The younger you take the pill, the more you risk depression.

In 1967, the birth control pill became legal in France. Almost sixty years later, its unwanted side effects still raise questions for its users. Migraines, nausea, acne, tummy aches… So many discomforts that are forcing a growing number of women away from their pads. Between 2010 and 2016, the use of birth control pills among French women aged 15 to 54 dropped from 40% to 33%, reaching 28% in 2020. To pill or not to pill? (Editor: Thierry Souccar). And a recent study raises new concerns. According to work by researchers at Uppsala University in Sweden and published June 12 in the journal; Epidemiology and Psychiatric Sciences Birth control pills increase the risk of developing depression.

In the video: 50 years of legalization of the pill

Effects that persist even after stopping

To assess this risk, researchers at Uppsala University used medical data from 264,557 British women from birth to menopause from the UK Biobank database. Specifically, their study aimed to examine the effects of taking the estrogen-progestogen pill (also called the “combined pill”) on depressive symptoms. Recall that the pill contains progestogen and estrogen, two hormonal components aimed at preventing ovulation, egg implantation and, therefore, any unwanted pregnancy.

The results of this work show that women who use the combined pill are 73% more likely to suffer from depression in the first two years than women who do not take it. And the frequency of depressive symptoms rises to 130% if the birth control treatment was started in adolescence (compared to 93% in adulthood), even after stopping the pill, the researchers noted. 24,750 women in the sample were diagnosed with depression during the study follow-up.

“Strong” observations that do not surprise Dr. Guillaume Fond, psychiatrist and teacher-researcher at the FondaMental Foundation and the University Hospitals of Marseille. “These variations with taking the pill will be due to the individual sensitivity of some women to hormonal fluctuations,” commented a depression specialist contacted by phone. Previous tests on rats have also shown that these types of fluctuations can disrupt the activity of a neurotransmitter called GABA, which is known for its benefits on anxiety. This can sometimes explain why some women do not respond to their antidepressants.

Explosive cocktail in adolescence

This new Swedish study adds to previous research that has already found a link between oral contraceptive use and depression. Danish papers published in the journal in 2016 JAMA Psychiatry and involving more than one million women between the ages of 15 and 34, it has already been reported that women using hormonal contraception are more likely to follow antidepressant treatment and be diagnosed with depression.

But why does this risk of depression affect young women more? “The strong effect of birth control pills on teenage girls can be attributed to hormonal changes caused by puberty. Because women in this age group have already experienced significant hormonal changes, they may be more receptive not only to hormonal changes, but also to other life experiences,” Therese explains in the study’s press release. Johansson from the Department of Immunology, Genetics and Genetics. Pathology at Uppsala University, one of the researchers who led the Swedish study.

If there is a family history of depression and you notice psychological difficulties in your teenage years, you will also have to ask yourself twice before starting the pill.

Guillaume Fond, psychiatrist and teacher-researcher

Psychiatrist and teacher-researcher Guillaume Fond shares this observation. “Adolescents between the ages of 18 and 25 are faced with an explosive cocktail that contributes to mental disorders and depression, he reports. Their brains haven’t finished maturing yet, and puberty puts them through some pretty intense hormonal upheaval. Add to that the stress of student life, food insecurity, and drug and alcohol use, and it’s enough to take a bigger toll on their mental health.

Not all women are affected

If these new studies, like the previous ones, confirm the risk of depressive syndrome associated with taking the birth control pill, experts do not want to be alarmist about it all. “This does not apply to all women, emphasizes Guillaume Fond. This increases the risk that is likely to be present in already vulnerable patients. Indeed, there are other concomitant risk factors for depression, such as alcohol, tobacco, lack of physical activity, or a poor diet.

Family history also influences this effect. Swedish scientists, studying different siblings in their sample, found that people in the same family who used the pill developed more depressive disorders than those who did not. “If there’s a family history of depression and you notice psychological difficulties in your teenage years, such as anxiety or adjustment disorder, you also have to ask yourself twice before starting the pill,” psychiatrist Guillaume Fond says generously.

In the video, the health question: “Phobias, anxiety, stress… The promise of a new therapy”

The benefit/risk balance still favors the pill

In their press release, researchers from Uppsala University remind, however, that the benefit/risk ratio to date still leans in favor of the pills. “The birth control pill allows women to avoid unwanted pregnancy and can also prevent diseases that affect women, including ovarian cancer and uterine cancer,” they said in their statement.

It is also important to emphasize that this work focused only on combined oral contraceptives. In other words, these results may not apply to contraceptive alternatives such as microdose pills, hormonal IUDs, vaginal rings, or even contraceptive implants. “In a future study, we plan to investigate different formulations and methods of administration,” says researcher Therese Johansson, who is responsible for the Swedish study.

Pending these in-depth studies, prevention is always in order when giving birth control. If it still isn’t, or if you fear a misunderstanding, start a conversation about the risks of depression with your general practitioner or gynecologist. And in all cases, psychiatrist Guillaume Fond advises patients to consult a medical professional in case of mood swings and depressive symptoms.