Danish researchers analyzed the health records of more than 1 million Danish women and girls between from 15 and 34 years of age. Fifty-five percent were on or had recently been on birth control.
Compared with women who were not on any form of hormonal birth control, those who used a combined pill, with estrogen and progestin, had a 1.23 times higher risk of going on an antidepressant for the first time.
If they were on a progestin-only pill, the risk was 1.34 fold.
The risk was even higher for adolescent girls — 1.8 on the combined pill and 2.2 on a progestin-only pill.
What we already knew
“It confirms what we’ve known for a long time.” That’s what Susan Doughty said when I asked her about the study. Susan is a nurse practitioner in Maine who founded the New England Women Center and most recently practiced at Coastal Women’s Healthcare.
“I’ve know about it since the ’80s,” she said. “And in the 1990s, when I started my GYN practice, we talked about synthetic progestins a lot,” she said. “I have always been concerned about the progestins in the pill and injections. [They] have contributed to major depression in many, and I have worked with my patients when this is the case to get them off and onto a form of contraception that would not lead to mood shifts.”
Carrie Levine, a certified nurse midwife who founded Whole Women Health in Newcastle, Maine, had a similar reaction. “I know there is a group of women who have that response to birth control pills,” she said. “It’s not big news to me, per se.”
What’s the big deal?
So, why is this study important? Because some women may not have made the connection and others may not have had their concerns taken seriously.
“Many women might not have put together their mood shifts with going on the pill,” Carrie said. “They deserve to be listened to and offered alternatives.”
Here’s why the Danish researchers say their study is important.
“Millions of women worldwide use hormonal contraception. Despite the clinical evidence of an influence of hormonal contraception on some women’s mood, associations between the use of hormonal contraception and mood disturbances remain inadequately addressed.”
Although the new study may be an aha moment for some women and validation for others, the researchers caution that their findings only suggest depression may be “a potential adverse effect of hormonal contraceptive use.”
Their findings probably won’t change how Susan and Carrie approach their patients. “We never know how a woman is going to respond until we try it,” Susan said. “If, after three months on the pill, we find that her mood is altered, we either look for a different progestin combination pill or a different form of contraception.”
What to watch for
Susan and Carrie say the important thing is to pay attention to mood changes if you’re on the pill, get Depo-Provera shots or use an IUD that contains progestin. By the way, progestin is a synthetic form of the female hormone progesterone.
“I think a lot of times people, providers especially, don’t take the impact of mood alteration on the woman’s life as seriously as they need to,” Susan said. “I saw a fair number of patients who were referred from other providers who didn’t know how to handle it. They need contraception, and yet here they are depressed on their oral contraceptive. What do you do about that? It demands a fairly in-depth history taking with a depression summary scale to determine whether or not it is in fact depression or situational variables that are causing upset that might need to be managed in different ways.”
There are often signs or certain patterns that may be a tip-off that birth control pills are not a great choice for some women. “Those women typically have a bad reaction to hormonal birth control pills,” Carrie said. “They may have a touch of seasonal affective disorder, severe PMS, post-partum depression and/or turbulent perimenopause. When a woman comes to me and says, ‘I’ve been on birth control pills and it was horrible,’ I tend to probe a little bit deeper and say, ‘So what happened, what was your experience?’”
Susan believes genetics play a big role.” What we’re learning about in the gene project,” she explains, “is why some women respond to medications in a certain way and others in a different way. The role of genetics plays a big part here. If we can figure out in advance whether a woman is going to react to a progestin with depression, we can avoid using the progestin. That’s the medicine of the future.”
Birth control options
What are the alternatives now, for women who are pretty sure it’s their method of birth control that’s making them depressed?
We could talk about trying a different contraceptive,” Susan said. “It depends on whether or not she’s wedded to the surety of the pill, the very small slim chance of her getting pregnant on the pill if she takes it as directed. We could talk about a different kind of progestin if she’s willing to try that. If she’s not, we could talk about — depending on where she is in her cycles — if she’s heading toward perimenopause we could talk about sterility. If she doesn’t want further children we could talk about her husband having a vasectomy. And they do talk about male contraception in the study, which is going to be very important, I think, for women. To be able to share that responsibility with men. We don’t have that now.”
“I pretty much run through the continuum of options,” Carrie said, “from abstinence to barrier methods to the ParaGard IUD, which is the nonhormonal IUD.”
And, of course, some women choose to start taking an antidepressant.
What about you? If you have ever been on the pill, got Depo-Provera shots or had an IUD that contained progestin, did you experience depression?