Reproductive health clinicians and their patients need more information about how hormonal contraceptives may affect people’s mood changes and depression, according to the authors of a recent paper.1
“There’s pretty consistent anecdotal data — just Google ‘the pill and depression,’ and you’ll find a whole lot of people talking about side effects,” says Natalie Tronson, PhD, lead paper author and an associate professor in the department of psychology at the University of Michigan. “That’s been true for a long time, and it’s probably less true now, but we don’t really know. In studies [looking at] mood changes and rates of depression at the individual level, there seems to be a benefit in mood for many women. For some women, there is an increased risk of depression or anxiety or negative mood, in general. That seems to be up to 10% of individuals who use hormonal contraceptives, including pills, IUDs, patch, and whatever.”
On a population basis, there is an increased rate of depression in people using hormonal contraceptives. But it does not mean everyone is at risk, Tronson adds. The range of people reporting a negative mood experience is 4% to 10% — a huge range.
“It speaks to how difficult this question is to study, and that’s for a lot of reasons, including how people who have negative side effects may stop taking the pill very quickly,” Tronson adds.
An important question for researchers is how to predict who will experience benefits in mood while on hormonal contraception, and who is at risk for negative moods and depression. “Which people will benefit the most from the hormonal contraception?” Tronson asks.
So far, most of the work has focused on people using oral contraceptives or in a study population of people using a mix of different kinds of hormonal contraceptives.
“The data suggest this is consistent across contraceptives, but we have better data on oral contraceptives of any kind,” Tronson explains. “There are some data that suggest there’s good reason to think that [having a] progestin component is an important contributor to mood-related changes, either positive or negative.”
Stress is another factor in hormonal contraceptive use. “We know from users of hormonal contraceptives there seems to be a change in the stress response,” Tronson says. “The stress system is sensitive to all kinds of hormones. It seems that in people who use hormonal contraceptives, there is a suppression of acute stress response.”
People taking hormonal contraceptives typically report a smaller increase in acute stress response. “That sounds like it should mean that people are more chill, but that’s not the case,” Tronson says. “But it suggests there is a modulation of how, physiologically, we respond to stress. Since there’s an important relationship between stress-signaling and mood disorders related to anxiety, what we wonder is whether the changes in stress response might cause different kinds of vulnerability to mood-related changes in different individuals.”
Although evidence is lacking, it is possible that an individual’s stress experiences, as well as genetic factors, may play a role in how their mood changes while taking hormonal contraceptives.
“We don’t know, though, and that’s a [difficult] question to study in people. But we can really effectively study it in rodent models,” says Tronson, who is beginning work on this type of research.
From a clinical perspective, the link between hormonal contraception and moods or depression suggests providers need to thoroughly screen patients for depression and anxiety.
“They’re incredibly busy and doing a lot of things,” Tronson says. “I think this is something where you have new guidelines out and screen for anxiety at check-up.”
Also, reproductive health providers can tell their patients that their mood might change while taking hormonal contraception, and they may want to give it a couple of cycles to see how they do before considering changing methods.
“We already do that for physical side effects, and we should do that for mental health issues as well, so patients don’t wonder why that’s happening to them,” Tronson says.
REFERENCE
- Tronson NC, Schuh KM. Hormonal contraceptives, stress, and the brain: The critical need for animal models. Front Neuroendocrinol 2022;67:101035. doi: 10.1016/j.yfrne.2022.101035. [Epub 2022 Sep 6].
Reproductive health clinicians and their patients need more information about how hormonal contraceptives may affect people’s mood changes and depression, according to the authors of a recent paper.
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