Does hormonal contraception exacerbate depression and anxiety?

From the Guidelines

Birth control does not increase depressive symptoms in women with depression compared to baseline or nonusers with depression. The relationship between hormonal contraceptives and mood is complex and influenced by individual factors including genetics, personal history, and hormone sensitivity 1. Some women may experience mood improvements on birth control, while others notice worsening symptoms. Those with a history of depression or anxiety may be more vulnerable to negative mood effects.

Key Considerations

• Hormonal contraceptives like combined oral contraceptives (containing estrogen and progestin) and progestin-only methods (mini-pills, implants, injections) may affect mood because sex hormones influence neurotransmitter systems in the brain that regulate emotions 1.
• Common hormonal methods that might affect mood include pills and injections, but the evidence suggests that these methods do not worsen depressive symptoms in women with depression 1.
• If you notice worsening depression or anxiety after starting birth control, consult your healthcare provider about switching to a different formulation or considering non-hormonal options like copper IUDs, barrier methods, or fertility awareness.

Monitoring and Next Steps

• It's essential to monitor your mood when starting any new contraceptive and report significant changes to your doctor rather than discontinuing use abruptly.
• The evidence from the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010, suggests that COC use did not increase depressive symptoms in women with depression compared with baseline or with nonusers with depression 1.

From the Research

Birth Control and Mental Health

The relationship between birth control and mental health, particularly depression and anxiety, is complex and has been studied extensively.

• Studies have shown that hormonal contraceptives may have both positive and negative effects on mental health, depending on the individual and the specific type of contraceptive used 2, 3.
• Some research suggests that hormonal contraceptives may increase the risk of depression and anxiety in some women, particularly those with a history of mental health disorders 4, 5.
• However, other studies have found that hormonal contraceptives may have protective effects on mental health, such as reducing symptoms of depression and anxiety in women with pre-existing mental health conditions 2, 3.

Key Findings

• A systematic review of 43 studies found that hormonal contraceptives were associated with a slight increase in the risk of depression development in women without previous mental disorders, but had protective effects in women with previous mental disorders 2.
• A study of over 200,000 women found that oral contraceptive use was associated with an increased risk of suicidal behavior, particularly in the first month of use, but that this risk declined with increasing duration of use 5.
• Another study found that oral contraceptive use was associated with more severe insomnia symptoms, but not with more severe depressive symptoms, in adult women with and without a history of depression 6.

Individual Differences

• It is essential to consider individual differences in experiences during birth control use, as some women may be more susceptible to negative effects on mental health than others 6.
• Women with a history of mental health disorders, such as depression or anxiety, may be more likely to experience negative effects on mental health while using hormonal contraceptives 3, 5.
• Healthcare providers should take individual aspects into account when selecting contraceptive methods to maximize benefits and minimize risks 2.