Depression as a side effect of the contraceptive pill

Alfred Psychiatry Research Centre, The Alfred, Prahran, Victoria, Australia.
Expert Opinion on Drug Safety (Impact Factor: 2.91). 08/2007; 6(4):371-4. DOI: 10.1517/14740338.6.4.371
Source: PubMed


Millions of women worldwide use the combined oral contraceptive pill as an effective form of contraception. However, the focus on its side effects to date has mainly been on physical aspects, even though the most commonly stated reason for discontinuation is depression. There are surprisingly few large studies investigating depression related to oral contraceptive use. A pilot study was conducted showing that women using the combined oral contraceptive pill were significantly more depressed than a matched group who were not. More research is needed to better inform women and doctors about depression related to oral contraceptive use, and clinical guidelines are needed regarding the different types of oral contraceptives and their potential depressogenic properties.

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    • "Reports on OC-related mood changes are inconsistent, ranging from beneficial in most women (Oinonen and Mazmanian, 2002) to increased rates of depression, anxiety, fatigue, neurotic symptoms, compulsion and anger (Robinson et al., 2004; Kulkarni, 2007). Repeated findings of beneficial mood changes may however be biased by data sampling. "
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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.
    Full-text · Article · Aug 2014 · Frontiers in Neuroscience
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    • "We hypothesized that the neurochemical changes induced by EE/LNG treatment may contribute to some of the emotional disorders observed in hormonal contraceptive users. In fact, several studies demonstrated that hormonal contraceptives might have a negative effect on anxiety, mood, and emotional well-being in women (Bottcher et al. 2012; Hall et al. 2012; Kulkarni 2007; Kurshan and Epperson 2006; Oinonen and Mazmanian 2002; Segebladh et al. 2009; Welling 2013). In addition, some studies have focused on effects of hormonal contraceptives on women's libido and sexual adaptations. "
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    ABSTRACT: Allopregnanolone is a neurosteroid involved in depression, memory, social, and sexual behavior. We have previously demonstrated that treatment with a combination of ethinylestradiol (EE) and levonorgestrel (LNG), two compounds frequently used in hormonal contraception, decreased brain allopregnanolone concentrations. These changes may contribute to some of the emotional and sexual disorders observed in hormonal contraceptive users. We thus examined whether the reduction in allopregnanolone concentrations induced by long-term EE/LNG administration was associated with altered emotional, learning, social, and sexual behaviors. Rats were orally treated with a combination of EE (0.030 mg) and LNG (0.125 mg) once a day for 4 weeks and were subjected to behavioral tests 24 h after the last administration. EE/LNG treatment reduced immobility behavior in the forced swim test, without affecting sucrose preference and spatial learning and memory. In the resident-intruder test, EE/LNG-treated rats displayed a decrease in dominant behaviors associated with a reduction in social investigation. In the paced mating test, EE/LNG treated rats showed a reduction in proceptive behaviors, while the lordosis quotient was not affected. Progesterone, but not estradiol, administration to EE/LNG-treated rats increased sexual activity and cerebrocortical allopregnanolone concentrations. Prior administration of finasteride decreased allopregnanolone concentrations and abolished the increase in proceptivity induced by progesterone administration. The decrease in brain allopregnanolone concentrations induced by EE/LNG treatment is associated with a reduction in social behavior and sexual motivation in female rats. These results might be relevant to the side effects sometimes exhibited by women taking hormonal contraceptives.
    Full-text · Article · Apr 2014 · Psychopharmacology
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    • "Sanders, Graham, Bass, and Bancroft (2001) found that negative changes in emotional and sexual well-being were important predictors of discontinuation of oral contraceptives (see also Graham, Ramos, Bancroft, Maglaya, and Farley, 1995; Rosenberg and Waugh, 1998; Rosenberg, Waugh, and Meehan, 1995), although HC users report experiencing less variability in affect across the menstrual cycle and less negative affect during menstruation (Oinonen and Mazmanian, 2002). While women low in social anxiety are more likely to use oral contraceptives (Leary and Dobbins, 1983), HC users describe higher rates of depression (e.g., Kulkarni, 2007) than normally cycling women. On the other hand, pairbonded (but not single) women report lower levels of intrasexual competition when using HCs as compared to when they are regularly cycling (Cobey, Klipping, and Buunk, 2013). "
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    ABSTRACT: Although female use of hormonal contraceptives (HCs) has been associated with a variety of physical side effects, the psychological and behavioral side effects have received comparatively little attention until recently. Indeed, the long-term impact of HC use on human psychology has been vastly under-researched and has only recently become a focus for mainstream scholars. Women who use HCs report higher rates of depression, reduced sexual functioning, and higher interest in short-term sexual relationships compared to their naturally-cycling counterparts. Also, HC use may alter women's ability to attract a mate, as well as the mate retention behaviors in both users and their romantic partners. Some evidence even suggests that HC use alters mate choice and may negatively affect sexual satisfaction in parous women, with potential effects on future offspring. Interestingly, HCs have become a standard method of population control for captive nonhuman primates, opening up exciting avenues for potential comparative research. Here, the existing literature on the psychobehavioral effects of HCs in humans and nonhuman primates is reviewed and discussed. The potential resulting downstream consequences for the path of human evolution and recommendations for how future research could tease apart the underlying causes of these psychobehavioral effects of HC use are discussed, including suggestions for research involving nonhuman primates.
    Full-text · Article · Jul 2013 · Evolutionary Psychology
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