Depression and contraceptives

Source, WHO

Source, WHO

A recently published paper suggesting a link between the use of hormonal contraception and depression has raised quite a bit of excitement. It is interesting to note though that this suggestion was made as way back as 1969 and published in the British Medical Journal
.
http://www.bmj.com/content/4/5680/380

The more recent study however has raised immense interest and I was interested in finding the paper and discussing it. I could only find the abstract…

https://www.ncbi.nlm.nih.gov/pubmed/27680324

I will try not to mourn, but I think if funders are going to put money into such sensational research, the data really ought to be public property and the research paper ought to be open access so that we can actually see the numbers involved, but I digress… I got a few extra numbers from a BMJ review to meat up this blog….

http://www.bmj.com/content/354/bmj.i5289

The Journal, JAMA Psychiatry published the results of what was a large study by Danish researchers. Data was collected from 1995 to 2013 from 1 million women aged 15-34 years of age. This was a substantially large study over a long period of time – the stuff that provides dependable data. The study compared women that used contraceptives and those that did not and followed them up to see whether they developed signs of depression over the course of follow-up

They compared women that did and those that did not use hormonal contraceptives. At the time of recruitment, the women did not show signs of depression and over follow-up, a total of 133, 178 had first time prescriptions of antidepressants and 23,077 had a first diagnosis in a psychiatric hospital during follow-up.

Across all the age groups, women using hormonal contraception had an increased risk of first diagnosis of depression. The youngest participants had the highest risk of anti-depressant use later in life. Among the adolescent group, the highest risk of depression was among those that used non-oral products. These are most effective and least risky choice that does not involve remembering to swallow a tablet daily.

The size of the study suggests that these results should not be ignored.

But I found another interesting study looking at adolescent girls that suggested that those who use non-oral contraceptives are more likely to themselves suffer from depression.

https://www.ncbi.nlm.nih.gov/pubmed/25553873

This study involved 15-19 year old sexually active girls in New York who sought reproductive health care. The researchers sought to find out whether signs of depression in this age group affected the method of contraception chosen. The teenagers with signs of depression were reported to prefer non-oral methods of contraception.

Perhaps the circumstances that lead a young teenager to use a more sure safe ‘impossible to forget’ method may reflect on the relationships they are involved in, that may in itself be the cause of the increased risk of depression.

The New York study did involve only 220 girls and therefore is tiny compared to the Danish study but perhaps it may provide an answer to this particular issue.

A smaller study by a Finish group lead by researcher named Toffol, had earlier (2012) shown that oral contraceptives were not only not associated with depression but were associated with well being.

https://www.ncbi.nlm.nih.gov/pubmed/21840911

https://www.ncbi.nlm.nih.gov/pubmed/22465115

One of their papers published data on 8586 women aged 25-54 years with data collected every five years to determine whether the women had experienced any mood changes in the last year of contraception use compared to women that did not use contraception. There results were rather interesting, of 1,255 women using oral contraceptives, 69 (5.5%) were recently diagnosed with depression compared to 571 (7.8%) of 6,632 women that did not use Oral contraceptives.

Although the numbers may seen alarming, the details tell you a bit more, there are almost 5 times more women that do not use oral contraceptives than those who did, so despite the high absolute figure among those not using contraception, the proportion is low.

It would be difficult to repeat this study in many parts of Africa as teenagers are supposed to be very innocently focused on their books and parents/caregivers refuse to face the fact that teenagers are having sex. I would bet that the results would be similar.

I do not wish to sensationalise this paper, the vast majority of women using hormonal contraceptives are extremely pleased with the freedom it gives them. An unwanted pregnancy is also a horrible predicament that would result in much worse well being for all involved.

However, women do need to be aware that this is a possibility. Some of us react very physically to hormonal contraception while for others, the reaction is emotional.

I tried oral contraceptives for less than 6 months many years ago and I was often dizzy, having to stop and sit quietly to stop feeling like I was passing out. I was nauseous – it felt like morning sickness and I would take pregnancy tests often. In the end, I stopped using the damn pills. I can’t help but wonder – if my body can’t face a small disruption of nice hormones, what will it do with the menopause? But I digress….

I do however believe that hormonal contraceptives are crucially important and I would not bad mouth. What I am saying is that as individuals, we should ‘listen’ to our bodies and not second guess ourselves if we think it is contraceptives that are affecting our mood and well being.

No fuss – just doing what is right for you.

If you suspect that hormonal contraception is not in tune with your system, then change what you use and find something else that works for you. Let those who can cope with hormonal contraceptives continue without fear, most women do ok. I could not handle the pill so I used other rather non-exciting methods – but such is life. Your health is vital.