A 2016 retrospective study of more than a million women between the ages of 15-34 living in Denmark explored the question of whether hormonal contraception increases the rate of depression in its users.
The study found that use of any kind of hormonal contraceptive increased both first time antidepressant use and first diagnosis of depression, with rates highest among adolescents. The types of hormonal contraception in question included combined and progestin-only oral birth control, and progestin-based vaginal ring, patch and intrauterine device (IUD).
This news does not come as a surprise to many, as legions of women have complained of severe moodiness and depression while using hormonal contraception since its inception in 1960. Perhaps what is most surprising is how long it has taken the medical community to explore the mental and emotional risks of hormonal contraception.
Combined oral contraceptives act by preventing ovulation. LH and FSH levels are suppressed, a midcycle surge of LH is absent and endogenous steroid levels are diminished, preventing ovulation. The effect of the progestin-only is thickening of cervical mucus, thus decreasing sperm penetration and altering the endometrium so as to impair implantation.
These alterations in the body’s natural hormone levels have been shown to contribute to depressed mood, anxiety and increased irritability in women. As well, hormonal contraception is known to deplete folic acid, vitamins B2, B6, B12, C, E and the minerals zinc, magnesium and selenium. B vitamin deficiency specifically has been linked with depression and psychiatric disorders as B vitamins are required for the proper functioning of the methylation cycle, monoamine oxidase production, DNA synthesis and the repair and maintenance of phospholipids. Deficiency can influence memory function, cognitive impairment and dementia. In particular vitamins B1, B3, B6, folate and B12 are essential for neuronal function and deficiencies have been linked to depression. As well, magnesium deficiency has been associated with anxiety disorders and migraines, zinc plays a role in synaptic plasticity and the learning process and selenium is a cofactor in thyroid hormone production. The free radical scavengers vitamins C and E seem to play a role in the prevention of cognitive decline and research is being conducted to explore this further.
Oral contraceptives have been shown to induce depletions of nutrients which, along with hormonal changes, are likely contributors to depression and mood changes in its users. While these nutrients are present in a healthy diet, an additional vitamin supplement may help to bridge the gap for women using progestin-based synthetic hormones.
References:
Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016.
Palmery M, Saraceno A, Vaiarelli A, Carlomagno G. Oral contraceptives and changes in nutritional requirements. Eur Rev Med Pharmacol Sci. 2013;17(13):1804-13.
Borgström A, Odlind V, Ekselius L, Sundström-poromaa I. Adverse mood effects of combined oral contraceptives in relation to personality traits. Eur J Obstet Gynecol Reprod Biol. 2008;141(2):127-30.
Gingnell M, Engman J, Frick A, et al. Oral contraceptive use changes brain activity and mood in women with previous negative affect on the pill--a double-blinded, placebo-controlled randomized trial of a levonorgestrel-containing combined oral contraceptive. Psychoneuroendocrinology. 2013;38(7):1133-44.
Mikkelsen K, Stojanovska L, Apostolopoulos V. The effects of vitamin B in depression. Curr Med Chem. 2016.
Gray SL, Hanlon JT, Landerman LR, Artz M, Schmader KE, Fillenbaum GG. Is antioxidant use protective of cognitive function in the community-dwelling elderly?. Am J Geriatr Pharmacother. 2003;1(1):3-10.
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