Oral contraceptives and concurrent depressive symptoms

November 7, 2019

A JAMA Psychiatry prospective cohort study found that scores for depression were higher among younger adolescents who used oral contraceptives (OCs) than those who did not, but the connection did not remain when all included age groups of the study were combined. 

Scores for depression were higher in 16-year-olds who used oral contraceptives (OCs) than those who did not, according to a prospective cohort study of depressive symptoms among women aged 16 to 25. However, the study in JAMA Psychiatry found no connection between OC use and depressive symptoms when all age groups were combined.

“We started this study because data on depressive symptom severity of women currently using oral contraceptives are needed to provide information on the immediate associated risks,” said senior author Anouk de Wit, a MD and PhD candidate in psychiatry at the University Medical Centre Groningen in the Netherlands. “These risks are one of the most common concerns women have when starting the pill, as well as what teens and their parents discuss.”

Data were collected from the third to sixth wave of the prospective cohort study Tracking Adolescents' Individual Lives Survey (TRAILS), conducted from 2005 onwards among children from the Netherlands. For this study, data from 1,010 females were analyzed, ranging from 743 to 903 females per wave. Study participants were assessed in waves every 2 to 3 years, with questionnaires, interviews, tests, and/or physical measurements. They filled out between one to four assessments of OC exposure at ages 16, 19, 22, and/or 25.

At age 16, nonusers of oral contraceptive had a higher mean socioeconomic status than users: 0.17 vs. -0.15. Nonusers were also more likely to be virgins: 79% vs. 24.4%, respectively.

Depressive symptoms were assessed by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-4)-oriented affective problems scale of the Youth Self-Report for the study’s 16 year olds and by the Adult Self-Report for the latter years.

“On average, depression scores were 21.2% higher among 16-year-old females using oral contraceptives,” compared to nonusers de Wit told Contemporary Ob/GYN. “This difference persisted after adjustment for age, socioeconomic status and ethnicity.”

The youngest contraceptive users particularly reported more crying (odds ratio [OR] 1.89; 95% confidence interval [CI]: 1.38 to 2.58; P  <  0.001), more hypersomnia (OR 1.68; 95% CI: 1.14 to 2.48; P = 0.006) and more eating problems (OR 1.54; 95% CI: 1.13 to 2.10; P = 0.009) than nonusers.

“However, the two core symptoms for the diagnosis of depression- anhedonia and sadness-were rarely noted,” de Wit said. “The more common self-reported symptoms mirror the symptom profiles of adolescent depression, where there is an emphasis on vegetative or physical disturbances, such as loss of energy and changes in weight, appetite and sleep, rather than on anhedonia.”

Two study limitations are that its observational data precludes any causal inference and the longitudinal analysis did not provide any information about specific oral contraceptive pills.

In addition, based on study results, “we cannot say that oral contraceptives cause mood changes,” de Wit said. “But we have evidence that suggests that the relationship between oral contraceptive use and depressive symptoms is going in both directions; in other words, oral contraceptive use might cause depressive symptoms, but depressive symptoms might also cause oral contraceptive use.”

de Wit recommends that if an adolescent or young woman is experiencing depressive symptoms, whether caused by OCs or not, she should contact her healthcare provider to review the options for improving mood.

She also said that monitoring depressive symptoms in adolescents who are using OC is important because use of the hormones may affect their quality of life and place them at risk of noncompliance.

Disclosures:

Anouk de Wit reports no relevant financial disclosures.

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