Depression potential side effect of hormonal contraceptive use: Wiley
Oral contraceptive pills (OCPs) are the most commonly used
contraceptive measure, owing to their effectiveness and practicability. Women
in this region were more familiar with oral contraceptive pill use than other
ways of contraception. Women often use oral contraceptive pills (OCPs) to
prevent pregnancy or address menstrual symptoms. However, many of the women
discontinue the use following 6 months for a variety of reasons, including mood
changes.
Women are twice more likely to develop depressive disorder
than men. Incidentally, the prevalence of depression correlates with hormonal
changes in women, especially during puberty, before menstruation, post pregnancy,
and at perimenopause, suggesting hormonal fluctuations as a probable trigger
for depression.
Female sex hormones have been hypothesized to play a role in
causing depression. There are several proposed mechanisms to explain how sex
hormones affect mood. The first postulated theory suggests a decrease in
catecholamines because of hormonal contraceptives (HCs)-induced monoamine
oxidase (MAO) activation. Second, decreased conversion of tryptophan to
serotonin was suggested as a contributor to depression. Third, HC is suggested
to suppress vitamin B6 and B12 metabolism causing low serotonin and GABA.
Finally, HC dysregulates the HPA axis by elevating circulating cortisol levels,
which cause effects analogous to chronic psychological stress and depression.
HC has mixed effects on mood, ranging from improved mood to
worse mood or having no effect at all. These findings suggest that some women
may benefit from HC use, while others do not or even have a negative impact.
Most studies have discovered a connection between teenage use of hormonal
contraception and an increased risk of developing depression. The impact of
hormonal contraception on adult depression risk is less clear; some sources
contend there is either no increased risk or a decreased risk in adults.
Few randomized clinical trials revealed that OCP improved
depressive symptoms while increasing mood swings and irritability. Literature
shows mixed findings about the relationship of HC with depression. Therefore,
Sadia Sultan et al. aimed to examine the association between HC use and
concurrent depressive symptoms.
A cross-sectional study was conducted on 326 women of the
reproductive age group (15–49 years) attending the family planning unit of the
obstetrics and gynecology department of a medical college in Saudi Arabia. Their
sociodemographic and medical details along with the current use of any
contraceptives (hormonal, nonhormonal, or not using any) with duration were
collected. Beck depression inventory-II (BDI-II) was applied to the women to
assess for depression along with its severity, and a BDI score of >16 was
taken to denote clinical depression. Women were stratified by type of
contraceptive used, and its association with depression category was assessed.
A total of 326 consenting eligible women in the age group of
15–49 years were enrolled in the study of which 165 (50.6%) were currently
using a hormonal contraceptive and 49 (15.0%) were using a nonhormonal
contraceptive and the rest 112 (34.4%) were not using any contraceptives. There
was no significant difference in the mean BDI scores (p = 0.79) and degrees of depression (p = 0.06) between the HC users and
HC nonusers. However, individual symptoms of depression such as sadness (p = 0.01), reduced libido (p = 0.0002), feelings of pessimism
(p = 0.02), and failure (p
= 0.003) were found to be
significantly higher in the HC users than non-HC users.
Future prospective longitudinal studies should
systematically document the short- and long-term effects of using different
types of OCs (and other forms of hormonal contraceptives) on women’s mental
health; this may also help to identify further the specific biochemical
mechanisms underlying the observed association.
Authors conclude that there was no significant difference in
the mean BDI scores between the HC and non-HC user groups. However, there were
significantly increased depressive symptoms such as sadness, decreased libido,
and increased feelings of pessimism and failure in HC users. Study findings
suggest that depression can be a potential side effect of HC use. Furthermore,
longitudinal studies are required to warrant depression as an adverse efect of
HC use.
Source: Sadia Sultan et al.; Wiley Obstetrics and Gynecology
International Volume 2024, Article ID 7309041, 11 pages https://doi.org/10.1155/2024/7309041