Birth Control and Depression: Are They Related?

There have been several studies and research conducted over the years on the topic of whether depression and taking a birth control pill is related. A very recent study was published this year on the topic, and is making headlines, as some of you may already know. But before discussing some of its findings, it is important to first understand how the pill works, and discuss its efficacy, side effects, and potential risks on your mental and physical wellbeing.

Birth control pills are the most commonly prescribed form of contraception to young females in North America. They contain a variety of different active and inactive ingredients. Among the more common ones are progestin, synthetic progesterone, and estrogen. The pills can contain a combination of these hormones in various dosages, or just consist of a single hormone. Ingesting synthetic hormones alters your body’s natural hormonal balance, levels, and production, ultimately preventing ovulation and subsequent ability to conceive.

The estimated probability of pregnancy during the first year of perfect use of the pill is 0.3% if taken at the exact same time every day, and a dose is never missed. However, actual rates of pregnancy with oral contraceptive are more like 9-11% in their first year of use [1]. Furthermore, an estimate 51% of unintended pregnancies happen while using a birth control pill [3], suggesting failure rate is high.
Furthermore, as a result of this natural hormone imbalance, it also affects responses within the brain, which causes altered psychological and physical responses. For instance, some of the more common side effects that have been reported from women taking oral contraceptives include:

• Water Retention
• Weight Gain
• Yeast Infections
• Overeating
• Weight Loss
• No Appetite
• Erratic Changes in Emotions
• Sense of Helplessness/Sadness
• Reduced Sex Drive
• Lack of Energy
• Problems Concentrating
• Increased Risks for Cervical and Breast Cancers

The University of Copenhagen Study on Depression and Birth Control

This recent study contained a large sample population, consisting of 1,061,997 female subjects, who were aged 15 to 34. In addition, none of these women had experienced any form of depression or other psychiatric/psychological problems prior to starting birth control. To help determine the effects of taking oral contraceptives, the researchers monitored whether subjects were diagnoses with depression or started a new antidepressant prescription throughout the study.

The study sample was also divided into two groups, where one set of women would take some form of birth control including:

• Transdermal Patches
• Progestin-Only Pills
• Vaginal Rings
• Combination Pills
• Levonorgestrel IUD

The other group of women would not use female birth control during the study. At the conclusion of the study, researchers compared the number of women who developed depression during the study period in both groups. The findings were as follows [3]:

• 131,178 women had obtained a prescription for antidepressant medications at some point during the study period.
• 23,077 women were newly diagnosed with depression.
• Subjects, aged 15 – 19 had the highest ratio of antidepressant medications and depression diagnoses.

Relative risks for first time use of antidepressants were as follows:

• Combined oral contraceptives: 23% increased risk
• Progesterone-only pill: 35% increased risk
• Contraceptive Patch: 100% increased risk
• Vaginal Ring: 60% increased risk
• Progesterone IUD: 40% increased risk

Based upon these findings, the study concluded there was evidence that birth control use and depression were related. However, future studies conducted at other research facilities have resulted varying findings. For instance, a 2007 study also found an increase in depression from subjects taking birth control, while another one in 2012 did not find a correlation between the two.

Natural Alternatives for Birth Control

If you are worried about potential risks and side effects of oral contraceptives, there are several natural alternatives available. Forms of hormone free birth control method include:

• Male Condoms
• Female Condoms
• Diaphragms
• Cervical Caps

A conversation I often have with my patients is the use of a hormone free intrauterine device made from copper. While the study did not assess the use of a hormone free intrauterine device, if you have a history of depression, or have previously experienced low moods on a birth control pill, this may be an effective alternative for you. Of course, it comes with its own risks and side effects, so always have a full discussion with your Medical Doctor or Naturopath to find an option that is right for you.
For more information about these and other natural alternatives, please feel free to contact Dr. Courtney Holmberg ND at 647.351.7282 or access the online schedule HERE today to arrange a consultation appointment at her naturopathic clinic in Toronto.
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References:

1. Trussell, James (2011). "Contraceptive efficacy". In Hatcher, Robert A.; Trussell, James; Nelson, Anita L.; Cates, Willard Jr.; Kowal, Deborah; Policar, Michael S. (eds.). Contraceptive technology (20th revised ed.). New York: Ardent Media. pp. 779–863
2. Unintended pregnancy in the United States. Sept 2016. https://www.guttmacher.org/fact-sheet/unintended-pregnancy-united-states
3. Charlotte Wessel Skovlund, MSc; Lina Steinrud Mørch, PhD; Lars Vedel Kessing, MD, DMSc, Øjvind Lidegaard, MD, DMSc, et al. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016;73(11):1154-1162.

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