Can Birth Control Pills Raise the Risk of Depression?

With depression rates a significant public health concern in the United States and across the world, research has long sought to establish significant risk factors. While there is surely no sole isolated cause of depression, and any given individual who struggles with it may have developed that vulnerability for a variety of reasons, including biological, cognitive, social and cultural factors, it's crucial to pay attention to trends when they are identified. And a recent study suggests that one such trend is that oral contraception—especially when taken as an adolescent—is associated with a higher risk of depression later on.

In a study of 264,557 women in the United Kingdom, led by Therese Johansson of the Department of Immunology, Genetics and Pathology at Uppsala University, those who were in the first two years of using oral contraceptive pills had a higher rate of depression than those who had never used oral contraception. Interestingly enough, this increased risk of depression persisted past the time they were using the pills. Past research has also uncovered a connection, especially among those who used oral contraception as adolescents, but randomized clinical trials have failed to show a definitive link. The authors of this study posit that one of the reasons for that is those studies have failed to account for past use of oral contraception, instead just looking at whether the pills have an effect at the most recent time they are taken. And past correlational studies may not account for the fact that those who experience the most negative mood effects simply stop taking the pills, thus not being "counted" in the same way. Thus, this most recent study—one of the largest scale to date exploring this issue—looked at the experiences of women past their use of the pills, and identified an increased risk of depression for those who had used oral contraception as adolescents even after they had stopped.

It's important to note that women may initiate the use of oral contraception for a variety of reasons, beyond just the prevention of pregnancy. Some women are prescribed such therapies for the reduction of uncomfortable or painful premenstrual symptoms or menstrual symptoms, for instance. For many, the benefits of birth control pills may far outweigh an increased depression risk, and in fact, the researchers are careful to point out that most women tolerate this type of contraception quite well and these findings are not a reason to stop taking them, or to ignore their potential significant benefits.

Potential confounds also need to be explored—might those who take oral contraceptives during adolescence already have a generally heightened risk of depression for some other reason? Might having uncomfortable premenstrual syndromes play such a role, or might levels of sexual activity be a confound?

Nonetheless, if there is such a link, it needs to be explored further—and medical providers need to empower patients to be aware of this potentially heightened risk, especially when those patients may carry additional risk factors for depression, whether genetic or environmental. With both depression and oral contraceptive use being extremely common, further clarity about a potential connection affects millions of people, who can be further empowered to make choices that are best for them once we truly know more.