The Triple Helix @ UChicago

Spring 2018

"How Birth Control and Mental Health Go Hand-in-Hand" by Rebeka Pushkar

 

Hormonal birth control is an effective and generally safe method of preventing unwanted pregnancy. It is also often prescribed to teenagers in the United States to treat acne. Since birth control is a steroid-based drug, it can affect not only the menstrual cycle but also appetite, energy levels, and mood. Even though depression is often cited as a possible side effect, there are very few studies with precise data about the effect of birth control on mental health. This issue is worth exploring because many people go on birth control without any way of knowing how their body and mind might react to it. 

A comprehensive study on the topic was conducted at the University of Copenhagen, Denmark and published in JAMA Psychiatry in 2015.[1] A unique feature of the study that made it successful (apart from it being one of very few that even considers this topic) is Denmark’s wide and accessible databases such as the Psychiatric Central Research Register, used to monitor the diagnoses, and the National Prescription Register, used to monitor the prescription of antidepressants.[1] The study included more than a million participants between 15 and 34 years old who were monitored from January 1st, 1995 to December 31st, 2013. In the study, the scientists focused on specific types of hormonal contraception – combined oral contraceptives, progestogen-only pills, the patch, vaginal ring and levonorgestrel intrauterine system – and studied their effects on the rate of first diagnosis of depression and first prescription of antidepressants.[1] For as the measurement of the effect of birth control on mental health, the scientists used “rate ratios” which are a measurement of frequency computed by dividing the incidence rate of an outcome in an individual not on birth control by the incidence rate of an outcome in an individual on birth control. The incidence rate is simply the occurrence of an event divided by time.[2] 

The results of the study showed that the use of every type of contraceptive studied is associated with subsequent diagnosis of depression and prescription of antidepressants, with especially high risk for the patch and vaginal ring.[1] The risk also peaked in adolescents between 15 and 19 years old and around six months into use of birth control. Furthermore, the study showed a decrease in sensitivity to the effects of hormonal birth control on mental health with increase in age. Thus, the data clearly suggests a relationship between contraceptives and depression that is especially strong in adolescence. Even though the study corrected for age, body mass index, and smoking habits, there were still some points missed by the scientists. 

A pediatrics professor from Indiana University School of Medicine, Aaron E. Carroll, wrote an article for the New York Times identifying those missed points. In the article, he compels the reader to focus on the benefits of birth control before dismissing it as dangerous. Prof. Carroll also claims that the Danish study “is not a controlled trial, and [that it is] impossible to establish causality” [3], identifying a few specific omissions. Firstly, he claims that the sample size of women was very specific – the women who were monitored went on the pill voluntarily and have access to healthcare, therefore, they were more likely to get access to antidepressants – which is not representative of a large part of the population. Secondly, Prof. Carroll points out that depression is a possible but statistically improbable side effect, calling attention to less “newsy” studies that didn’t find a causal relationship between hormonal contraceptives and depression.[3]

In this article, Prof. Carroll calls out the media’s abuse of the medical ambiguity of a lot of issues associated with women’s health, which is an important issue. Carroll also advocates for birth control as a factor in reducing teenage pregnancy, citing statistics, and ends the article by advising women to consult their doctor before starting hormonal birth control.[3] However, he fails to emphasize the importance of a conversation about mental health in additionto continuous effort to make birth control more accessible around the world. Prof. Carroll’s criticism of the study pertaining to the skewed sample size of women highlights that it is likely that those who have limited access to birth control also have limited access to psychiatric help and antidepressants, which is a problem precisely because of the lack of research on mental health-related side effects.   

So, how do we reconcile the potentially adverse effects of hormonal birth control on an individual’s well-being and its success rate in preventing unwanted pregnancy? How do we even approach the question of mental health when talking about the part of the population that doesn’t have access to antidepressants or therapy as is? There is only one way to prevent this – to expand the conversation about women’s reproductive rights to include women’s mental health and ensure that more research is done on the issue to allow for accessible hormonal birth control and education for those who choose to use it. 

 

References

[1] Charlotte Wessel Skovlund, Lina Steinrud Mørch, Lars Vedel Kessing, and Øjvind Lidegaard. 

2016. “Association of Hormonal Contraception With Depression.” JAMA Psychiatry

73(11):1154–1162. doi:10.1001/jamapsychiatry.2016.2387. 

[2] “Rate Ratios,” Wikipedia, last modified 16 December 2017, https://en.wikipedia.org/wiki/Rate_ratio

[3] Carroll, Aaron. 2017. “Birth Control Causes Depression? Not So Fast.” New York Times

April 3, 2017.  https://www.nytimes.com/2017/04/03/upshot/birth-control-causes-depression-not-so-fast.html

 
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