The Chronic Pain of Contraception

 
The results of a study published this week in the latest edition of the “Journal of the American Medical Association: Psychiatry,” raises the specter of depression as a result of taking
hormonal contraceptive agents.
A prospective Danish study found that rates of women filling their first prescription for an antidepressant were highest among women using medroxyprogesterone acetate depot (Depo Provera), contraceptive implants and the norgestrolmin transdermal patch, as described by researchers at the University of Copenhagen.

It is theorized by some that the link between hormonal contraception and depression may center around the influence of estrogen and progesterone on the cortical and subcortical regions of the brain, areas of the brain that manage our daily emotional input and output.
The Danish Sex Hormone Register Study remains an ongoing study, with the particular cohort described in this particular publication comprised of girls and women aged 15 through 34 years. Data from 1,061,997 women was examined. The subjects were followed up for a mean duration of six years, and 55.5% were users of hormonal contraception.

In fact, women who took any combined oral contraception or a progestin-only pill experienced a much higher rate of first-use antidepressant therapy compared to those who used non-hormonal means of contraception.  Nonetheless, contraceptive injections, implants, patches, or ring contraceptives were associated with the highest rates of antidepressant use.
Interestingly, depression appears to be a particular problem among adolescent women on contraceptives. Use of non-oral contraceptive products, such as the etonogestrel vaginal ring and the levonorgestrel intrauterine system were associated with a more than threefold increase of first use antidepressants, with progestin-only pills linked to a more than twofold increase compared to non-hormonal contraceptive users.
Depression is associated with a substantial burden in developed and developing countries. The lifetime prevalence of depression is about twice as high in women as in men across different populations. Nevertheless, before puberty, girls are found to be equally or less depressed than boys. The two female sex hormones—estrogen and progesterone—have been hypothesized to play a role in the cause of depressive symptoms.

This study makes one wonder whether birth control is only adding to the burden of depression, at least on an individual level.  And so the individual must ask herself whether she indeed feels worse with a given contraceptive product.
It is of concern that adolescents in this research seemed more vulnerable to this risk than women 20 to 34 years old; this is a population often more at risk of the life-threatening effects of depression. Further research may further elucidate whether we can without hesitation list “depression” as an adverse event associated with hormonal birth control.