Women taking the contraceptive pill and other hormonal contraception are more likely to be depressed. These are the findings from a Danish study published in JAMA Psychiatry and reported in an article on PubMed Health.
This was a large prospective cohort study which aimed to investigate whether using hormonal contraception is associated with the future use of antidepressants and a diagnosis of depression.
More than 1 million women aged 15 to 34, with no prior history of depression, were included in the study [and followed for 13 years].
The researchers compared users of hormonal contraception with non-users and found users were more likely to be prescribed antidepressants and diagnosed with depression.
This study found that those women who used the pill were 23% more likely to use antidepressants.
And here are the connections between antidepressant use and these other birth control methods (categorized by estrogen type and dose, progesterone type and the method of contraception):
- progestogen-only pill – 34% more likely to use antidepressants
- levonorgestrel intrauterine system (IUS) – 40% more likely to use antidepressants
- vaginal ring (etonogestrel) – 60% more likely to use antidepressants
- contraceptive patch (norgestrolmin) – 100% more likely to use antidepressants
The study authors state this:
it’s important to note this study is not able to prove that the contraceptive methods are responsible for the depression, only to find possible links to investigate further.
The researchers don’t advise that women should stop using their contraception, just that further studies are needed. If this association is found to be true, depression may have to be added as a possible side effect of hormonal contraception.
My fellow nutritionist Karla Maree says this: ‘we’re going to need black box warnings on these medications” and I agree. It’s disappointing that the researchers say further studies are needed.
Dr. Daniel Amen sees the association in his practice and shared this about birth control pills when I interviewed him during season 3 of the Anxiety Summit.
Unfortunately, they drop serotonin levels. You’ve got to ask yourself why are 23 percent of women between the ages of 20 and 60 taking antidepressants. In large part, it’s the birth-control pills that are changing the hormones in their brain, the neurotransmitters in their brain. All of a sudden, they’re more anxious and they’re more depressed.
Birth control pills also can drop magnesium. Magnesium is a natural calmer to nerve cells. They literally can change things.
We know the pill can also deplete vitamin B6 and folate, and can raise copper levels so these are likely some of the additional reasons we see mood changes in women taking them.
You may have noticed that Dr. Amen mentions 23 percent in our interview – which was actually done in May 2015. He is referring to a 2011 report released by the National Center for Health Statistics:
- the rate of antidepressant use in this country among teens and adults (people ages 12 and older) increased by almost 400% between 1988–1994 and 2005–2008.
- 23% of women in their 40s and 50s take antidepressants, a higher percentage than any other group (by age or sex)
- women are 2½ times more likely to be taking an antidepressant than men
Is this related to hormonal birth control? Very likely! I’m not in favor of any of these hormonal birth control methods and know from experience that they often cause both depression and anxiety in my clients but seeing these percentages is still shocking!
It’s quite strange how many of my clients don’t think of birth control as having side-effects or being as “bad” as other medications. This was certainly the case for me. I’ve very seldom taken medications in my life but I did use the pill and then an IUD for a short while, and initially I didn’t give either a second thought. But I’m sure they were part of the perfect storm that contributed to my anxiety and panic attacks in my late 30s. I was prescribed an antidepressant at this time but chose not to take it, instead searching for nutritional solutions.
During my search for answers, I read tons of books and one book has had a huge impact on me: Taking Charge of Your Fertility by Toni Weschler. It offered a powerful non-hormonal option for birth control: the Fertility Awareness Method or FAM and gave me so much insight about my body and hormones. It’s also something I now share with my clients. It deserves an entire review so stay tuned. For now, you can check out an overview on her website.
My version of the book was published in 1995 and Toni now has a new revised 2015 edition: Taking Charge of Your Fertility, 20th Anniversary Edition: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health.
What about you? Do you consider birth control more acceptable than other medications? Are you or were you on birth control and an antidepressant? And do you/did you feel that the birth control affected your mood and contributed to your depression or anxiety?
Or did it improve your symptoms (some women do report a better mood)?
Have you considered or used FAM as an alternative method of birth control? (or pregnancy achievement?)
Have you been offered birth control because of heavy periods or PMS? There are better ways to deal with this and one approach would be to address low serotonin levels with tryptophan.
If you’re in menopause and have no need for this information, please pass it on to your daughters and grand-daughters, nieces, sisters and girlfriends.
What a great article-thank you! How do bcp’s increase copper? I have been experiencing Rosacea symptoms and according to the Medical Medium Anthony William copper buildup in the liver plays a big part. How long could it potentially take to rebalance your systems once off the pill?
Sam
Many medications cause what we call drug-induced nutrient depletions. For example in this paper it is reported that “Use of combined estrogen-progestogen contraceptives resulted in a significant decrease in serum zinc levels within 3 days and an increase in serum copper levels within 10 days. ” https://www.ncbi.nlm.nih.gov/pubmed/6444895
Estrogens in contraceptives also play a role: “Estrogen along with progestogen is the most widely used form of contraceptive by women. Its use in any dose, form or route has been shown to increase serum copper and ceruloplasmin levels in humans and rats. However, its effect on plasma zinc levels is not established unequivocally. We demonstrated in female Long-Evans-Hooded rats that 4 weeks after implantation with 17 ß-estradiol their serum copper and ceruloplasmin and brain copper levels increased while hepatic copper levels decreased significantly.” https://link.springer.com/chapter/10.1007/978-1-4613-0537-8_13
This paper discusses “oral contraceptives with antiandrogen effective progestins” https://www.ncbi.nlm.nih.gov/pubmed/9805216
Often addressing low zinc with zinc supplementation can help.
Dr. Jolene Brighten has an excellent article for those struggling with post BCP syndrome https://drbrighten.com/post-birth-control-syndrome/
Trudy,
While I note that this study was for women 15 to 34 followed for 13 years, I feel the need to share a longer term outcome of the use of birth control pills as a now 72 year old woman. I have no proof of what is related to what, but this post brings forth the long suspicion that I have had for several years–that birth control pills for about 17 years, hormone replacement therapy after a total hysterectomy for 18 years, and hormone blocking medication (aromosin) after a lumpectomy in 2008 for five years have contributed to my own anxiety and depression issues. Two other possible factors that I believe might have had an impact on my total health picture are that I learned after her death that my Mother apparently maintained her pregnancy with me by taking DES and my Dad suffered from depression that was never treated. I can now see that I grew up with parents overwhelmed by their own sorrows and unmet dreams but I think my health issues were deeper than that. After a lot of my own seeking answers to “why” I have pretty much found my peace but I have felt very alone in the search so I am sharing this brief history of my health story for your consideration if you feel it has any relevance for your research or interests. You are serving a real need for women of today.
I began taking birth control pills when I got married in 1966. Who knows what affected me then, but with reflection I know I experienced a LOT of anxiety and tearfulness that didn’t make sense. My periods were more regular but I fought tears all the time. I was happily married but even during my high school and college years I knew I felt “different” from my peers. How that complicated things I will never know, but in my heart I knew I would never have the energy or temperament to have a career outside our home even though I would have liked to. I had healthy pregnancies in 1969 and 1972. Between then and 1984 I took birth control pills–whatever they were at the time. Never having had excessive energy anyway, I really didn’t know how I was supposed to feel but I can see a lot of self protective strategies were at play because of high anxiety and self esteem issues. In 1984 I turned forty three weeks after my 83 year old Mother suddenly passed, just as I was beginning chemotherapy to treat a rare kind of taratoma which is a form of germ cell ovarian cancer that was curable. When I returned for my second series of treatments after the funeral an astute nurse observed that it was interesting that I wasn’t angry. In fact, I was pretty screwed up and the menopausal women I did NOT want to be.
With educational pursuits, a lot of reading and intentional inner work since that time I recognize a family history of unresolved and complicated grief that contributed to my stress and anxiety but the physical dimensions have been both fascinating and frustrating. I took hormone replacement therapy for about 18 years after I completed chemotherapy–a recommended procedure at the time. Along with this I was taking 5 mg of simvastatin to treat elevated cholesterol. I learned that I could not take anything to prevent osteoporosis. Parallel to all this, I was counseling and taking antidepressants with some relief of anxiety symptoms but I had this nagging feeling they weren’t really getting at the source of them. In 2008 a mammogram caught a small lump in my right breast so I had a lumpectomy, took radiation and started the hormone blocker, aromosin which I managed to take for the recommended length of time but with hot flashes (again) and a burning discomfort in the last few months. While I was taking a minimal dose of simvastatin, when I stopped taking the aromosin I was weak and more depressed than ever so I stopped that. For the first time in 50 years I now take no prescription medicine.
Make no mistake, I have come to feel that I am blessed that I only have to flow with the ups and downs of depression and anxiety and knock on wood no other autoimmune diseases but I am very thankful for the nutritional information that Functional Medicine is now offering. My question has long been, what are the connections between estrogen, cholesterol and insulin so this is now my focus of interest. What was causing what I can only guess. Now it’s supplements only ! I have been taking a multi vitamin and calcium for several years. Along the way, I have added fish oil, Vitamin D, Vitamin B12, CoQ10 and most recently magnesium and Vitamin K-hopefully in the correct forms. It has been a long slow process, but I feel better than I ever have–if I get my sleep. That is still somewhat problematic but better than it used to be.
So, I thank you and your colleagues for all the webinars that you have presented. They have been and I am sure will continue to be very helpful for me. We are blessed with the information technology that is available and hopefully will improve our personal health pictures and reduce health care costs for future generations.
Orla,
Thank you for sharing your personal journey. I think every woman who has gone through a tough spell feels very isolated and alone, some for decades. Over the years I have found the sleep is especially critical in wellness. I successfully broke my poor sleep patterns (waking up between 2 and 3 in the AM for 30-90 min.) by correcting diet, use of essential oils (vetiver on the bottom of my feet), and good early AM exercise in the sunlight (with skin and eyes exposed early in the AM as I learned from one of Trudy’s blogs). After 6 years it’s rare I don’t sleep well 6 out of 7 nights a week. I’d be interested in hearing Trudy’s views on the essential oils.
Good luck on you journey!
Jolene
I’m a big fan of essential oils for sleep, anxiety and much more! Glad to hear the AM light is helping too
Orla
Thank you for sharing your journey – I’m sure all that you describe had an impact – very likely staring with the DES your mother was prescribed. And you are correct, there is the estrogen/copper factor and the cholesterol/hormone factor (we need cholesterol to make our hormones).
I’m so glad you have discovered functional medicine and are on your healing journey! So glad you enjoy the webinars and summits – I love that it’s allowing us to reach so many people with this information
For sleep I always consider low serotonin, low GABA, high cortisol, low blood sugar to start.
(My apologies – it seems I missed commenting on all of these on this blog post)
Hi Jolene , question how did you change your diet? from what to what….?
I am wondering what is the mechanism in which birth control lowers serotonin levels?
Thank you!
Cristina
Many medications cause what we call drug-induced nutrient depletions. For example in this paper it is reported that “Use of combined estrogen-progestogen contraceptives resulted in a significant decrease in serum zinc levels within 3 days and an increase in serum copper levels within 10 days. ” https://www.ncbi.nlm.nih.gov/pubmed/6444895
With oral contraceptives “It has been shown that the key nutrient depletions concern folic acid, vitamins B2, B6, B12, vitamin C and E and the minerals magnesium, selenium and zinc.” https://www.ncbi.nlm.nih.gov/pubmed/23852908. Zinc, magnesium, folate, vitamin C and vitamin B6 are needed to make serotonin.
Other mechanisms relate to estradiol, progesterone and prolactin: oral contraceptives lead to lowered levels of endogenous estradiol “which could result in negative mood changes. In female cynomolgus monkeys on OCs a decreased prolactin response was observed, suggesting reduced serotonergic activity. Progesterone, however, may promote positive mood changes at low concentrations and negative mood changes at high concentrations due to biphasic effects on GABAergic neurons . Again, synthetic progestins as contained in OCs simultaneously act as progesterone receptor agonist and reduce the level of endogenous progesterone. In a meta-analysis Oinonen and Mazmanian suggest that the progesterone/estrogen ratio correlates to the direction of emotional changes.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4139599/
This paper discusses alterations in serotonin and corticosteroid metabolism https://www.ncbi.nlm.nih.gov/pubmed/7140295