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Can hormonal birth control trigger depression?

October 17, 2016


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L. Creyon
October 30, 2016

This article states that the increased instances of depression were noticed “especially for non-oral, progesterone-only forms of birth control such as the ring, patch and IUD. That the IUD”. but both the ring and the patch, and certain types of IUD are of the combined hormone variety. I’ll have to double-check on the patch, but I know for a fact that the ring is combined. Unless there is something new on the market now besides Nuva Ring? My understanding was always that the method of delivery shouldn’t make a difference in side effects, that these methods, medically speaking are the same as taking the traditional pill. Is the risk really higher with slow-acting methods than with a daily pill, even if the hormone combination is the same?

Monique Tello, MD, MPH
October 31, 2016

Agreed, It’s supposed to read “non-oral” only so we will correct that. Appreciate your close reading.

Dr Sophie Fourie
November 30, 2016

1 Comment:
Agree that the pharmacological principle is: local acting preparations at lower doses give less systemic adverse effects.

2) Question on a patient please answer.
A patient of 31 years has clinically confirmed major depression and has recently been prescribed fluoxetine.
Her depression was aggravated – while taking the fluoxetine – by
a) The injectable progestogen: norethisterone enanthate – severely
b) Nordette (levonorgesterel 150 and oestradiool 30 microgram)

She also develloped severe depression when she became pregnant about 4 years ago.
About 9 years ago she developed depression for the first time while on “Triphasal”
– (levonorgesterel and oestradiol) without taking any antidepressants.

Q1 : Would it be of any use to try Yaz – drospirenone 3 mg ethynylestradiol 0.02 or should she abstain from any hormonal products?
Q2: It seems as if the progestogens have more depressive side effects than the oestrogens?

Kelly Wilson
October 21, 2016

The small risk is present in the main analysis, but the risks when comparing to a group with no history of ever using hormonal birth control is substantially larger. About 70% for older women and more than double for adolescents. I have no idea why these data are relegated to the additional analyses. They seem extremely relevant to me.

Monique Tello, MD, MPH
October 26, 2016

OK, I’m trying to see where this is- are you looking at the sentence “When the reference group was changed to those who never used hormonal contraception, the RR estimates for users of combined oral contraceptives increased to 1.7 (95% CI, 1.66-1.71)” , as compared to the 1.23 in the main analyses? If so, it’s not easily converted to a percentage risk; rather it’s better to think of it as “1.7 times more likely” vs “1.23 times more likely”. If someone knows how to easily express these in terms of percentage risk, please, go ahead!

October 19, 2016

In this country, at least, women on birth control must see their doctors regularly for prescriptions, leading to regular patient/doctor contact. Women not taking birth control do not have to see a doctor regularly, at least for this reason. Could it be that the slight difference between the groups has more to do with the patients discussing depression when they happen to be in the doctors’ offices anyway?

Monique Tello, MD, MPH
October 26, 2016

Yes, that certainly could be offered as a hypothesis. I think we really don’t know why there seems to be an increased risk.

Liz Turnock
October 19, 2016

I wonder about causation vs correlation. Perhaps women who are requesting the contraception at those ages are more prone to depression.

Monique Tello, MD, MPH
October 26, 2016

That could be offered as a hypothesis. Hard to say what the underlying physiology is.

October 19, 2016

What do we know about hormonal birth control? We know it reduces B12 levels. Take a handful of women who aleady have low B12 and give them hormonal birth control, and you get depression. Would be helpful if you knew the B12 levels of each person in the study.

Monique Tello, MD, MPH
October 26, 2016

A rigorous PubMed query for any research on oral contraceptives or hormonal contraceptives on serum B12 levels turned up two older studies that did suggest a negative effect. Both studies concluded that further research was needed. So, I agree with you that this idea is interesting and should be investigated, especially given this Danish study.

October 19, 2016

Hi Monique –

Has there been any research into patients with existing depression that are using hormonal birth control? Does it increase the effects of depression or make the depression harder to treat?

Thank you for any comments and insight.

Monique Tello, MD, MPH
October 26, 2016

Yes, there has. A 2016 article in Contraception presents a systematic review of different studies examining hormonal contraception and mood in women with previously diagnosed depression found no consistent significant effect. They conclude: “Limited evidence from six studies found that OC, levonorgestrel-releasing IUD and DMPA use among women with depressive or bipolar disorders was not associated with worse clinical course of disease compared with no hormonal method use.” The authors note, however, that the studies they looked at were all very different and some were perhaps not of the highest quality.

Safety of hormonal contraception and intrauterine devices among women with depressive and bipolar disorders: a systematic review.
Pagano HP1, Zapata LB2, Berry-Bibee EN2, Nanda K3, Curtis KM2 Contraception. 2016 Jun 27.

October 19, 2016

Dear Monique,

It would be helpful, if it could be extracted to understand the increased risk for those one the pill – the most common form. As I read your article, it seems that IUD, ring, and patch are particularly noted for their increased risk. If you looked just at the pill, would that just take you from 1.7 to 1.8 out of 100? Or how is that assessed. Thank you for this.

Monique Tello, MD, MPH
October 26, 2016

Yes, the risk of depression in users of combined oral contraceptive was slightly higher than for nonusers, but lower than for all forms of hormonal contraception combined, so it fell between 1.7 and 2.2 per 100 people.

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