Does birth control increase depression?

Chelsea is a 24-year-old female mother of one who has been using oral contraceptive (OC) since she was 15 years old. She has always experienced painful intercourse, so her gynecologist referred her to pelvic floor physical therapy. She has also struggled with depression for many years and is receiving mental health therapy. Chelsea has recently discussed stopping oral birth control because she wants to “see what happens with her hormones”. She was wondering if her birth control had any impact on her history of depression.

Based on the available research, the short answer is that there is not a definitive relationship between depression and oral contraceptives (OC); however, it is possible that certain individuals are more susceptible to depression symptoms when using oral birth control especially when they are younger, and their brains and hormones are still developing. 

For example, a study looked at 534 adolescent oral contraceptive (OC) users and 191 non-users which found an increased risk in experiencing a major depressive episode up to 6 years after OC use, especially in women with no history of a major depressive episode in adolescence.1 The adolescents who used OC and had a history of major depressive episode(s) had less of a risk of future depressive episodes. In other words, OC use did not increase the risk of depression in those who had already experienced a previous depressive episode.

Another study looked at 4,765 adolescent U.S. females 13-18 years old and found no relationship between ever using OC and lifetime depressive disorder or current use and current depressive disorder.2 There were increased odds of current and lifetime depressive disorders in users versus non-users; however, it is important to note that users were more likely to be older, had sex at younger age, and used cigarettes than non-users which could contribute to the increase likelihood of depressive disorders.2 A study of 1,010 adolescents over 9 years found when all age groups were combined (16, 19, 22, and 25 years old) there was no overall association with depressive symptoms.3 However, 16-year-old contraceptive users showed higher depressive symptom scores as compared to those who did not use oral contraceptives. Adolescent users reported more crying, excessive sleepiness, and more eating concerns than non-users. This indicates that younger adolescents, such as 16 years old, may be more influenced by OC.3 

For those who are postpartum and use hormonal birth control, a review found that there was no increase in postpartum depression with hormonal birth control use.4 One study found a 35-44% decreased risk of postpartum depression when using progestin-only pills and levonorgestrel IUDs.4 

While OC use was not associated with increased depressive symptoms or depressive disorders overall, it was consistently associated with more severe insomnia symptoms.5 

The research does not support a clear relationship regarding oral contraceptives and increased risk of depression. There is some indication that certain individuals may experience more depressive symptoms and a higher instance of insomnia as compared to non-users. This just highlights the “importance of accounting for individual differences” with OC use.5 It is very important to discuss all possible medication side effects, including hormonal birth control, with your medical provider and to adjust your contraception method accordingly based on your individual needs.

Written by Jordan Schmidt, PT, DPT

References

1. Anderl, C., de Wit, A. E., Giltay, E. J., Oldehinkel, A. J., & Chen, F. S. (2022). Association between adolescent oral contraceptive use and future major depressive disorder: a prospective cohort study. Journal of child psychology and psychiatry, and allied disciplines, 63(3), 333–341. https://doi.org/10.1111/jcpp.13476
2. McKetta, S., & Keyes, K. M. (2019). Oral contraceptive use and depression among adolescents. Annals of epidemiology, 29, 46–51. https://doi.org/10.1016/j.annepidem.2018.10.002
3. de Wit, A. E., Booij, S. H., Giltay, E. J., Joffe, H., Schoevers, R. A., & Oldehinkel, A. J. (2020). Association of Use of Oral Contraceptives With Depressive Symptoms Among Adolescents and Young Women. JAMA psychiatry, 77(1), 52–59. https://doi.org/10.1001/jamapsychiatry.2019.2838
4. Ti, A., & Curtis, K. M. (2019). Postpartum hormonal contraception use and incidence of postpartum depression: a systematic review. The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception, 24(2), 109–116. https://doi.org/10.1080/13625187.2019.1569610
5. Morssinkhof, M. W. L., Lamers, F., Hoogendoorn, A. W., de Wit, A. E., Riese, H., Giltay, E. J., van den Heuvel, O. A., Penninx, B. W., & Broekman, B. F. P. (2021). Oral contraceptives, depressive and insomnia symptoms in adult women with and without depression. Psychoneuroendocrinology, 133, 105390. https://doi.org/10.1016/j.psyneuen.2021.105390