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Can birth control cause depression?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Oct 18, 2021.

Official answer

by Drugs.com
  • Depression or mood changes have been reported to occur as a side effect with hormonal birth control, but are not usually common or permanent side effects.
  • Research looking at the link between depression and birth control is conflicting, but most studies do not find a strong association.
  • If you are experiencing worrisome mood changes or symptoms of depression, contact your doctor right away for an evaluation. Depression is a serious and common condition, and may occur in women separate from birth control use.

Symptoms of depression can vary widely but may include trouble sleeping or sleeping too much, low energy, feeling weak, fatigue, irritability, and changes in appetite or mood changes (feeling low, blue, or sad).

Before you start treatment with any form of birth control, tell your doctor if you are currently being treated for depression, have a history of depression, or have other mental health issues. Your healthcare provider can determine if hormonal birth control is the best form of contraception for you.

It is important to note that if you have been using the over-the-counter (OTC) herbal supplement St. John's Wort to treat depression, mood changes, or other conditions, it may reduce the effectiveness of hormonal contraceptives such as the pill, patch, shot, vaginal ring or implant. You may need an alternative or additional method of birth control. Speak to your pharmacist or doctor about this drug interaction.

For a complete list of side effects and drug interactions with birth control, please refer to the individual drug monographs, which you can find here.

Does birth control cause depression in studies?

Not all studies agree on whether hormonal birth control can cause depression or mood changes. Most published studies suggest that hormonal birth control does not lead to negative impacts on mood. Contact your healthcare provider for any questions you have related to depression or birth control.

The product labeling for the pill states mood changes may occur in some women. For example, 1% to 10% of women using ethinyl estradiol and norethindrone (brand examples: Lo Loestrin Fe or Junel Fe 1/20) have reported side effects like mood swings, depression, or a change in mood. These changes typically clear up in 2 to 3 months while continuing on birth control.

Depression has also been reported to occur with other forms of hormonal contraception, such as the patch, the implant, the vaginal ring, or the intrauterine device (IUD).

Some studies suggest that depression may be more common in:

  • younger women or teens
  • when using contraceptives with higher levels of estrogen
  • when using progestin-only products.

But researchers and clinicians agree that the concern over mood changes is not a reason to avoid hormonal birth control in most cases.

Studies

1. A large study from the Netherlands in 2021 looked at 12 randomized controlled clinical studies with 5833 participants to determine if there was a link between hormonal contraceptive use and symptoms of depression.

  • Researchers compared women using any form of hormonal birth control to women using birth control that did not contain hormones or a placebo (an inactive treatment).
  • Nine different types of hormonal contraception were compared with each other and a placebo.
  • The authors concluded that none of the hormonal contraceptives causes more depressive symptoms than placebo.

2. A review of multiple studies from 2016 looked at the safety of hormonal contraception and IUDs in women with depressive and bipolar disorder. Researchers found overall that use of oral contraceptives, levonorgestrel-releasing IUD and depot medroxyprogesterone acetate (Depo-Provera) was not associated with worse depression or bipolar disorder outcomes compared to women who did not use hormonal contraceptives. For example,

  • In one study of women diagnosed with depressive or bipolar disorder, researchers found oral contraceptives did not lead to mood changes over the menstrual cycle among women with bipolar disorder, but mood did change in women not using oral contraceptives.
  • A study in women using fluoxetine or placebo for depression treatment found no increase in measured depression in women who were either using or not using oral contraceptives.
  • One study found that adolescents using combined oral contraceptives (COCs) had improved depression scores after 23 months compared to placebo.

3. In contrast, a large, Danish prospective cohort study from 2016 followed over 1 million adolescents and women between the ages of 15 and 34 from 2000 to 2013. Researchers looked at the association between the use of contraceptives, and a first diagnosis of depression or first use of an antidepressant as compared to women who did not use hormonal birth control.

  • Women used a variety of birth control options, including combined oral contraceptives, progestogen-only pills, the patch, a vaginal ring, and a levonorgestrel intrauterine system (IUD).
  • The investigators found that use of all types of hormonal contraceptives was associated with a diagnosis of depression and antidepressant prescribing compared to women who did not use hormonal contraceptives.
  • Risks appeared higher with the use of progesterone-only forms, such as the progesterone-only pills, vaginal ring, and IUD.
  • Younger adolescents also appeared at greater risk than women in general.

Bottom Line

  • Studies evaluating the link between depression and birth control is conflicting, but most studies do not find a strong association.
  • If you have a history of depression, or are experiencing depressive symptoms now, be sure to tell your healthcare provider before you are prescribed any hormonal contraceptive.
  • Most healthcare providers agree that the concern over mood changes is not a reason to avoid hormonal birth control in most cases, but you may need further evaluation.
References
  • de Wit AE, de Vries YA, de Boer MK, et al. Hormonal contraceptive use and depressive symptoms: systematic review and network meta-analysis of randomised trials. BJPsych Open. 2021;7(4):e110. Published 2021 Jun 8. doi:10.1192/bjo.2021.64
  • McCloskey LR, Wisner KL, Cattan MK, et al. Contraception for Women With Psychiatric Disorders. Am J Psychiatry. 2021 Mar 1;178(3):247-255. doi: 10.1176/appi.ajp.2020.20020154.
  • Skovlund CW, Mørch LS, Kessing LV, et al. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016 Nov 1;73(11):1154-1162. doi: 10.1001/jamapsychiatry.2016.2387. Erratum in: JAMA Psychiatry. 2017 Jul 1;74(7):764.
  • Pagano HP, Zapata LB, Berry-Bibee EN, et al. Safety of hormonal contraception and intrauterine devices among women with depressive and bipolar disorders: a systematic review. Contraception. 2016 Dec;94(6):641-649. doi: 10.1016/j.contraception.2016.06.012.
  • Zettermark S, Perez Vicente R, Merlo J. Hormonal contraception increases the risk of psychotropic drug use in adolescent girls but not in adults: A pharmacoepidemiological study on 800 000 Swedish women. PLoS One. 2018;13(3):e0194773. Published 2018 Mar 22. doi:10.1371/journal.pone.0194773
  • Kaunitz A, et al. Patient education: Birth control; which method is right for me? (Beyond the Basics). Up to Date. Updated Feb. 2020. Accessed Oct. 18, 2021 at https://www.uptodate.com/contents/birth-control-which-method-is-right-for-me-beyond-the-basics
  • Roe, et al. Combined estrogen-progestin contraception: Side effects and health concerns. Up to Date. Updated Feb. 2021. Accessed Oct. 18, 2021 at https://www.uptodate.com/contents/combined-estrogen-progestin-contraception-side-effects-and-health-concerns

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