The study, a comprehensive review of published research on contraceptives for women with psychiatric disorders, found that hormonal birth control, such as the pill, IUD, and vaginal ring, don’t cause depression and anxiety disorders.
Anxiety and Depression in Women
“Basic contraceptive knowledge is a critical component of health care for female patients, and here we focus on women with psychiatric disorders,” says corresponding author Katherine Wisner, MD, the Norman and Helen Asher Professor of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine and the director of the Asher Center for the Study and Treatment of Depressive Disorders. Anxiety and depressive disorders are among the most common diseases in women of reproductive age, Dr. Wisner explains. The prevalence of mental illness is higher among women (24.5%) than men (16.3%), and young adults (age 18-25) are at the highest risk.
Association vs. Cause
As well as having a high rate of psychiatric disorders, reproductive-aged women are frequent users of contraceptives. “It follows that the co-occurrence of psychiatric illness and contraceptive use will occur, and is an association,” Dr. Wisner says. However, when the researchers evaluated the data to determine whether hormonal contraceptive use causes depression, they found that this wasn’t the case. “Clinical studies and randomized, placebo-controlled trials of women with psychiatric disorders have reported similar or lower rates of mood symptoms in hormonal contraceptive users compared to nonusers,” Dr. Wisner says. The study also found that in some cases, hormonal contraceptives may even help stabilize or reduce the rates of mood symptoms in women with psychiatric disorders.
Regular Mental Health Screening is Needed
However, it’s also clear that some women who are prescribed hormonal contraceptives will develop low mood. “Although research studies have not unanimously confirmed any direct correlation between hormonal contraception and depression, and often have conflicting findings, in my clinical experience many adolescents and adults may experience depressive symptoms subsequent to starting birth control,” says Leela R. Magavi, MD, a Hopkins-trained adult, adolescent, and child psychiatrist and regional medical director for Community Psychiatry, California’s largest outpatient mental health organization. Dr. Magavi says that in some cases she’s discussed changing or discontinuing hormonal contraception with patients’ OB/GYNs, and a few months later, many of those women experience an improvement in their overall mood state. She references one particular study, published in JAMA Psychiatry in 2016, which tracked more than a million Danish women over the age of 14. It indicated an increased risk of depression with all forms of hormonal contraception, especially progestin-only forms, including the IUD. However, Dr, Magavi also points out that the study suggested that the overall number of affected women was minimal. The researchers examined 18 years of data (1995–2013), so they measured the incidence rate in terms of person-years rather than individuals. For every 10,000 person-years, there were 30 new diagnoses of depression among women who used hormonal birth control. For non-users, there were an average of 28 new depression diagnoses per 10,000 person-years. The new study authors note that psychiatrists don’t typically receive enough training in contraceptive management to properly advise their patients on their birth control choices. They hope the findings will lead to better communication between gynecologists and psychiatrists so they can work together to help the women they treat decide which contraceptive is best for them. “The appropriate practice is to screen women for depression at all health care appointments, as is recommended by the American College of Obstetricians and Gynecologists (ACOG), to identify and treat this common and often unrecognized illness,” Dr. Wisner says. And women should be encouraged to bring up contraceptive and family-planning questions during healthcare appointments with any provider, including their psychiatrist.
Risk Factors
Every woman is different, and some might be more likely to develop depressive symptoms with hormonal birth control, such as those who have a personal or family history of psychiatric illness or who have experienced peripartum or postpartum depression. And while interactions between psychotropic drugs and contraceptives are rare, doctors need to be aware that certain medications may interfere with some contraceptives, such as the antipsychotic drug clozapine and carbamazepine, which is used to treat bipolar disorder and seizures. And when you read study results, it is important to remember that associations refer to possible, rather than definitive, side effects. “If a study suggests that some women may or may not experience a specific side effect, this cannot be generalized,” Dr. Magavi says. “Each woman has her own story and needs.”
