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If you’re thinking about using hormonal birth control, you may have some concerns because you’ve heard other women say that hormonal contraceptives have made them depressed. Or you may currently be experiencing some symptoms of birth control depression yourself.
There’s a valid basis for these concerns, as there’s a small, but real, chance of developing depression when taking hormonal forms of birth control.
Let’s look at the link between birth control and depression, and what you can do about it.
What’s the connection between hormonal contraception and depression?
It’s well known that hormonal changes can lead to mood swings. Natural changes in hormone levels are the reason for the mood changes that can happen in the days before your period (called premenstrual syndrome, or PMS) and also during menopause.
Just like natural hormonal changes, birth control that uses hormones to prevent pregnancy can affect your mood. But the effects of hormonal contraception on mental health are mixed. Hormonal birth control may (rarely) cause depression, but it’s also sometimes prescribed to treat mood disorders.
Every woman is different. Reactions to hormonal changes are very individual, and the side effects of hormonal contraceptives can vary a lot from woman to woman.
What are the different types of hormonal birth control?
There are many different types of hormonal birth control. Combined forms contain both progestin (a synthetic form of progesterone, which occurs naturally in your body) and estrogen. Progestin-only forms contain just progestin (InformedHealth, 2017). Here are some of the most common forms of hormonal birth control (Bansode, 2020):
- Pills—Birth control pills (oral contraceptives) come in two forms. Combined estrogen-progestin oral contraceptives (COCs) contain both progestin and estrogen. Mini-pills contain only progestin. Birth control pills are taken once a day.
- Patches—Birth control patches release estrogen and progestin into your bloodstream through your skin. They’re placed on your skin once a week for three weeks, then taken off for the fourth week to simulate your menstrual cycle.
- Implants—Contraceptive implants are flexible plastic rods, about the size of a matchstick, that contain progestin. They’re inserted under the skin of your upper arm, where they continuously release the progestin into your body for up to three years.
- Vaginal rings—Birth control vaginal rings are small, flexible rings that are inserted into the vagina, where they continuously release progestin and estrogen. They need to be replaced about once a month.
- Injections (birth control shots)—Contraceptive injections contain progestin only. The shot is injected into the muscles of your shoulder or buttocks, or under the skin of your abdomen or thigh, every 12 weeks.
- Intrauterine devices (IUDs)—IUDs are T-shaped plastic devices with strings attached for removal. This progestin-only device is inserted into the uterus and can remain there for three to five years. There’s also a non-hormonal IUD available (coated with copper) that lasts up to 10 years.
What does the research say about birth control depression?
Many studies have been done over the years to find out if there’s a link between hormonal birth control and depression. The results of these studies have been mixed—some found a connection, while others didn’t.
A critical review of studies done before 2016 found that there wasn’t enough consistency in how these studies were conducted to draw any useful conclusions from them (Schaffir, 2016).
The first big, well-designed study on the link between hormonal contraception and depression was done in 2016 in Denmark. The Danish study analyzed health records for over a million women of ages 15–34. It looked at a broad range of hormonal birth control types, including the pill, patch, implant, ring, and IUD, and at both combined and progestin-only types (Skovlund, 2016).
The researchers discovered that women who use hormonal birth control are, in fact, at a slightly higher risk of later being prescribed antidepressants than women who don’t use it. The risk, they found, is highest in young women, ages 15–19 (Skovlund, 2016).
While you might think the pill was the biggest culprit, the study showed otherwise. Non-oral types of hormonal birth control, such as the patch, IUD, and ring, were more likely to lead to antidepressant use than birth control pills. What is interesting about the IUD’s link to depression is that for many years healthcare providers have thought IUDs affect only the tissue where they are implanted—the uterus—and don’t affect the rest of the body.
Progestin-only forms of contraception also had a higher chance of causing depression, the study found.
More evidence for the possible link between progestin-only contraceptives and depression comes from a 2018 study. It found that women who developed postpartum depression had a high rate of previously using progestin-only contraceptives (Horibe, 2018).
What are the symptoms of depression?
If you, or your friends or family members, use hormonal contraception, you should know the symptoms of depression. Depressive symptoms include (Chand 2020):
- Changes in sleep (either more or less than usual)
- Loss of interest or pleasure in activities you used to enjoy
- Feelings of guilt or thoughts of worthlessness
- Fatigue or changes in your level of energy
- Loss of ability to concentrate or pay attention
- Changes in your appetite or weight
- Trouble performing ordinary physical tasks, or moving restlessly
- Suicidal thoughts
- Depressed mood (feelings of sadness)
If you’re experiencing these symptoms, be sure to speak with your healthcare provider. If you’re having thoughts of suicide or self-harm, contact the National Suicide Prevention Lifeline immediately.
Does this mean you shouldn’t take hormonal contraceptives?
Just because there’s a possible link between hormonal birth control and symptoms of depression, that does not necessarily mean you shouldn’t use this form of birth control.
The Danish study found that the increased risk of depression in women who used hormonal birth control was small. Only 2.2 out of 100 women who used hormonal birth control developed depression, compared to 1.7 out of 100 women who didn’t use it (Skovlund, 2016).
In other words, your chances of developing depression from taking hormonal contraceptives are slim.
But if you do experience mood symptoms, talk to your healthcare provider. The earlier you recognize and treat depression, the better the treatment results (Kraus, 2019). Your healthcare provider may recommend trying a different form of birth control—people can respond differently even to various forms of hormonal birth control.
If you’re diagnosed with depression, effective treatments are available. Discuss them with your provider. You may benefit from taking an antidepressant medication or from other forms of depression treatment, like exercise and talk therapy.
- Bansode, O. M., Sarao, M. S., & Cooper, D. B. Contraception. [Updated 2020 Jul 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK536949/
- Chand S.P., Arif H. Depression. [Updated 2020 Nov 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK430847/
- Horibe, M., Hane, Y., Abe, J., Matsui, T., Kato, Y., Ueda, N., Sasaoka, S., Motooka, Y., Hatahira, H., Hasegawa, S., Kinosada, Y., Hara, H., & Nakamura, M. (2018). Contraceptives as possible risk factors for postpartum depression: A retrospective study of the food and drug administration adverse event reporting system, 2004-2015. Nursing open, 5(2), 131–138. doi: 10.1002/nop2.121. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29599988/
- InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Contraception: Hormonal contraceptives. [Updated 2017 Jun 29]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK441576/
- Kraus, C., Kadriu, B., Lanzenberger, R., Zarate, C. A., Jr, & Kasper, S. (2019). Prognosis and improved outcomes in major depression: a review. Translational psychiatry, 9(1), 127. doi: 10.1038/s41398-019-0460-3. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30944309/
- Schaffir, J., Worly, B. L., & Gur, T. L. (2016). Combined hormonal contraception and its effects on mood: a critical review. The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception, 21(5), 347–355. https://doi.org/10.1080/13625187.2016.1217327. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27636867/
- Skovlund, C. W., Mørch, L. S., Kessing, L. V., & Lidegaard, Ø. (2016). Association of hormonal contraception with depression. JAMA psychiatry, 73(11), 1154–1162. doi: 10.1001/jamapsychiatry.2016.2387. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27680324/
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.