason. Of its multiple reported benefits, from  clearing up acne  to making periods less painful (or getting rid of them altogether, should we choose), it's transformed many women’s lives for the better. The pill, along with other forms of hormonal contraception, puts us firmly in control of our own fertility for starters, can reduce symptoms associated with PCOS and  endometriosis  and can even reduce the risk of womb, cancer and colon cancers. What’s more, the pill and other forms of contraception are available for free on the good old NHS.

Many of us only experience positive effects when taking the pill and other forms of hormonal contraception, which likely explains the widespread demand for such forms of birth control, and the knowledge that we can easily come off the pill, or other contraceptives in time, at any point, with no impact on our fertility, only increases their appeal and convenience. For some, the pill is pure magic, but clearly, as Lidegaard’s study suggests, altering natural hormone balance isn’t an easy, or healthy, ride for every woman.

Without more conclusive clinical studies, guidelines around hormonal contraception don’t look like they’ll be changing anytime soon, but the experiences of around the approximately 500,000 Danish women taking them is likely to provoke everything from indifference to mild concern to serious alarm in women taking such contraceptives on our shores, and worldwide, often depending upon personal experience or the experience of peers, mothers and friends. Hormonal contraception leaflets list side effects such as ‘mood swings’, but mental health problems and depression go far beyond the boundary of this description, and for women that have been dismissing the onset of  depression  as a ‘mood swing’, this new research will serve to validate their feelings and provide serious food for thought, whether that’s on the topic of changing to a different form of hormonal contraception, or deciding that a non-hormonal method is the way forward instead.

The results of the Danish study, however, are indicative of the fact that such decisions shouldn’t be rushed, taken casually or made under pressure, especially in the case of teenage girls. Whether it’s booking out a double appointment at the GP for a thorough analysis of family medical history, preferences or concerns, or going straight to a sexual health clinic for a comprehensive service, perhaps our approach to considering our options ought to be upgraded, and frank, open discussions made the norm, rather than a bonus when you, or a medical specialist, has the time.

Given that a failure to treat and address mental health issues costs the global economy close to $1 trillion a year according to analysis by the World Health Organisation, and that’s not measuring the human cost of such illnesses, it’s high time that we invested both time and money to support sufferers. The fact that the same study found that women in the developed world were twice as likely to suffer from depression or anxiety as men, with young women being particularly affected, makes linking up hormonal contraception consideration and mental health all the more pressing.

Psychological side effects should not only be considered as important as physical ones (this goes for our approach to mental health in general), but also why not screen for mental health issues and mood changes during pill check appointments, along with the obligatory blood pressure test and weigh-in? If a teenage girl has just started on a new form of hormonal contraception, whether for the first time or not, perhaps more regular, informative pill checks could stop mental health issues in their tracks. Messaging as to what to look out for in terms of mood changes and mental health could go a long way to reassuring non-sufferers, and helping to identify those that are experiencing depression while taking hormonal contraceptives, and a common practice of keeping a ‘pill diary’ or similar could give GPs and medical staff a relatively accurate idea of what’s going on should side-effects rear their head.

Guidance as to what to do if something does go wrong when taking hormonal contraceptives should be made easily accessible, with alternatives explained without bias, and men, be they sons, partners or fathers, should be informed of all of the above too, because contraception shouldn’t be a matter for gender politics - equality is the aim of the game here. Incidentally, where’s that male pill at…?

What’s your experience of taking hormonal contraception? Positive or negative, feel free to comment below or tweet us  @GetTheGloss

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