Does the PILL make you sad?
(If this week wasn’t depressing enough already)
Birth control pills reign supreme in the world of hormonal contraception. 50 years later, they are the most favoured option with billions of women using them. Yes, billions. Men apparently complain too much about side effects to make male contraception viable, which means zero men are using any form of hormonal prevention. Yes, zero. So the onus is still on women and women are bombarded with conflicting advice on the Pill.
The latest headline is the Pill causes depression.
The most recent study that has caused quite the frenzy is one that has linked depression with hormonal contraception. One frequently shared article reads “The Pill is Linked to Depression and Doctors can no Longer Ignore it.” I don’t know about that. Actually I do, and I don’t think it’s fair.
Don’t get me wrong, synthetic hormones aren’t healthy for us for multiple reasons. However, they do have some benefits and I definitely don’t want to overstate their harms including the risk of low mood and depression.
This study found that every year 2.2% of women using hormones were prescribed antidepressants versus 1.7% of women who weren’t using hormones. That’s a difference of 0.5%. The scale they used doesn’t really suggest diagnosis of depression because 50% of women are prescribed antidepressants for a whole host of other reasons such as physical pain, PMS, insomnia, IBS, and stopping smoking. So how can we use the taking of antidepressants as a marker for depression? We can’t.
Remember too that people who take prescriptions like the Pill probably have a relationship with their doctor, which makes them also more likely to be treated for other conditions. Comparing these women to women to don’t take the Pill might be measuring doctor/patient relationships more than rates of depression.
Why is there an association at all?
Fluctuating levels of progesterone in adolescence are linked with higher rates of depression amongst women than men. This is probably why the progestin (synthetic progesterone) in the Pill are associating with depression. It’s probably also why the progestin-only pill and the vaginal ring is linked even moreso to depression than Pills with lower levels of progestins.
In the same study, comparing the same groups to see how many women were actually diagnosed with depression reveals some interesting things. 0.3% of women taking hormones were diagnosed with depression vs. 0.28% not on hormones. That’s 0.02% of a difference. Having said that, the highest increased rate of depression was in adolescent women coming back to the idea that teenage women are more susceptible to hormone fluctuations enabling depression.
To put this study into relatable terms, for every 300 women to take hormonal birth control 1 will be prescribed an antidepressant. That number might be valuable to you. It might not be.
How effective is the Pill anyway?
There is 0.2% chance of unintended pregnancy with the pill or IUD as opposed to 4% chance with fertility monitoring methods and 2% chance with PERFECT use of a male condom. Having said that there are novel programs that combine digital monitoring with physical signs to hone in on when women are most fertile. We’ll discuss this later.
I want to provide a brief overview of most relevant side effects of hormonal birth control (and how often they occur):
- Irregular bleeding or loss of period (2-3%)
- Blood clots (1.5 per 10,000 users per year) with the greatest increase with higher dosages of hormones.
- Breast cancer (3 cases per 1000 women vs 2 cases per 1000 women without the Pill) although simultaneously decreases risk of ovarian and uterine cancer (50% reduction).
- Folic Acid, Vitamins B2, B6, B12, vitamin C and E and magnesium, selenium and zinc are all associated deficiencies with hormonal birth control. Given that just B12 alone is associated with depression it’s crucial to supplement these nutrients to replenish both the deficiency and reduce the increased risk of any side effect including mood changes. What if vitamin deficiencies are responsible for the negative changes we see with the Pill?
- Important note: Many women look to herbals therapies like St Johnswort to help with depression symptoms. It cannot be taken with oral birth control because it significantly reduces the efficacy, which makes the Pill pointless as contraception. There are however, MANY other natural supports women can use to support side effects from the Pill or to treat depression.
Contraception meets the digital age
An app called Natural Cycles (https://www.naturalcycles.com/en/) is making headlines for being an advanced period tracker that with a sensitive thermometer and fancy math tells women where they are in their cycle. One main feature is the ability to predict ovulation therefore warning women when fertility is high. It’s been shown to be as good as birth control pills for preventing pregnancy, bearing in mind that you can’t have unprotected sex during the hilited ovulation days. The app is ideal for women wanting to conceive who track their cycles to maximize their chances. For women who aren’t interested in the Pill looking into apps like this and many other programs that currently exist might be more viable.
Women respond differently to the different methods of contraception, which include the Pill, injections, IUDs of many varieties, implants, and rings. It’s important for every woman to go over their options, benefits and side-effects of each as well as what would be most suitable for them given their health history and current health status. For women who are already at higher risk of depression they may want to avoid the Pill and look into other options.
Related links:
JAMA study on depression and oral contraception
http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2552796
Male Contraception – Men need to toughen up and take birth control
https://star.txstate.edu/2016/11/14/men-need-to-toughen-up-and-take-birth-control/
Canadian Contraception Consensus SOGC
https://sogc.org/wp-content/uploads/2013/01/143E-CPG2-March2004.pdf
Antidepressants and Why they are prescribed
http://jamanetwork.com/journals/jama/article-abstract/2524175
Depression and Birth Control Critique
http://www.dallasnews.com/news/debunked/2016/10/07/freak-birth-control-depression-read
