Can Birth Control Cause Depression?

Whether you just started taking birth control, or have been on The Pill for a while, you probably have questions about how contraceptives could impact your mood. Here's what experts and the research say about if birth control can cause depression.

Can Birth Control Make You Depressed? - The 28 day cicle of the contraceptive pill in the shape of a sad face
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As of 2020, more than six in ten sexually active women reported using birth control in the past year, according to the Kaiser Family Foundation (KKF) Women's Health Survey. Whether you're new to taking birth control or have been cycling through different forms of contraceptives for years, you likely have questions about how preventing pregnancy affects your mental health. You may be wondering, "Can birth control cause depression, anxiety, or mood swings?" These questions are totally valid.

When it comes to birth control and depression, there's a lot to unpack. Ahead, medical professionals answer the burning questions you have about the birth control-depression link, and what you should do if you suspect that your birth control is messing with your mental health. Just remember: If you're feeling depressed right now, there are resources that can help. You can make a free, confidential call to the Substance Abuse and Mental Health Service Administration's national helpline at 1-800-662-HELP(4357) any time. (Plus, here's how to help a friend with depression.)

How common is depression among birth control users?

The American Psychiatry Association (APA) defines depression as a serious medical illness that negatively affects your life. "Depression causes feelings of sadness and/or a loss of interest in activities you once enjoyed," according to the APA. "It can lead to a variety of emotional and physical problems and can decrease your ability to function at work and at home." Symptoms include sadness, depressed mood, change in appetite, increased restless activity such as pacing, slowed speech or movements, difficulty concentrating, indecisiveness, trouble sleeping or sleeping too much, and suicidal thoughts.

One of the most influential studies about birth control, published in 2016 in JAMA Psychiatry, found that over the course of a year, 2.2 percent of women using hormonal birth control were prescribed antidepressants compared to the 1.7 percent of women not using hormonal birth control. In the same study, taking non-oral forms of hormonal birth control — such as the ring, patch, and IUD — was associated with a three times higher risk of depression than the birth control pill, and women using a hormonal IUD were 1.4 times more likely to be prescribed antidepressants compared to women who were not on hormonal birth control. Unfortunately, researchers didn't explore why non-oral forms of contraception were associated with a higher risk of depression, so more research is needed to better understand the possible connection.

The connection between birth control and depression

While these statistics may be interesting and helpful when you're deciding what form of birth control is right for you, it's important to remember that this is an associative study. Meaning, the research can't definitely conclude that birth control causes depression; it simply shows that there's some link between the two.

This distinction is important for a few reasons, says Anisha Patel-Dunn, D.O., chief medical officer at LifeStance Health. First of all, researchers in this study only knew that a contraceptive user was depressed if they sought out medical treatment. And thus, there could be more folks living with depression who simply aren't represented in these statistics. Plus, depression affects about one in 15 adults each year per the APA, so researchers can't single out birth control as the factor that's causing depression. "Because so many women are using birth control, we would still expect to see that same prevalence [of depression] — but whether it's because of the birth control or not, is unclear," says Dr. Patel-Dunn.

She also points out that a 1999 study from Harvard published in JAMA Psychiatry found that women with a history of depression were more likely to experience mood worsening when on oral conception than those birth-control users with no history of depression, which is something to keep in mind if you have a similar health history. Although, it's important to note that this study was conducted on a fairly small sample size of around 700 people.

What's more, many folks in the scientific community just aren't satisfied with the quality of the research on this topic to make any conclusions about a possible link between contraceptive and mood, much less contraceptive and diagnosed depression, adds Amy Roskin, M.D., ob-gyn and chief medical officer of The Pill Club, a birth control delivery and prescription service. "Some research has found that use of hormonal birth control does not typically have a correlative impact on mood, says Dr. Roskin. "Other scientists have indicated that birth control can even help alleviate depression and anxiety, rather than exacerbating it. Translation: Current research simply doesn't draw a straight line between anxiety and birth control use.

The research is so inconclusive, in fact, that Planned Parenthood doesn't even list depression as a side effect of the birth control pill. There are also concerns over the quality of the research."While many of these [research studies] did not show a definitive association, a critical review of this literature revealed that all of it has been of poor quality, relying on iffy methods like self-reporting, recall, and insufficient numbers of subjects," Monique Tello, M.D., M.P.H., a contributor to Harvard Health, writes in an article questioning whether birth control can cause depression. "The authors concluded that it was impossible to draw any firm conclusions from the research on this birth control and depression."

All of this iffy research stems from the historical underrepresentation of women in medical research, particularly women of color. This is largely due to doctors' incorrect belief that women and men were the same on a cellular level, according to the National Women's Health Network (NWHN), and thus experts overwhelmingly chose to conduct research on men. Even by the late 20th century as researchers began to recognize the stark differences between medical interventions for men and women, they often chose not to forgo using women participants due to a lack of understanding of the menstrual cycle and how it may impact results in scientific research, per the NWHN. For example, in 1977, the Food and Drug Administration (FDA) recommended that women of "childbearing age" be left out of clinical research in the wake of a scandal involving a drug that turned out to cause birth defects. Leaving women's bodies out of research creates holes in the science and professional community's understanding of how women's bodies work and should be treated in the medical world — and research on birth control and depression is no exception.

To add another layer to a complex topic, Dr. Roskin also points out the possibility that some birth control side effects may be what's actually contributing to poor mental health. "It's possible that other symptoms of taking birth control, such as headaches, bloating, or weight gain, could contribute to depressive symptoms," she says. "For example, it has been shown that changes in weight can have an impact on mood, however, links between weight gain and depression are also complex.

The theme here? The medical community is divided on how seriously to take the current body of research studying the link between depression and birth control. That divide also comes into play when considering how different types of birth control affect mental wellbeing — but research is evolving. (More: Can Birth Control Make You Tired?)

Are certain forms of birth control more likely to cause anxiety and/or depression?

In 2022, contraceptive choices are abundant. From oral contraceptives to IUDs to patches, there's no shortage of ways to protect against unwanted pregnancy. But if you're wondering which type of contraceptive will have the lightest touch on your mental health, the jury is still out on that as well (sorry!), says Dr. Tello.

"Most studies that have analyzed the relationship between birth control and depression have focused on hormonal birth control like birth control pills and non-copper IUDs, the NuvaRing, and the birth control patch because of the two hormones — progestin and estrogen — that hormonal birth control contains," she explains. "Research findings on ties between hormonal IUDs — like other forms of hormonal birth control — and depression are mixed. However, the majority of people who use a hormonal IUD don't develop depression," adds Dr. Roskin. While some scientific studies have linked levonorgestrel, the synthetic progestin hormone emitted by the IUD, with mood swings and negative moods, the Mayo Clinic does not name any mental health conditions as side effects to levonorgestrel. Again, if it feels like there's contradicting research here (remember above with the IUD's association with depression?), it's because the research isn't yet air-tight.

Still, your feelings are valid and those gut instincts matter. So if you start to suspect that your birth control may be causing or contributing to a depressive state — or an altered mood of any kind — talk to your doctor.

What to do if you suspect your birth control may be making you feel depressed or anxious

If you have a history of depression, or just feel concerned that your new birth control may affect your mental wellbeing, ask your doctor what specific depressive symptoms you should note, says Dr. Patel-Dunn. "Some of [depression] prevention is just educating women before they start on birth control to look out for signs and symptoms of depression," she says. That way, you can identify how you're feeling immediately and seek medical advice if necessary.

"If you're worried that your birth control may be affecting your mood, you should definitely consult a licensed medical professional," says Dr. Roskin. They will be able to tailor an individualized diagnosis and treatment plan and get to the bottom of why your mood may have shifted — perhaps due to birth control, but most likely not, she explains. "I'd recommend scheduling a consultation with your health-care provider and sharing some of the symptoms you've been experiencing, as well as a timeline for when you felt a change in mood." Together with your doctor, you can decide if it's time to switch your birth control method, consider going on an antidepressant or opt for another intervention entirely. Remember: You're not alone.

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