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By Fiona Riddle

“…there are many potential downsides to these pills…”

Oral contraceptives, more commonly known as birth control pills, are prescribed to millions of women worldwide for preventing pregnancy as well as for mitigating painful periods, eliminating acne and numerous other reasons. However, there are many potential downsides to these pills such as the impact on natural hormones, an increased cancer risk and influences on the brain. Recent studies have suggested a potential association between these hormonal contraceptives and an increased risk of depression.

A 2023 study analyzed the risk of developing depression while taking oral contraceptives. The study pulled data from over 250,000 women and found that “the first 2 years of [oral contraceptive] use were associated with a higher rate of depression compared to never users.”

“…adolescents who were prescribed the pill had a greater risk of developing depression later in life.”

Additionally, adolescents who were prescribed the pill had a greater risk of developing depression later in life. Women who started taking oral contraceptives as teenagers had a 130% higher incidence of symptoms of depression. It is estimated that about 18% of teenagers aged 13-18 use these oral contraceptives.

Multiple other studies have shown similar findings such as a 2016 prospective cohort study and a 2018 pharmacoepidemiological study. Other studies, however, have not corroborated these findings and some have even found the opposite. These mixed results could be a result of the healthy user bias, in which those suffering from mental health side effects abstain from continuing use of oral contraceptives. Other factors such as individual biology, medical history, age of initial usage and the specific type of contraceptive used can all influence whether or not women experience depressive symptoms while on the pill.

“The hormones in birth control pills, typically a combination of synthetic estrogen and progestin, can affect neurotransmitters in the brain.”

It is clear, however, that these pills, especially when taken daily for many years, can have an impact on the brain. The hormones in birth control pills, typically a combination of synthetic estrogen and progestin, can affect neurotransmitter systems in the brain “including serotonergic, noradrenergic, GABAergic, dopaminergic, and glutamatergic systems.” These systems play a crucial role in regulating mood, emotion and cognition.

“Oral contraceptives can also alter brain structures and functioning…”

Additionally, the estradiol found in oral contraceptives binds to and activates estrogen receptors throughout the brain, “influencing neurotransmission, gene transcription and neurogenesis”. This can have an effect on cognition and, in particular, memory. Oral contraceptives can also alter brain structures and functioning by increasing prefrontal brain activation when processing “negatively arousing stimuli”. This in turn alters stress reactivity and could influence experiences of mood disorders.

There is strong evidence, however, that “estrogen has protective anxiolytic- and antidepressant-like effects,” which suggests estrogen itself does not increase stress reactivity. It is possible that the effects stem from chronic activation of these estrogen receptors in the brain through the use of oral contraceptives as opposed to the cyclical activation associated with a natural menstrual cycle.

Another potential explanation is the amount of and type of progesterone found in oral contraceptives. In a natural menstrual cycle, progesterone dampens the effects of estrogen by downregulating estrogen receptors. The popular combination pills contain synthetic forms of progestin, which could reverse or inhibit the positive effects of estrogen on the brain. Additionally, the role of estrogen in depression depends on other variables such as age, reproductive window, stress and genetics.

“….women of all ages should be informed of the possible consequences in order to monitor changes and make the best individualized choices.”

To summarize, there is a possible association between oral contraceptive usage and depression, especially among those who begin using contraceptive pills during adolescence, however the exact mechanisms are not fully known. It is important to note, however, that the increased risk of depression is relatively small, with one study showing “2.2 out of 100 women who used hormonal birth control developed depression, compared to 1.7 out of 100 who did not.” Additionally, the increased risk likely occurs in the presence of other factors previously mentioned.

Regardless of the small effect, women of all ages should be informed of the possible consequences in order to monitor changes and make the best individualized choices. Further research should be conducted on the specific mechanisms at play as well as the impact of extended usage of oral contraceptives as long term effects remain fairly uncertain.

Fiona Riddle is a Certified Health Coach with a degree in Psychology from UCLA. She is passionate about a holistic approach to health when working with her private coaching clients. She is an avid cook, constantly creating and sharing new recipes on her Instagram (@feelgoodwithfi) to showcase simple clean home cooking. She has helped clients take their health into their own hands and successfully boost their energy and confidence through sustainable lifestyle changes. www.feelgoodwithfi.com