What To Know About That New Study Linking Birth Control To Depression

The latest iteration of the never-ending discussion about women’s mental health and reproductive decision-making comes in the form of a large-scale longitudinal study on the link between birth control and depression. The results quickly started trending, with women understandably raising alarm over such a serious side effect to a widely used and crucial reproductive-health option.

The findings, published in the Journal of the American Medical Association: Psychiatry, indeed confirm that depression can be a side effect of hormonal contraception. The research monitored data across a 19-year-period in Denmark, and involved charting medical records of more than 1 million participants between the ages of 15 and 34 who had no prior diagnosis of, or treatment for, depression.

When reviewing the data, researchers noticed a correlation between people who took various forms of hormonal birth control — including the Pill, the patch, vaginal rings, and IUDs — and depression.

The authors found that taking the combined birth control pill — a mix of estrogen and progestin — were 23% more likely to be prescribed antidepressants than those not using hormonal birth control; it went up to 34% for those on progestin-only pills.

But while most media headlines have focused on just the Pill, the rates of depression actually were higher for those on long-acting reversible contraception (LARCs), with 40% of IUD users, 50% of those using the patch, and 60% of vaginal ring users being more likely to receive a depression diagnosis.

Teens aged 15–19 who took combined birth control pills were 80% more likely to end up depressed.

These rates certainly look alarming. But as with any study, it’s important to consider a variety of factors when analyzing the results . . . and determining what this means going forward.

***

The first thing to consider when assessing the results is potential existing differences between the two groups that were studied: those who use hormonal birth control, and those who don’t. Those using hormonal contraception may have been more likely to be regularly visiting a doctor, and perhaps would be more aware of the possibility and symptoms of depression (typically referred to as “mood swings” during the quickly-spoken part at the end of TV commercials), than nonusers. When prescribing birth control, it is standard practice for physicians to ensure that the patient is fully aware of any potential side effects of the drug or the device, including changes in mood. Therefore, it is possible that those on hormonal contraception may be particularly conscious of their mental health and other side effects, and may be more inclined to report any noticeable changes to the doctor.

(That said, it should be noted that study co-author Øjvind Lidegaard told The Washington Post that this was the first study to conclude that there might be a link between birth control and clinical depression specifically; patients have only ever been warned of potential “mood swings.”)

The second thing to consider is how easy it is to misread or misinterpret the results of the study — gleaning, for example, that 80% of teens and 23% of adults who take the combined birth control pill are depressed, when in fact, they have an 80% or 23% increased likelihood of receiving a depression diagnosis. To put that another way: Adult women who did not use the combined pill reported an average of 1.7 cases of depression out of 100, which increased to 2.2 out of 100 for those taking that pill. This is a significant correlation, but not as drastic as it may look at first glance.

We should also be careful about what we take away from these results. Advances in contraceptive technology are more nuanced than we’d like to think: With reproductive freedom — or any medication — comes the potential for side effects. And it’s important that we address possibly harmful effects from hormonal birth control carefully. Those who are opposed to women taking control of their reproductive decision-making — politicians, religious leaders — could very well seize this opportunity as an example of why it hurts women. Already, some outlets are using the study to justify an anti-birth-control stance.

Part of being a patient and a consumer is being able to be informed on the risks and benefits of taking a particular drug. Indeed, this study adds to the body of knowledge available to people making the decision on whether or not to use birth control (and if so, what kind).

Rather than looking at this as a signifier of the inherent dangers of birth control, we should consider how to make improvements in birth control research and development. There may be a lack of will to find a better, safer birth control pill option because women’s health isn’t necessarily a priority as a research subject. Maybe the medical establishment saw the development of the Pill in the 1950s as sufficient: Women got what we want; sure, there will be side effects, but it’s time to move on and spend time, energy, and resources researching something else. As Holly Grigg-Spall rightly points out in an op-ed in The Guardian, “no study will ever be good enough for the medical community to take women’s experiences seriously.”

“We’re told not to be alarmed, concerned, or deterred from continuing to use our hormonal contraceptives, mostly by men who have never and will never take them themselves (partly because the long-term, large-scale study undertaken by WHO on the ‘acceptability’ of the male pill revealed it would negatively impact their emotional wellbeing),” Grigg-Spall writes.

She makes the case that it is possible to support women’s reproductive choices while calling for additional research on a drug initially developed 60 years ago.

This is a complex topic without a simple solution. As the authors of the study state, further research in this area is required in order to gain a better understanding of how different hormones and dosages affect our physical and mental health. For many, hormonal contraceptives are a lifesaver, dramatically reducing the effects of period pain, which for many can be debilitating — not to mention, birth control gives women the crucial ability to gain control over our own bodies.

The findings of this study should not be used to limit women’s access to birth control options or stigmatize those who chose to use them, but rather to spur additional research.

***

Lead image: NIAID