No link between hormonal birth control and depression

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A US meta-analysis found no evidence to support a link between hormonal birth control and depression.

Women face several options when it comes to birth control, so potential side effects often factor into their decision. Depression is a common concern for many women, but a new study by researchers at The Ohio State University Wexner Medical Centre is putting patients at ease. It found there’s no evidence to support a link between hormonal birth control and depression.

“Depression is a concern for a lot of women when they’re starting hormonal contraception, particularly when they’re using specific types that have progesterone,” said Dr Brett Worly, lead author of the study and OB/GYN at Ohio State Wexner Medical Centre. “Based on our findings, this side effect shouldn’t be a concern for most women, and they should feel comfortable knowing they’re making a safe choice.”

Worly and his team reviewed thousands of studies on the mental health effects of contraceptives. They included data tied to various contraception methods, including injections, implants and pills. Similarly, researchers reviewed studies examining the effects of hormonal birth control on postpartum women, adolescents and women with a history of depression, all with the same conclusion: there is insufficient evidence to prove a link between birth control and depression.

“Adolescents and pregnant moms will sometimes have a higher risk of depression, not necessarily because of the medicine they’re taking, but because they have that risk to start with,” said Worly. “For those patients, it’s important that they have a good relationship with their healthcare provider so they can get the appropriate screening done – regardless of the medications they’re on.”

Worly said patient concerns are valid, and he wants women to continue having open and honest discussions with their doctor about which options work for them. “We live in a media-savvy age where if one or a few people have severe side effects, all of a sudden, that gets amplified to every single person,” he said. “The biggest misconception is that birth control leads to depression. For most patients that’s just not the case.”

Most women have tried at least one method of contraception in their lives, with nearly 37m women in the US currently using birth control – 67% current users have opted for a non-permanent hormonal method such as an oral pill, but among those, 30% have discontinued their use due to dissatisfaction with potential side effects.

Abstract
Objective: We performed a systematic review to look for an association between progestin-only contraception and depression.
Methods: We searched PubMed, Ovid and Web of Science for English-language articles including progestin-only contraception and depression from database inception to September 2016. We evaluated study quality with the procedures guiding reviews for the United States Preventive Services Task Force and the Cochrane Risk of Bias Tools. We included studies that evaluated progestin-only contraception and depression, focusing on externally validated depression measures. We excluded case studies, review articles and other psychiatric disorders.
Results: We identified 26 studies that met the inclusion criteria, including 5 randomized controlled trials, 11 cohort studies and 10 cross-sectional studies. We found minimal association between progestin-only methods and depression. No correlation with depression was found in five low-quality, high-risk-of-bias progestin subdermal implant studies and four out of five varying-quality and medium-risk-of-bias levonorgestrel intrauterine device studies. Three medroxyprogesterone acetate intramuscular injection trials with varying levels of quality and bias show no difference in depression. Two progestin-only contraceptive pill studies with varying levels of quality and bias indicate no increase in depression scores, while one good-quality, medium-bias study shows an association between progestin-only pills, the intrauterine device and depression.
Conclusion: Despite perceptions in the community of increased depression following the initiation of progestin contraceptives, the preponderance of evidence does not support an association based on validated measures (mostly level II-1 evidence, moderate quality, low risk of bias).

Authors
Brett L Worly, Tamar L Gur, Jonathan Schaffir

The Ohio State University Wexner Medical Centre
Contraception abstract
www.contraceptionjournal.org/article/S0010-7824(18)30032-5/fulltext


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