Eastern Iowa experts weigh in on ‘birth control blues’

Millions of women use hormonal birth control - from the pill to IUDs, implants and more - not only to prevent unwanted pregnancy but also to regulate menstrual cycles and related symptoms such as painful cramps, PMS, heavy periods, acne and more.

It's not news that contraceptives have negative side effects as well, such as weight gain, increased risk of blood clots and changes in sex drive and mood - but a recent study published in JAMA Psychiatry in October revealed a link between hormonal birth control and depression in women, particularly teens between 15 and 19 years old.

Scientists at the University of Copenhagen in Denmark analyzed the health data of more than 1 million Danish women between the ages of 15 and 34 for a span of 13 years to determine whether users of hormonal contraception saw higher rates of treatment of depression, which they measured by diagnoses at psychiatric hospitals or filling of prescriptions for antidepressants.

The study found that women taking birth control pills with a mix of estrogen and progestin were 23 percent more likely to be prescribed anti-depressants than nonusers. Risk increased to 34 percent for progestin-only pill-users, 40 percent for hormonal IUDs and 60 percent for users of vaginal rings.

Overall, two percent of the women studied were diagnosed with depression at a hospital and 13 percent began taking antidepressants after hormonal birth control use. Women aged 15 to 19 using oral contraceptives saw the greatest relative increase, at 80 percent.

A closer look at the numbers shows only 1.7 of 100 women not taking birth control began taking anti-depressants during the study. That number rose only to 2.2 of 100 for users of hormonal birth control. Overall, only .5 percent of women who started taking hormonal birth control developed depression where they may not have otherwise.

'It's an interesting article, but the overall change is relatively small,” said Dr. Alan Whitters, medical director of Mercy Medical Center's behavioral medicine department in Cedar Rapids.

And although interesting, the study does not prove causation, Whitters continued. There's no way to be sure, either, that an increase in depression treatment was the result of the pharmological effect of hormonal birth control, or a psychological effect of the use of contraception, he said.

'We have to be careful about jumping to conclusions,” he added, explaining that there could be other factors at play.

For example, the rise in depression in adolescent girls could be related to puberty, or a response to onset of sexual activity. Previous research has shown those who become sexually active in adolescence have higher risk for depression and anxiety, in fact. Perhaps the practice of taking birth control itself influences women's behavior and mood or points to other circumstances that affect their mental well-being. Other studies found even placebos resulted in similar mood disturbances, for example.

'Lots of people are depressed and on antidepressants,” said Dr. Alvina Driscoll, an OB-GYN at OB-GYN Associates in Cedar Rapids.

In fact, one in ten people in the U.S. take antidepressants and the rate of antidepressant use increased 400 percent in the three years between 2005 and 2008, she said.

'We need to be really careful to be clear that this does not prove causation by any sense of the imagination,” she said of the study.

So while birth control may cause depression, it also may not. Questions still remain.

Dr. Hannah Anderson, chiropractor and co-founder of Well Labs - a nutrition startup in Cedar Rapids - suggests women ask more questions of their doctors and know that there are other options beyond hormonal birth control, such as barrier methods like condoms or others that avoid contraceptives altogether, such as natural family planning, which requires women to diligently keep track of their cycle.

But it can be difficult to get off the pill, Anderson said.

'Some women go through a sort of birth control hangover where they get some wild symptoms in the months after stopping hormonal contraceptive,” she said. 'I've had patients stop taking contraceptives in their 40s and 50s after decades of taking it and have uncontrollable joint pain, insomnia or headaches.”

Anderson suggests women considering ditching their hormonal contraceptive consult with a doctor trained in functional medicine or a naturopathic doctor to help them through the process.

'We're lucky to have multiple functional medicine practitioners in the Corridor,” she said. 'Even though your regular OB-GYN or family practice doctor can prescribe birth control, they often aren't taught in school or elsewhere how to get off of it.”

Anderson also suggests women consider taking a B complex vitamin to supplement nutrients lost in contraceptive use, however there is little research to support the theory that nutrients are lost when taking birth control or that a B vitamin supplement would have an effect. Though, Anderson said the vitamin helped her with her own experiences combating the side effects of birth control. particularly when it comes to energy levels.

Anderson said when she started replenishing her B vitamins, it was like she 'had coffee in her veins.”

Julie Gudenkauf, medical student and assistant to Dr. Whitters, was able to find only two studies that associated oral contraceptives with deficiency in nutrients - one of which had to do with obesity associated with oral contraceptives which may have contributed to micronutrient deficiencies and the other related to absorption of B12. But, she said, with so little evidence it's difficult to say 'one way or the other” whether birth control relates to nutrient deficiencies.

'Everything we do in medicine has to be evidence based,” Whitters said, adding that in order to draw conclusions, more research needs to be done.