Can the pill cause depression for teens?

Ask Dr. Jen

I read a post that says the pill can cause depression for teens. Is that something they should be warned about?  

— Sarah, via Instagram 

On the fly…

Some studies have linked oral contraception (the birth control pill or, simply, the pill) with an increased risk of depression for teens, but these studies are not conclusive. They only show an association, so are not proof of a cause and effect. There are also many health benefits to the pill, so as with any medication, a discussion of the risk-benefit ratio is required for informed decision-making. 

Go on…

There is a link between depression and reproductive hormones. There is post partum depression, mood changes related to the menstrual cycle, and an increased risk of depression during the menopause transition (the years leading up to the final menstrual period). As the teenage years are associated with an increased risk of depression, especially for teen girls, it is important to understand if the hormones in oral contraception might have a negative impact during this time of increased vulnerability. 

Several studies in the past few years have suggested a link between oral contraception and depression for teens. In one of these studies, for every 200 teens who were prescribed oral contraception an additional one developed depression. Another study from 2019 found that teens who took oral contraception were approximately twice as likely to be later diagnosed with depression as an adult. However, a study from 2020 did not find a link between the pill and the diagnosis of depression, although 16 year old girls who were taking the pill were more likely to reported crying, excessive sleepiness, and eating problems versus those not taking the pill.

None of these studies linking depression and oral contraception are clinical trials, meaning the teens were not randomized to either hormonal contraception or a copper IUD as a control (a birth control method without hormones) and then followed to see if the rates of depression differed. This means the studies that we currently have only show an association between oral contraception and depression for teens, but they are not proof of cause and effect.

The researchers in these studies tried to control for many variables that could affect depression, but ultimately there could be other non pill-related factors that led to the increased risk of depression for the teens in these studies. For example, approximately one-third of teens who take oral contraception do so because of medical conditions, such as heavy periods, painful menstrual cramps, acne, or premenstrual syndrome (PMS). These conditions can be associated with an increased risk of depression, so the link between the pill and depression could be due to the underlying condition for which the pill was prescribed and not the pill itself.

Everyone considers the mental health consequences of taking the pill, but it’s also important to consider the mental health and medical consequences of not taking the pill. 

Teens can have especially heavy periods that can lead to serious health consequences, missing school, and avoiding sports. Often hormonal contraception is the best choice for treatment. What are the consequences if that treatment is withheld? Should a teen soak her clothes each month or miss school? How might that affect her mental health?

Or what if a teen goes without contraception because the pill was their contraceptive method of choice and they have an unplanned pregnancy? Postpartum depression affects 5-25% of new mothers, and there is some data suggesting teens are at an even greater risk. Or what if the lack of contraception results in an unplanned pregnancy and the teen wants an abortion, but lives in a state where access is limited due to cost and/or distance, or parental consent is required and it is unobtainable? Being denied access to abortion can increase anxiety.

Never mind the medical as well as social and economic consequences of teen pregnancies. Maternal mortality is also higher for teens.

Right now there isn’t enough data to say the pill causes depression for teens. With all medications, it is important to line up all the benefits and weigh those against the risks to make an informed choice and the pill is no different. When considering potential health risks it isn’t enough to only consider what might happen if the pill is prescribed, it is also important to consider what the pill may be treating or preventing.

Personal Note...

I’ve seen a lot of false statements about hormonal birth control and depression on Instagram. Many of these accounts sell services or products that benefit from amplifying fears about hormonal contraception — such as diets, coaching, or supplements that all claim to “balance hormones” (not a medical thing). It’s always important to look at the source of information and ask yourself, is there a financial interest in this advice? Remember, it isn’t possible to get unbiased information from someone selling a product or a service related to that information. 

The information above is not direct medical advice.