Summary: In a large, long-term study of young women, researchers found no overall link between oral contraceptive use and the severity of depressive symptoms among females aged 16 to 25. However, 16-year-old oral contraceptive users reported modestly higher depressive symptom scores than their nonusing peers.
Source: Brigham and Women’s Hospital
Overview
Researchers from Brigham and Women’s Hospital in collaboration with University Medical Center Groningen (UMCG) and Leiden University Medical Center analyzed data from more than 1,000 young women to explore whether taking oral contraceptives is associated with depressive symptoms. Unlike clinical depression, depressive symptoms include subtler changes in mood and behavior — for example, increased crying, sleep disturbances, changes in appetite, low energy, guilt, or diminished pleasure. By following participants in a well-established longitudinal cohort and surveying them repeatedly over several years, the investigators were able to examine these subclinical mood symptoms across adolescence and early adulthood.
The peer-reviewed study, published in JAMA Psychiatry, reports that across the full sample of females aged 16 through 25, there was no measurable association between oral contraceptive use and overall depressive symptom severity. An important age-specific finding emerged: at age 16, girls taking oral contraceptives had higher depressive symptom scores — about 21 percent greater on average — than 16-year-old girls who were not using oral contraceptives.
“A common concern for teens and parents when starting the pill is whether it will affect mood right away,” said corresponding author Anouk de Wit, MD, PhD, MPH (formerly of Brigham and Women’s Hospital). “Because many women begin hormonal contraception during adolescence — a period of intense emotional and social development — monitoring mental health during this time is especially important.”
Hadine Joffe, MD, MSc, co-author and vice chair for Psychiatry Research at Brigham and Women’s Hospital, emphasized that depressive symptoms occur more frequently than diagnosed depression and can significantly reduce quality of life. “This is the largest study to date to examine these more subtle mood changes that concern girls, parents and clinicians, even when they don’t meet criteria for major depression,” she said.
Study design and methods
The investigators used data from female participants enrolled in the Tracking Adolescents’ Individual Lives Survey (TRAILS), a prospective cohort study from the Netherlands. Participants completed questionnaires about depressive symptoms at multiple study waves, generating a standardized depressive symptom severity score for each assessment. The analysis included responses from participants at ages 16, 19, 22 and 25, with data collection spanning 2005 to 2016.
Responses addressed symptoms such as crying, excessive sleeping (hypersomnia), appetite or eating problems, suicidal thoughts, self-harm, feelings of worthlessness or guilt, low energy, sadness and reduced ability to experience pleasure. The dataset included 1,010 women who completed between one and four assessments of oral contraceptive use and depressive symptoms.
Key findings
When combining all age groups (16–25 years), the researchers found no significant association between oral contraceptive use and depressive symptom severity. However, a focused comparison at age 16 revealed that girls using oral contraceptives reported higher depressive symptom scores than nonusers. Specifically, adolescent contraceptive users were more likely to report frequent crying, hypersomnia, and eating problems.
The authors caution that this relationship may be bidirectional: mood symptoms could prompt some teens to start oral contraceptives, or starting the pill could precede mood changes, or both. Observational data cannot establish causality, and the timing of symptom onset relative to contraceptive initiation varied between individuals.
Other study limitations include the relatively homogeneous Dutch sample, which may limit generalizability to more diverse populations. Strengths include the study’s large size, repeated measures across adolescence and early adulthood, and the focus on subclinical symptoms that are meaningful to patients and families.
Clinical implications
Although the observed increase in depressive symptoms among 16-year-old oral contraceptive users was small and did not meet criteria for major depression, the finding highlights the importance of monitoring mood in adolescents who begin hormonal contraception. Mild depressive symptoms can still affect daily functioning, quality of life, and adherence to contraceptive use. Clinicians, patients and parents should weigh these potential mood effects against the significant benefits of effective contraception, including prevention of unintended pregnancy and related medical and psychosocial risks.
The investigators note interest in studying whether long-acting reversible contraceptives (LARC) such as intrauterine devices — which deliver hormones locally rather than systemically — show a different relationship to mood symptoms than oral contraceptives.
“Providers, teens and parents should be aware that depressive symptoms may be more likely among adolescent oral contraceptive users,” said de Wit, “and should monitor mental health and address any concerns promptly.”
Funding
Dr. Joffe reports support from grants and research programs including the National Institutes of Health and various industry and foundation awards for unrelated work; she has also served as a consultant for several companies. These disclosures do not relate directly to the findings summarized here.
Source:
Brigham and Women’s Hospital
Media Contacts:
Serena Bronda – Brigham and Women’s Hospital
Image Source:
The image is in the public domain.
Original research
“Association of Use of Oral Contraceptives With Depressive Symptoms Among Adolescents and Young Women.” Anouk E. de Wit; Sanne H. Booij, PhD; Erik J. Giltay, MD, PhD; Hadine Joffe, MD, MSc; Robert A. Schoevers, MD, PhD; Albertine J. Oldehinkel, PhD. Published in JAMA Psychiatry. DOI: 10.1001/jamapsychiatry.2019.2838.
Abstract
Importance: Prior research has linked oral contraceptives to increased risk of later clinical depression in adolescents, but connections with concurrent depressive symptoms are less clear.
Objectives: To examine associations between oral contraceptive use and depressive symptoms, to assess how age affects this relationship, and to identify which specific symptoms relate to use of oral contraceptives.
Design, Setting, and Participants: Data were drawn from waves three through six of the TRAILS prospective cohort (September 1, 2005 to December 31, 2016), among females aged 16 to 25 who completed one to four assessments of contraceptive use and depressive symptoms. Analyses were conducted between March 1, 2017 and May 31, 2019.
Exposure: Self-reported oral contraceptive use at ages 16, 19, 22, and 25.
Main Outcomes and Measures: Depressive symptoms were measured with the DSM-IV–oriented affective problems scales of the Youth Self-Report at age 16 and the Adult Self-Report at ages 19, 22, and 25.
Results: The analysis included 1,010 females (age at first assessment mean 16.3 years; age at final assessment mean 25.6 years). While pooling all ages showed no overall association between oral contraceptive use and depressive symptom scores, 16-year-old users reported higher symptom scores than nonusers after adjusting for age, socioeconomic status and ethnicity. At age 16, contraceptive users were more likely to report crying, hypersomnia, and eating problems compared with nonusers.
Conclusions and Relevance: Overall, oral contraceptive use was not associated with depressive symptoms across ages 16 to 25, but 16-year-old users showed a modest increase in symptom scores. Monitoring depressive symptoms in adolescents using oral contraceptives is recommended to support quality of life and adherence.