Should We Screen For This Before Taking The Pill?

Taking hormonal birth control can feel like a never-ending pros and cons list of weighing the side effects against the benefits. And a new study published in JAMA Psychiatry may not be helping matters. Researchers have found a link between hormonal birth control and depression, adding it to the potential hazards list along with mood swings, weight gain, diminished libido, and insomnia. But despite the myriad of side effects women report experiencing, associations between hormonal birth control and what the study calls "mood disturbances" remain "inadequately addressed." In other words, birth control is yet another area in which women's health is inadequately studied, in spite of the fact that it's a product made for women.

The wide-reaching study out of Denmark followed one million women between the ages of 15 and 24, who'd never previously been diagnosed with depression from 2000 to 2013. The women who were on The Pill — that is, combination hormonal birth control — were 23 percent more likely to start taking an antidepressant over the 13-year period than women who didn't use hormonal birth control. But women who were on progestin-only pills, the patch, a ring, or hormonal IUDs were also more likely to take antidepressants. The rates at which women began taking antidepressants peaked at six months after starting birth control. Rates of a depression diagnosis, as opposed to taking antidepressants, were "similar or slightly lower."

"Don't make this [study] more than it is," Dr. Lauren Streicher, practicing OBGYN and clinical professor at Northwestern University Feinberg School of Medicine in Chicago. "It was a very small association. Yes, they found this association, but it's not like they're saying this is the number one side effect of using birth control. They're saying that this is seen rarely but it was statistically significant for this population."

There's also an important distinction to make here, however, is that there's a difference between having depression, being diagnosed with depression, and taking an antidepressant. As The Cut notes, while the study did exclude women who had previously been diagnosed with depression, it also did not account for women who may have already had depression but gone undiagnosed. Furthermore, many folks with depression seek treatment in ways other than going on an antidepressant, which was the study's major link between birth control and depression.

The study's other significant finding related to the age at which women began taking birth control and how it correlated to their depression rates. Women who began taking birth control at older ages were less likely to go on antidepressants that women who began taking birth control during adolescence. And more importantly, women who had been on birth control for longer periods of time — after four to seven years — actually experienced depression at lower rates than women who had never gone on birth control at all.

"I don't think i would sit there and say [to a patient] I'm going to prescribe birth control and it may make you depressed," Streicher says. "Whenever you prescribe a medication, you'll see a list of the 50 of the things it could cause, so when I prescribe a medication for someone, I'm going to tell them about the most common things. I'm going to say, "There are a number of side effects, the most common ones are breakthrough bleeding, headaches, breast tenderness etc., but if you have any other concerns or don't feel well on them let me know.

Should women be screened for depression before taking birth control?

"I think it is important for women screened for depression and mental health period — period," Streicher says. "Whether someone comes in and she's asking for hormonal birth control or she's coming in and she's asking for pap test and STD screening. The point is, it is part of a well woman exam to screen for depression."

So while the link between hormonal birth control and depression may be real, factors like age, the length of time a woman is on it, and previous mental health history are also important to take into account. It may be useful to get screened for depression if you're worried about the side effects — or get screened even if you're not on birth control, as Streicher suggests.

"I always tell women if you notice any change in the way you feel, positive or negative, certainly be aware," Streicher says. "It may or may not be something related to the medication."

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