Association of Hormonal Contraception With Depression – JAMA Network – Charlotte Wessel Skovlund, MSc1; Lina Steinrud Mørch, PhD1; Lars Vedel Kessing, MD, DMSc2; et al. – November 2016
Question: Is use of hormonal contraception associated with treatment of depression?
Spoiler alert: the answer is a resounding “yes”. all the patients who didn’t get antidepressants (which require a pain or depression diagnosis).
Progesterone is in all birth-control pills, yet women seeking contraception are given these pills almost routinely, and never with the warning that they could cause depression.
This could explain why women tend to be more depressed than men.
Findings: In a nationwide prospective cohort study of more than 1 million women living in Denmark, an increased risk for first use of an antidepressant and first diagnosis of depression was found among users of different types of hormonal contraception, with the highest rates among adolescents.
Meaning : Health care professionals should be aware of this relatively hitherto unnoticed adverse effect of hormonal contraception.
Importance: Millions of women worldwide use hormonal contraception. Despite the clinical evidence of an influence of hormonal contraception on some women’s mood, associations between the use of hormonal contraception and mood disturbances remain inadequately addressed.
Objective: To investigate whether the use of hormonal contraception is positively associated with subsequent use of antidepressants and a diagnosis of depression at a psychiatric hospital.
Design, Setting, and Participants: This nationwide prospective cohort study combined data from the National Prescription Register and the Psychiatric Central Research Register in Denmark.
All women and adolescents aged 15 to 34 years who were living in Denmark were followed up from January 1, 2000, to December 2013, if they had no prior depression diagnosis, redeemed prescription for antidepressants, other major psychiatric diagnosis, cancer, venous thrombosis, or infertility treatment.
Data were collected from January 1, 1995, to December 31, 2013, and analyzed from January 1, 2015, through April 1, 2016.
Exposures : Use of different types of hormonal contraception.
Main Outcomes and Measures: With time-varying covariates, adjusted incidence rate ratios (RRs) were calculated for first use of an antidepressant and first diagnosis of depression at a psychiatric hospital.
Nevertheless, before puberty, girls are found to be equally or less depressed than boys.6,7 The 2 female sex hormones—estrogen and progesterone—have been hypothesized to play a role in the cause of depressive symptoms.8–12
In a recent review, Toffoletto et al13 found initial evidence that sex steroid hormones have an influence on the cortical and subcortical regions implicated in emotional and cognitive processing.
Gingnell et al 14 found that use of combined oral contraceptives among women who previously had experienced emotional adverse effects resulted in mood deterioration and changes in emotional brain reactivity.
And this is my favorite:
The addition of progesterone to hormone therapy has been shown to induce adverse mood effects in women.
Yet, they hand it out to countless women (in all birth control pills) without a warning, or even a hint, of the possible mood depressant side-effect of this drug.
Such women might spend thousands of dollars on psychotherapy (like I did) to no avail, trying to “cure” themselves of their biologically induced depression. They might start taking anti-anxiety medications (benzodiazepines) and become physically dependent on them, unable to quit without great suffering. It seems to be OK with doctors to be “dependent/addicted” to prescribed drugs… unless those drugs are opioids.
Such cruelties arise from foisting standards on medical care with little regard for individual differences.
These days, doctors are directed by their corporate employers to assume all their patients are “standard humans” who respond to standard therapies and have the standard reactions to medications.
And, this increasing standardization is also a source of easily countable metrics which can be used to evaluate a doctor’s adherence to those standards.
If we as patients happen not to be “standard”, and suffer when standard treatments are applied, our doctors will still be penalized if they don’t show they handed out the “gold standard” treatments that have been decided on and decreed mostly by administrators and financial officers.
We statistical outliers are just collateral damage of the current efforts to standardize healthcare to make it less expensive, not for the providers themselves or their patients, but for the corporations employing the providers.
…external progestins, probably more than natural progesterone, increase levels of monoamine oxidase, which degrades serotonin concentrations and thus potentially produces depression and irritability.18
Clinical studies have indicated that changes in estrogen levels may trigger depressive episodes among women at risk for depression19 and that women with major depression generally have lower estradiol levels than do control individuals.20
If the medical establishment were honestly concerned about women with depression instead of only men, it seems they would be developing an antidepressant based on this information. But women are left to try to find the cause of their depression and cope on their own.
Freeman et al21 found that women with a faster transition to menopause followed by stable hormone levels had fewer depressive symptoms.
In a recent double-blind placebo-controlled study, 22 women were randomized to sex hormone manipulation with groserelin (gonadotropin-releasing hormone agonist) implant or placebo, which triggered subclinical depressive symptoms in the intervention group. The depressive symptoms were positively associated with the net decrease in estradiol levels.
In this study, use of all types of hormonal contraceptives was positively associated with a subsequent use of antidepressants and a diagnosis of depression.
That finding complies with the theory of progesterone involvement in the etiology of depression, because progestin dominates combined and progestin-only contraceptives.
Adolescent women who used hormonal contraception experienced higher risks than women in general.
Our data indicate that adolescent girls are more sensitive than older women to the influence of hormonal contraceptive use on the risk for first use of antidepressants or first diagnosis of depression. This finding could be influenced by attrition of susceptibility, but also that adolescent girls are more vulnerable to risk factors for depression.38
We must consider that not all depressed individuals are treated with antidepressants or seen at psychiatric clinics or hospitals.39
This is one of the problems that arises when incomplete information, like medication milligrams, are used out of context as proxies in studies of human symptoms (like in all the studies of opioids).
Moreover, antidepressants are prescribed for treatment of conditions other than depression, although depression is the main indication (approximately 80%) for the prescription of selective serotonin reuptake inhibitors.40,41
- Use of hormonal contraceptives was associated with subsequent antidepressant use and first diagnosis of depression at a psychiatric hospital among women living in Denmark.
- Adolescents seemed more vulnerable to this risk than women 20 to 34 years old. Further studies are warranted to examine depression as a potential adverse effect of hormonal contraceptive use.