To what extent do oral contraceptives influence mood and affect?

Department of Psychology, Lakehead University, Thunder Bay, Ont., Canada P7B 5E1.
Journal of Affective Disorders (Impact Factor: 3.38). 09/2002; 70(3):229-40. DOI: 10.1016/S0165-0327(01)00356-1
Source: PubMed


Studies examining the effects of oral contraceptives (OCs) on mood, affect, and affect variability are reviewed.
MEDLINE and PsycLIT data bases were examined to identify studies that compared OC users with nonusers using daily ratings of mood, affect, or affect variability.
Compared to non-users, OC users experience less variability in affect across the entire menstrual cycle, and less negative affect during menstruation (i.e. withdrawal bleeding). In women with OC-related negative mood and affect change, potential mediators of the relation between OCs and mood or affect were identified: a history of depression, psychiatric symptoms, dysmenorrhea, and premenstrual mood symptoms prior to OC use; a history of pregnancy-related mood symptoms; a family history of OC-related mood complaints; being in the postpartum period; and age. Furthermore, a lower ratio of progesterone to estrogen is associated with more negative mood change in women with a history of premenstrual emotional symptoms, higher progesterone to estrogen ratios are associated with increased negative mood effects in women without such a history, and monophasic OCs have a greater stabilizing effect on mood than triphasic OCs.
The 'survivor effect', psychological factors, and indirect pharmacological effects (e.g. weight gain) have not yet been systematically investigated. Furthermore, most studies have examined only negative mood or affect, as opposed to both positive and negative affect and affect variability; and few affect studies have assessed potential mediators of OC-related affect change.
While the only consistent OC-related mood effects experienced by most women are beneficial, a subgroup of women do experience negative mood change. Future research must focus on expounding the individual difference and OC-related risk factors for negative mood change.

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    • "These effects are restricted to premenopausal women suggesting a moderating effect of female gonadal steroids on the function of the MR (Klok et al, 2011b). The observed differences in sensitivity between different MR-haplotypes may also explain why some women experience depression-like side-effects of OCs whereas others do not (Oinonen and Mazmanian, 2002; Boron and Boulpaep, 2012). "
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    ABSTRACT: Background: Female carriers of mineralocorticoid receptor (MR) haplotype 2 may be more optimistic and less vulnerable to depression than the remaining MR haplotypes. Oral contraceptives are associated with subtle changes in emotional cognition. Some of these effects are moderated by MR-haplotype. Aim: To investigate the potential moderating effect of MR genotype on the effect of hormone levels and oral contraceptives on emotional cognition. Methods: Ninety-three healthy premenopausal volunteers of West-European descent completed a battery of (emotional) cognition tests. Forty-nine were OC users and 44 naturally cycling, 21 of whom were tested in the early follicular and 23 in the mid luteal phase of the menstrual cycle. Results: MR haplotype 2 carriers in the mid luteal phase tended to make more risky decisions (trend; χ2 = 5.4; df = 2; p = .068) and tended to recognize positive mood states better (χ2 = 6.0; df = 2; p = .051). OC users with MR haplotype 1 and 3 performed worse on tests of facial expression recognition [F (2,31) = 4.7; p = .016] and attention (χ2 = 8.4; df = 2; p = .015). Conclusions: MR haplotype 2 carriers tend to perform better when levels of estradiol and progesterone are high. OCs negatively affect emotional cognition in MR haplotype 1 and 3 carriers but not in haplotype 2 carriers. This is consistent with previous findings that suggest that MR haplotype 2 carriers are at lower risk of de- pression during their childbearing years.
    Biological Psychiatry, Toronto, Canada; 05/2015
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    • "Repeated findings of beneficial mood changes may however be biased by data sampling. Only women, who continue the intake of oral contraceptives ( " survivor effect " ) are included in those studies, while women, who discontinue the use of oral contraceptives due to negative emotional side effects, do not contribute to these results (Oinonen and Mazmanian, 2002). Possible physiological mechanisms underlying both positive and negative mood swings in oral contraceptive users are manifold and at the moment speculative. "
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    ABSTRACT: Hormonal contraceptives are on the market for more than 50 years and used by 100 million women worldwide. However, while endogenous steroids have been convincingly associated with change in brain structure, function and cognitive performance, the effects of synthetic steroids contained in hormonal contraceptives on brain and cognition have barely been investigated. In this article we summarize the sparse findings, describing brain structural, functional and behavioral findings from the literature and suggest that synthetic steroids may contribute to masculinizing as well as feminizing effects on brain and behavior. We try to identify methodological challenges, explain, how results on endogenous steroids may transfer into research on hormonal contraceptives and point out factors that need to be controlled in the study of hormonal contraceptive dependent effects. We conclude that there is a strong need for more systematic studies, especially on brain structural, functional and cognitive changes due to hormonal contraceptive use. The hormonal contraceptive pill is the major tool for population control. Hence, such behavioral changes could cause a shift in society dynamics and should not stay unattended.
    Frontiers in Neuroscience 08/2014; 8(8):256. DOI:10.3389/fnins.2014.00256 · 3.66 Impact Factor
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    • "Finally, OC formulation varies between users. Some research has indicated that monophasic OCs, which contain a constant dose of hormones in active pills, might have a stronger positive effect on mood than multiphasic OCs, in which active pills vary in hormone dosage across the menstrual cycle (Oinonen and Mazmanian 2002), although other studies have found no significant differences (Abraham et al. 2003; Walker and Bancroft 1990). This potential heterogeneity has not yet been explored in population-based research. "
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    ABSTRACT: The purpose of this study is to examine the association between oral contraceptive use (any current use, duration, and type) and major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder (PD) in a nationally representative sample of women in the USA. Data were drawn from 1,105 women aged 20-39 in the National Health and Nutrition Examination Surveys from 1999 to 2004. The associations between self-reported use of oral contraceptives in the past year and DSM-IV diagnosed and subthreshold MDD, GAD, and PD in the past year were assessed comparing oral contraceptive users to all non-users, former users, and former long-term users. Women using oral contraceptives had a lower past-year prevalence of all disorders assessed, other than subthreshold MDD. When adjusted for confounders, women using oral contraceptives in the past year had significantly lower odds of subthreshold PD, compared to former users (odds ratio (OR) = 0.34, 95 % CI 0.14-0.84). Effects estimates were strongest for monophasic (versus multiphasic) oral contraceptive users. Hormonal contraceptive use was associated with reduced risk of subthreshold PD. A potential mental health benefit of hormonal contraceptives has substantial public health implications; prospective longitudinal studies are needed to confirm whether hormonal contraceptive use improves mental health.
    Archives of Women s Mental Health 08/2014; 18(1). DOI:10.1007/s00737-014-0453-4 · 2.16 Impact Factor
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