Oral contraceptives: do they increase the risk of depression?

Many women rely on oral contraceptives for family planning. But reliable data on the prevalence of depressive disorders had not been available to date.

The contraceptive pill and depression: some statistics

Adult and adolescent women who take or have taken the pill have a higher risk of depression than non-using controls.
In particular, use during adolescence is associated with increased incidences.
The likelihood of depression is particularly high in the first two years of oral contraceptive use.
A sibling analysis confirms the causal relationship between the contraceptive pill and depressive disorders.

Oral contraceptives and depression: how high is the risk?

Although every gynaecologist knows that taking oral contraceptives (OCs) can increase the risk of depression and other psychiatric disorders, little is known about how high the risk actually is.

This is partly due to the fact that studies often do not include data from women who discontinued use due to mood swings. This leads to a bias that now needs to be circumvented. A multinational group of researchers has now published a study comparing the risk of depression in OC users with that of non-users.

Do contraceptives lead to more depression?

To this end, they analysed the data of more than 250,000 women and adolescents who are currently taking the pill or have taken it in the past. The data was then compared with the control group who were not taking the pill. In order to confirm - or refute - the causal relationship between taking the pill and the occurrence of mood disorders, a sibling analysis was also carried out.

The results have indicated that the risk of depressive disorders does indeed increase with the use of oral contraceptives.

Are there particularly vulnerable phases?

Although the overall risk for pill users is increased (even if the medication has already been discontinued, the lifetime prevalence is still increasing), there are two particularly vulnerable phases. In the first two years of taking the pill, the risk of developing an affective disorder is particularly high compared to women who do not take the pill. And, there is an increased risk of depression, especially for adolescents, even years after taking OC.

The sibling analysis clearly demonstrated the causal relationship.

Implications for their prescription

Ultimately, these data do not mean that the contraceptive pill should no longer be prescribed. Nevertheless, it is important not to neglect the risk of later affective disorders. Women and especially adolescents should be informed about this. Patients at high risk of depression in particular should be able to make an informed decision.

As with any medication, a detailed risk-benefit analysis should be carried out for oral contraceptives. The risk of depressive disorders is higher than expected for users and must therefore be factored into the decision-making process. For some patients, other contraceptive methods may be more suitable in view of this data. The user should always be informed in detail.

Source

Johansson T, Vinther Larsen S, Bui M, Ek WE, Karlsson T, Johansson Å. Population-based cohort study of oral contraceptive use and risk of depression. Epidemiol Psychiatr Sci. 2023 Jun 12;32:e39. doi: 10.1017/S2045796023000525. PMID: 37303201; PMCID: PMC10294242.