Is there a link between oral contraceptives and depression?

A new study in JAMA Psychiatry provides another reason to recommend long-acting reversible contraceptives to adolescent female patients: oral contraceptives may increase the risk of depression.

Researchers used data from the third to sixth wave of the Tracking Adolescents’ Individual Lives Survey, which was conducted between September 2005 and December 2016. The data included women aged 16 to 25 years who had completed at least 1 assessment on oral contraceptive use. Symptoms of depression were assessed by the Diagnostic and Statistical Manual of Mental Disorders, 4^th edition- oriented affective problems scale of the Youth when the respondents were 16 years old and adult self-report when the respondents were aged 19, 22, and 25 years.

The data had a total of 1010 girls, between 743-903 depending on the wave, to analyze. The average age at first assessment of oral contraceptive use was 16.3 years and average age at the final assessment was 25.6 years. At 16 years of age, girls who used oral contraceptives had a pronounced difference from nonusers, with the nonusers having a higher average socioeconomic status (0.17 [0.78] vs –0.15 [0.71]) and more likely to have no history of sexual activity virgins (424 of 533 [79.5%] vs 74 of 303 [24.4%]). When all users were combined, they did not show higher depressive symptoms score than nonusers. However, adolescents users did have higher depressive symptom scores than nonuser, which persisted even after taking into account age, ethnicity, and socioeconomic status (β coefficient for interaction with age, –0.021; 95% CI, –0.038 to –0.005; P = .0096).  Commonly reported issues among adolescent users included more eating problems (odds ratio, 1.54; 95% CI, 1.13-2.10; P = .009), more crying (odds ratio, 1.89; 95% CI, 1.38-2.58; P < .001), and hypersomnia (odds ratio, 1.68; 95% CI, 1.14-2.48; P = .006).

Researchers concluded that a link between oral contraceptives and depression may exist, at least in teenagers. They stated that providers should monitor for signs of depression in their adolescent oral contraceptive users because the loss in quality of life could increase the risk of nonadherence to the medication.