Research looks into the complicated link between hormonal birth control and depression.
Birth control pills are awesome: They give you ways to control when (and if) you get your period and make it lighter and less painful when you do get it, they can clear up your skin, and, of course, they allow you to have sex without getting pregnant. If you struggle with mood swings during PMS, or if you have PMDD (premenstrual dysphoric disorder)‚ hormonal birth control can help keep your mood under control. But hormones are complicated, and the relationship between birth control and mood is confusing, with both scientific and anecdotal evidence suggesting that some methods may actually make some people feel mentally worse, not better.
“Hormones are instrumental in regulating and effecting our emotions,” clinical psychologist John Mayer, Ph.D., tells SELF. “The action of birth control pills is directed to hormonal regulation; therefore you have the perfect storm to set the table to have consequences on mood.”
Licensed clinical psychologist Alicia H. Clark, Psy.D., agrees. “I have worked with numerous women whose birth control has appeared to suppress their mood,” she tells SELF. “When non-hormonal forms of birth control have been substituted, I have noticed a consistent trend in mood and energy elevation.” Now, she asks patients who complain about their mood if they’re on hormonal birth control for that reason.
A new study published in JAMA Psychiatry has found a link between hormonal birth control use and an increased incidence of depression. For the study, researchers analyzed data from more than 1 million women in Denmark with no history of depression for 13 years and found that those who used hormonal birth control had a 50 percent greater risk of depression within six months of using hormonal birth control than those who didn’t use it.
Overall, the use of any combined oral contraceptive was associated with a 10 percent increased risk of a first diagnosis of depression, and a 20 percent increased risk of using antidepressants. The risk was higher among women aged 15-19, and was also higher among women who used any type of hormonal birth control for six months. Women who used progestin-only pills doubled their risk of developing depression, while those who used the levonorgestrel IUD (aka Mirena) tripled their risk.
It’s worth noting here that, as with all studies that find links between two things, correlation doesn’t equal causation—just because two things are linked doesn’t mean that one thing directly caused the other. After news of the study broke, experts quickly pointed out a few reasons why you can’t actually draw any solid conclusions from it. One example: There was no control group. That means that it’s possible that taking the pill or hormonal birth control wasn’t the cause of the antidepressant use, but potentially a marker for it—for instance, taking the pill could be a sign that someone is more likely to take meds (hat tip to the always on-top-of-it Dr. Jen Gunter). Another expert, epidemiologist Chelsea Polis, PhD, pointed out on Twitter that in media reports about the study, you only see relative risk, rather than absolute risks. Meaning that you only see that the risk increases by a certain percentage—but that doesn’t tell you how likely you are to actually be effected by it. (Think of it this way: If the risk of something increases from 2 out of 100 to 3 out of 100, that’s a 50% increase in relative risk, but the absolute risk is still very small—only 3 percent). Case in point: The researchers note that most women who use hormonal birth control methods don’t get depressed, but say there is a possibility it can happen. The possibility exists, but it’s not an issue for the majority of birth control users.
Another thing: Previous research has found the opposite effect to be true. A study published in the American Journal of Epidemiology in 2013 found that women on hormonal birth control were less likely to have symptoms of depression and to have attempted suicide than women who weren’t on hormonal birth control.
All that being said, experts aren’t shocked that the association exists. Clark says hormonal birth control can be risky for women who may be prone to emotional sensitivity because the sex hormones used in them—estrogen and progesterone—impact emotional and cognitive processing (which then impacts your ability to regulate your mood). Hormonal birth control tricks your body into thinking it’s pregnant, she points out, so it’s not surprising that it can potentially negatively impact your mood. Indeed, some hormonal birth control options, including pills and the ring, list mood changes and even depression as a possible side effect.
For those same reasons, it’s also possible for some women to have mental perks on birth control—indirectly, at least. “Hormonal birth control can improve mood as likely as it can detract,” says Mayer. He cites patients who have struggled with difficult periods who feel much better on hormonal birth control. “The emotional relief of not having the extreme symptoms from their former symptoms is very uplifting,” he says. “This has been especially true in adolescent girls where their periods can be very painful and disruptive.” And some birth control pills—including the often controversial but still popular Yaz—are prescribed to women to alleviate the symptoms of PMDD, an extreme form of PMS that can result in monthly bouts of depression.
At the end of the day, how you respond to birth control is a very personal thing. What works great for your friend might not be a great fit for you (and vice versa). If you suspect that your birth control is messing with your emotions, talk to your doctor about alternative options. “No woman should have to endure cognitive and mood symptoms in order to maintain reproductive control,” says Clark. “There are other effective methods.” But if you are afraid of trying out hormonal birth control because of the risks, you should talk to your doctor about that, too—and not be scared by sensationalist headlines.