Can Yaz (drospirenone and ethinyl estradiol) birth control cause depression symptoms?

Yaz Birth Control and Depression Symptoms

Yes, Yaz (drospirenone and ethinyl estradiol) birth control can cause depression symptoms in some women, particularly those with a history of depression or mood disorders.

Risk Factors for Depression with Hormonal Contraceptives

• Women with a pre-existing history of depression are approximately twice as likely to experience mood deterioration when using hormonal contraceptives (OR = 2.0; 95% CI, 1.1-3.8) 1
• Individuals with pre-existing mood disorders may have increased sensitivity to estrogen fluctuations that could occur with hormonal contraception 2
• Age at onset of contraceptive use is a risk factor that may predict depression following hormonal contraceptive use 3
• Mental health history/susceptibility is a significant predictor of depression risk with hormonal contraceptives 3

Evidence on Hormonal Contraceptives and Depression

• The FDA label for ethinyl estradiol (a component of Yaz) specifically lists depression as an adverse reaction, stating: "Carefully observe women with a history of depression and discontinue if depression recurs to a serious degree" 4
• The link between oral contraceptive pills and depression relates to the amount and type of progestogen contained in these pills 5
• Drospirenone (found in Yaz) is specifically mentioned in research examining the relationship between hormonal contraceptives and depression 6
• Mood disturbances are associated with estrogen fluctuations and instability rather than just low levels 2

Prevalence and Presentation

• Depression is not considered a common side effect of hormone-based contraceptives, but it does occur in some women 7
• Approximately 16.3% of women report oral contraceptive pill-related premenstrual mood deterioration 1
• Some women (12.3%) actually report premenstrual mood improvement with oral contraceptive pills 1
• Symptoms can include mental depression, nervousness, and changes in libido 4

Clinical Considerations and Management

• Monitor patients with pre-existing mood disorders closely when initiating hormonal contraceptive therapy, particularly watching for signs of mood destabilization during the first weeks of treatment 2
• If depression occurs or worsens to a serious degree, discontinuation of Yaz is recommended 4
• Consider the temporal relationship between the use of hormonal contraception and development of new or worsened depression or mood changes 5
• For women with early-onset premenstrual mood disturbance or dysmenorrhea, oral contraceptives might actually improve mood symptoms (OR = 3.1 [95% CI, 1.9-5.2] and OR = 2.3 [95% CI, 1.4-3.9], respectively) 1

Alternative Options

• For women with a history of depression who experience mood deterioration with Yaz:
  • Consider alternative contraceptive methods with lower hormonal doses or different hormone compositions 8
  • Progestin-only contraceptives may be an option for some women 6
  • Non-hormonal contraceptive methods (barrier methods, copper IUD) may be appropriate alternatives 8

Important Caveats

• The relationship between hormonal contraceptives and depression is complex and not fully understood 7
• Individual responses to hormonal contraceptives vary significantly 3
• Some recent research suggests certain combined hormonal contraceptives (including those containing drospirenone and ethinyl estradiol) may actually be associated with a lower risk of depression in some populations 6
• Women appear to be differentially sensitive to the mood-destabilizing effects of changes in gonadal steroids 2