Depression affects many of our patients. In the United States, the lifetime prevalence of major depression is 17%, approximately twice as common among women as among men.

According to the U.S. Medical Eligibility Criteria for Contraceptive Use, patients with depression may safely use all types of contraception, including hormonal methods, without restriction. While it is known that hormones are related to mood, the impact of hormonal contraception on depression is unclear. Multiple studies have investigated the possible effects of hormonal contraception on depression, with conflicting results. While a recent study in Denmark demonstrated an increased relative risk of depression in adolescents and women using hormonal contraception (RR 1.1-1.7, depending on type of contraception), the absolute risk of depression remained small (crude incidence in hormonal users 0.30 per 100 person-years vs 0.28 per 100 person-years in non hormonal users).

Nevertheless, the Denmark study resonates strongly, with many women believing that their birth control method causes them to feel depressed. Clinicians should watch for depressive symptoms and honor patients’ preferences whenever possible. A safe method chosen by the patient is the one that’s most likely to succeed.

Helpful Resources

Medical Eligibility Criteria for Initiating Contraception

Sources

Karg RS, Bose J, et al.  Past Year Mental Disorders among Adults in the United States: Results from the 2008-2012 Mental Health Surveillance Study.  SAMHSA.  October 2014.

Skovland CW et al.  Association of hormonal contraception with depression.  JAMA Psychiatry 2016 September 28. [ep-pub]

Pharma-free

The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.