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Adolescent oral contraceptive use is associated with a small yet meaningful increased risk of experiencing an episode of major depressive disorder (MDD) in early adulthood, especially among women with no history of MDD in adolescence.
This is the major finding of an analysis of data from the prospective cohort study TRacking Adolescents' Individual Lives Survey (TRAILS) in women aged 13 to 25.
The analysis in the Journal of Child Psychology and Psychiatry underscores one of the potential side effects of oral contraceptives, which will help women and their health care providers make informed choices among possible methods of birth control.
“Oral contraceptives are used by many women and are generally considered safe; however, several studies have suggested that their use may increase risk for depression, especially when oral contraceptives are used during adolescence,” said Albertine Oldehinkel, PhD, a professor of lifecourse epidemiology of common mental disorders at the University Medical Center Groningen in Groningen, The Netherlands.
Oldehinkel, who serves as principal investigator of the TRAILS study, said the evidence is mixed on oral contraceptives causing depression and that little is known about long-term effects of the birth control method after discontinuing use.
“In TRAILS, we followed women from early adolescence until young adulthood and collected information about both oral contraceptive use and depressive symptoms and disorders, so we had an excellent opportunity to shed more light on this issue,” Oldehinkel told Contemporary OB/GYN®.
The research team analyzed a variety of different models, 818 in total, among 534 adolescent oral contraceptive users and 191 nonusers.
The results indicated that adolescent oral contraceptive users were, across all models, on average 1.41 times (minimum estimation 1.08, maximum 2.18) more likely to have an episode of MMD in early adulthood than adolescents who did not use oral contraceptives (P < .001).
This association was mainly driven by adolescents with no history of MDD, who were on average 1.72 more likely to have an episode of MMD in early adulthood after oral contraceptive use.
“Associations between oral contraceptive use and depression had been reported before, and our results strengthen the evidence for this association,” Oldehinkel said. “In addition, it was interesting to notice that this connection was strongest for women who had not been depressed before.”
Because the TRAILS study was observational, “it is too early to jump to causal conclusions,” Oldehinkel said. “We therefore do not yet advocate that oral contraceptive use be limited to prevent depression risk, because many women benefit from oral contraceptive use. But it is important for clinicians to be aware that oral contraceptive use among adolescents might produce an increased risk of depression.”
Depression is an extremely heterogeneous disorder with various expressions and risk factors, according to Oldehinkel, and the etiology of depressive disorders is highly multifactorial. “Depressive episodes are almost always caused by a combination of personal vulnerabilities and external triggers, but the exact nature of these factors can vary widely,” she said. “Oral contraceptive use might be one of those triggers.”
To reduce the incidence of MDD in the study population, Oldehinkel recommends teaching children from an early age onward how to cope with stressful experiences effectively to increase their resilience.
“Still, it appears to be very hard to reduce the prevalence of depression, despite a wealth of evidence-based prevention and intervention strategies,” she said. “It is definitely not an easy job.”
1. Anderl C, de Wit AE, Giltay E, et al. Association between adolescent oral contraceptive use and future major depressive disorder: a prospective cohort study. J Child Psychol Psychiatry. Published online July 12, 2021. doi:10.1111/jcpp.13476