Birth control linked to depression, new study says | CNN

A woman's choice —

Women have many choices when it comes to avoiding pregnancy, but men have only two. According to the Centers for Disease Control and Prevention, 99% of sexually active women used at least one contraceptive method at some point between 2006 and 2010. Here's a look at a variety of birth control methods and how they each work.

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A male condom is a thin covering worn on the penis during intercourse. It can prevent sexually transmitted diseases, and is about 82% effective at preventing pregnancy.

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During a vasectomy, a surgeon cuts the vas deferens, the tubes that carry sperm from the testicles. It has a failure rate of about 0.15% and can be reversed, but the procedure is complicated.

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IUD —

An intrauterine device, or IUD, is a flexible T-shaped device that's inserted by a doctor into a woman's uterus. The devices block sperm and change the lining of the uterus, which may keep a fertilized egg from attaching. Pregnancy is prevented from three to 12 years, depending on the type.

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The pill —

Approved in 1960 by the Food and Drug Administration, oral contraceptives involve taking a daily pill with a combination of estrogen and a progestin. The hormones prevent ovulation and thicken a woman's cervical mucus, blocking sperm from fertilizing an egg.

Female condom —

Condoms aren't just for men. The female condom fits inside the vagina with a ring at one end that covers the cervix. When used correctly all of the time, the National Institutes of Health says, it's 95% effective, with bonus protection from sexually transmitted infections.

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Diaphragm —

The diaphragm also fits inside the vagina but covers only the cervix, where it blocks sperm from entering the uterus. It is made of silicone and can last up to two years. A spermicide must also be used for greatest effectiveness.

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Cervical cap —

The cervical cap is similar to a diaphragm but smaller in size and made of rubber instead of silicone. It is useful for women who find it hard to keep a diaphragm in place.

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Implant —

Implants are flexible matchstick-size devices that are surgically inserted into a woman's arm. They slowly release the hormone progestin into the body, preventing a woman's ovaries from releasing eggs. The protection can last several years.

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The patch —

For women who don't want to take a pill or insert a device, the Ortho Evra birth control patch sticks to the body and releases pregnancy-preventing hormones through the skin. A woman must change her patch once a week for three weeks in a row. No patch is used in the fourth week, and then the cycle starts again.

Vaginal ring —

NuvaRing, approved for use in the United States in 2001, is a small, flexible ring inserted into the vagina. It releases estrogen and progestin, the same pregnancy-preventing hormones found in most variations of the birth-control pill.

Vaginal sponge —

Introduced in 1983, the Today Sponge was pulled from the market after fears of toxic shock but returned in 2005 following design changes. The sponge contains spermicide and can be inserted into the vagina before sex, like a diaphragm, to prevent pregnancy.

Meijer/Today Sponge

The shot —

Depo-Provera, an injection form of birth control, provides protection for three months with hormones that prevent ovulation and block sperm. It doesn't contain estrogen, as do some other forms of birth control. As a result, it is a popular option for women who can't take estrogen or who are breastfeeding.

Pfizer

Morning-after pill —

Emergency contraception, frequently referred to as the morning-after pill, can be taken to prevent pregnancy up to five days after unprotected sex. It can prevent the ovaries from releasing eggs and thickens a woman's cervical mucus. The morning-after pill can also thin the uterus lining, which could prevent a fertilized egg from attaching.

Birth control methods

Story highlights

New research links hormonal birth control to depression

"Adolescents seemed more vulnerable to this risk than women," study says

However, the findings won't change how one doctor says she counsels patients

CNN —

Taking hormonal birth control might be associated with an increased risk for depression compared with those who don’t use contraception, according to a new study published in the journal JAMA Psychiatry last week.

The finding is something that users have long suspected, as about 30% of women who ever used the pill in the United States eventually quit because of dissatisfaction with side effects, according to a 2013 report from the Centers for Disease Control and Prevention (PDF).

“We have known for decades that women’s sex hormones estrogen and progesterone have an influence on many women’s mood. Therefore, it is not very surprising that also external artificial hormones acting in the same way and on the same centers as the natural hormones might also influence women’s mood or even be responsible for depression development,” said Dr. Øjvind Lidegaard, a professor at the University of Copenhagen in Denmark and lead supervisor of the study.

Lidegaard and his colleagues tracked the health of more than 1 million Danish women between the ages of 15 and 34 over 14 years, using data from the National Prescription Register and the Psychiatric Central Research Register in Denmark.

To ensure that depression was properly identified in connection with birth control use, women with a depression diagnosis before their 15th birthdays or the start of the data collection were excluded.

After analyzing the data, the researchers found that the use of hormonal birth control was positively linked to a subsequent depression diagnosis and use of antidepressants.

Depression risk, by the numbers

Among all hormonal birth control users in the study, there was a 40% increased risk of depression after six months, compared to women who did not use hormonal birth control, the researchers found. The mean age of birth control users in the study was 24.

The users of combined oral birth control pills experienced a 1.2-fold higher rate of subsequently taking antidepressants during the study period than those not using the birth control. Women who used progestin-only birth control pills experienced a 1.3-fold higher rate, according to the study.

As for non-oral forms of hormonal birth control, those who used the transdermal patch had a two-fold increased risk and those who used the vaginal ring had a 1.5-fold increased risk.

Similar rate increases were found for depression diagnoses, according to the study.

The researchers noted in their study that the difference in risk rates among women taking non-oral and oral forms of birth control might be due to a difference in dose rather than how the contraceptives are administered.

The researchers also noted that this association does not imply that birth control alone causes depression – and more research is needed to better understand the possible link.

“Adolescents seemed more vulnerable to this risk than women 20 to 34 years old. Further studies are warranted to examine depression as a potential adverse effect of hormonal contraceptive use,” the researchers wrote in their study.

One of the study authors has a history of consulting for two pharmaceutical companies, Lundbeck and AstraZeneca, and another author reported receiving funds for talks from Exeltis. No other conflicts of interest were disclosed.

Lidegaard said the study results could translate to women in the United States.

In the United States, about 62% of women 15 to 44 years old use some form of contraception (PDF).

Among those women, 16% use the pill, 15.5% use female sterilization, and 7.2% use long-acting reversible contraception, such as an IUD or implant, according to the National Center for Health Statistics.

What this new data means for women

What do other experts think of the new study? Dr. Kathryn Holloway, an ob-gyn practitioner at the Institute for Women’s Health in San Antonio, Texas, called it impressive.

However, while there may be a correlation between hormonal birth control with the prescription of antidepressants and perhaps a depression diagnosis, causation is hard to prove, she said.

“Although this study suggests an increased risk of depression with combined hormonal contraception, the increase does not seem so great as to significantly change how I counsel patients,” Holloway said, adding that, “Depression is not something to be taken lightly and should not be a missed diagnosis. It is important for physicians to monitor and evaluate for any possible side effects, even if rare, with any prescribed medication.”

While birth control comes with some negative side effects, from stomach cramps to increased risk of stroke, it can also provide some health benefits.

Hormonal birth control not only prevents unwanted pregnancies, but also can regulate menstrual cycles, treat endometriosis pelvic pain, control symptoms of fibroids, help acne breakouts, and reduce the risk of some cancers that affect reproductive organs.

There are some forms of birth control that are not hormonal, Holloway said.

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“Hormonal contraception options range from the combined oral contraceptive pills to an intrauterine device and a birth control shot such as Depo-Provera,” Holloway said.

“Non-hormonal contraception options include condoms, cervical caps, the vaginal sponge and spermicide, and the copper IUD,” she added. “Some patients are successful with natural family planning by monitoring their cycle on a calendar or menstrual cycle app. It’s up to the patient and their ob-gyn to decide which method of birth control is right for their lifestyle and well-being.”