COPENHAGEN, Denmark — Women taking hormonal birth control are more likely to be diagnosed with depression, according to a new study — a link that is particularly pronounced among teenaged girls who use such drugs.

Published in the Journal of the American Medical Association (JAMA) Psychiatry, the study from the University of Copenhagen is the largest of its kind. It followed more than 1 million women in Denmark aged between 15 and 34 from 2000 until 2013, for an average of 6.4 years.

It found that adolescents taking a combined birth-control pill (containing both estrogen and progestogen) were 1.8 times (80%) more likely to get a first-time diagnosis of depression at a psychiatric hospital. Teens prescribed a progestin-only pill had a 2.2-times higher risk, and those using long-acting vaginal rings, implants, patches and depo-provera shots had three times the risk of depression after starting the drugs.

Overall, use of the combined oral contraceptive pill was linked to a 23% increased diagnosis of depression, and use of progestin-only pills (also known as “the mini-pill”) with a 34% increased risk. Other hormone-based methods commonly offered to women — such as the hormonal transdermal patch, vaginal ring and implant — increased depression rates even more than oral contraceptives. Patch and implant users had double the rate of depression, and vaginal ring users were 60% more likely to be diagnosed with the disorder.

Women have cited mood disorders as a reason for stopping the pill for decades, a finding substantiated in research, and a look at women’s internet chat rooms reveals depression is still a common experience among users.

Nikki Cosier, commenting on the Australian Broadcasting Corporation’s article about the study, was one of many who claimed contraceptives had altered her mental health: “I lost more than 10 years of my life to suicidal depression while I was on hormonal birth control. ... My body displays a clear link between the two.”

 

‘Causal Relation’

But manufacturers of birth control have dismissed the epidemiological findings. Bayer pharmaceuticals issued a statement to the Register saying that the most recent study “does not conclusively answer the scientific question [of] whether hormonal contraception increases the risk for major, clinically relevant depression in women. While minor depression and depressive symptoms are reflected in the labeling of Bayer’s hormonal contraceptives as common undesirable effects (‘depressed mood,’ ‘altered mood’ in COCs [combination oral contraceptives], “Depressed mood/Depression” in Mirena), it remains unclear whether the occurrence of more severe or major depression is causally related to the use of hormonal contraception.”

Mainstream media featured a number of doctors and feminists also suggesting that the findings only suggested a correlation, not causation.

However, Øjvind Lidegaard, one of the study’s authors, told the Register, “If you find such a strong, statistical correlation as we have done, and controlled for the confounding factors, and until we have another association (and I would find that a big surprise), we have to conclude the statistical finding is an expression of causal relation.”

Information in the study used bar codes for prescription data in the Danish health system and eliminated the problem of so-called “recall bias” — or women’s recollection of their prescription drug use. Women who had babies during the time frame of the study were temporarily excluded for six months to reduce the influence of postpartum depression, and the study excluded women who were previously mentally ill or had taken antidepressants.

Lidegaard told the Register he believes his research is “unwelcome” by many American researchers because abortion is still a polarizing issue in the United States, and teenage motherhood is a problem. He said that is not the case in Denmark, where abortion is “the usual” and accepted response to teen pregnancy.

 

Hormone Havoc

It has long been speculated that hormones play a role in depression, and women’s two times higher rate of depression has been generally ascribed to having to do with the female sex hormones estrogen and progesterone.

The contraceptive pill, made of synthetic chemical hormones, is by far the most popular contraceptive pharmaceutical worldwide, taken by more than 200 million women. According to the Guttmacher Institute, it has been the leading contraceptive choice for American women since 1982 (followed closely by surgical sterilization) and is consumed by 9.7 million American women and girls in a given month. The average U.S. woman is on a contraceptive for 30 years of her life.

According to one market report, oral contraceptive pills make up the largest and fastest-growing share of the global contraceptive market, which was valued at $16 billion in 2011 and is projected to exceed $23 billion by 2018.

A big chunk of that growth is due to increased marketing of the pill to preadolescent girls on up, as a treatment for acne, irregular menstrual cycles, premenstrual syndrome (PMS) and virtually any symptom that might be hormone-related. Fourteen percent of pill users are using it exclusively for these non-contraceptive reasons, according to Guttmacher.

Antidepressant use has soared in the U.S. as well, increasing by almost 400% between 1988-1994 and 2005-2008. One in four American women was taking an antidepressant in any given month, according to the most recent federal data. According to a 2013 report from the Centers for Disease Control, between 2005 -2010, more than 4.5% of adolescent girls were taking an antidepressant drug in any two-week period.

Serious documented side effects of the pill include a sixfold increased risk of thromboembolism, which kills thousands of women. It has also been linked to breast cancer since 2005, when the United Nation’s International Agency for Research on Cancer (IARC) issued Monograph 91, which reclassified the contraceptive pill as a Group-1 carcinogen (like tobacco and asbestos), based on a number of recent studies that found a positive connection, particularly with those containing levonorgestrel.

Other complaints about the pill’s side effects include weight gain, anxiety, mood swings, acne, flu-like fatigue, migraines, gallstones, hair loss, poor circulation, hypoglycemia, infertility after stopping the pill and more.

“Synthetic hormones like those in combined oral contraceptives that contain estrogen and progestin increase thyroid- and sex hormone-binding globulin (SHBG), effectively decreasing the available testosterone and thyroid hormone in circulation, which can render you of nun-like libido and functionally hypothyroid or depressed, constipated, overweight, cloudy and with dry skin and hair to boot!” said New York psychiatrist Kelly Brogan, in her book of A Mind of Your Own (Harper Collins, 2016).

Brogan is one of a growing movement of women who experienced the side effects of birth control firsthand and were shocked when they looked at the research on the pill and discovered its unreported dangers. “Then I began paying attention to my patients’ stories,” she said. “Over and over again, I would learn about their onset of anxiety, depression and even mania after beginning synthetic hormones.”

Nowadays, she counsels her patients to consider kicking “Pharma out of your bedroom” and looking at “fertility awareness” gadgets similar to those Catholic natural family planners have been using for decades.

Holly Grigg-Spall is another woman who started to wonder if her emotional flatness and other symptoms were related to 10 years of compliantly swallowing the public-health and general-practitioner endorsements of oral contraception. Her book, Sweetening the Pill: Or How We Got Hooked on Hormonal Birth Control (Zero Books, 2013) encourages women to view birth control as the drug that it is as well as something like patriarchal mind control.

 

In Line With Church Teaching

The Catholic Church has held that artificial birth control objectifies women for decades. Catholic teaching in the papal encyclical Humanae Vitae (The Regulation of Birth) also describes artificial contraception as “intrinsically wrong” because it thwarts God’s gift of children and stunts marital relationships by removing fertility from the offering.

“Our bodies’ fertility cycles are not design defects that need to be ‘fixed,’” said Mary Rice Hasson, director of the Catholic Women’s Forum at the Ethics and Public Policy Center in Washington, D.C. “It turns out, not surprisingly, that the Catholic teaching against contraception is not only right, morally, but also the right answer for women’s health.”

 

Register correspondent Celeste McGovern writes from Scotland.