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Why Are Former Contraceptive Pill Users More Likely to Report Depression?

A month's supply of the contraceptive pill in its blister packet.
Credit: Reproductive Health Supplies Coalition/ Unsplash
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A new study has shown that women who are taking the oral contraceptive pill are less likely to report depression.

The research, which analysed data from 6,239 women in the United States aged 18-55 years old, found that the prevalence of major depression amongst users of the oral contraceptive pill (OCP) was significantly lower, at 4.6%, compared to former OCP users (11.4%). 

The study was led by researchers at Anglia Ruskin University (ARU), alongside experts from the Dana-Farber Cancer Institute in Boston and University of California, Davis. 

The researchers suggest two possible explanations for their findings, which are contrary to a commonly held belief that OCP can cause depression.

One is that taking the pill can remove concerns about unwanted pregnancy, therefore helping to improve the mental health of OCP users. It is also possible the results could be influenced by “survivor bias”, where women who experience signs of depression while using OCP stop taking it, moving them into the category of former users.

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The cross-sectional study, which used data collected by the Center for Disease Control and Prevention in the United States, controlled for demographic characteristics, chronic conditions, and the use of antidepressants. 

In both users and former users, widowed, divorced or separated women, obese women or those with a history of cancer were more likely to report depression. In addition, in former users, depression was more commonly reported in women who were Black or Hispanic, were smokers, had lower levels of education, or were experiencing poverty.

Lead author Dr Julia Gawronska, a Postdoctoral Research Fellow at Anglia Ruskin University (ARU), said: “Contraception is a crucial component of preventive health care. Most women tolerate taking the oral contraceptive pill without experiencing depressive symptoms but there is a subset of women that may experience adverse mood side effects and even develop depression, and the reasons are not entirely clear.

“Unlike some previous studies, we found that women currently taking the oral contraceptive pill were much less likely to report clinically relevant depression compared to women who previously took the pill.

“Taking the pill could provide positive mental health benefits for some women, simply by removing their concerns about becoming pregnant. The ‘survivor effect’ could also play a part, with women who experience symptoms of depression more likely to discontinue taking it, placing them into the group of former users.

“However, stopping taking the pill without a suitable alternative increases the risk of unintended pregnancy. It is important that women are fully supported, provided with full information, and offered alternative forms of contraception if necessary.”

Reference: Gawronska J, Meads C, Smith L, Cao C, Wang N, Walker S. Association of oral contraceptive pill use and depression among US women. J Affect Disorder. 2024;344:132-140. doi: 10.1016/j.jad.2023.10.041

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