Teenagers seem most at risk, according to Danish scientists. A new large-scale study recently published in the journal JAMA Psychiatry suggests that there is a link between the use of hormonal birth control and clinical depression.

By Nerti U. Qatja | @nertiqatja | @VOP_Today

The Danish study, conducted by University of Copenhagen researchers, followed more than one million female participants between the ages of 15 and 34 over a 13-year period (and an average of 6.4 years for each participant). While there have been smaller studies, as well as significant anecdotal evidence, of a link between hormonal contraceptives and mood disorders, this is the first study that seems to firmly establish the risk.

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The Copenhagen study divided the participants into two groups, about 55% of the women in the “user” group (i.e. used hormonal contraceptives), with the rest in the “non-user” group. The data from the completed study found that women using a combination birth control pill (pills containing both estrogen and progestin) were 23% more likely to have been prescribed antidepressants vs. non-users. Women who took progestin-only pills were 34% more likely. Participants using other hormonal contraceptives also showed increased risk. Users of a progestin-only IUD (intrauterine device) were 40% more likely to have been given an antidepressant prescription, users of vaginal rings (etonogestrel) were 60% more likely, and users of contraceptive patches (norgestrolmin) were 100% more likely.

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The study’s authors began with the hypothesis that progesterone, and its synthetic twin progestin, played a role in the onset of depression. The results of the study, with progestin-only contraception having higher rates of depression than combination doses seemed to bear out their hypothesis.

Maybe more concerning, teenagers on combination hormonal birth control pills were 80 percent more likely to be prescribed an antidepressant during the course of the study than the non-user group, and 120 percent more likely if on progestin-only birth control pills. Worse, for teenagers on non-oral hormonal birth control (vaginal rings, IUDs, patches) the risk was actually tripled.

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An increasing number of sexually active teenage girls are either already on hormonal contraceptives or are being encouraged to go on them due to the contraceptive’s 99 percent effectiveness rate. Combined with the facts that20% of teens have suffered some symptoms of depression; that teenage girls are twice as likely to suffer from depression as teenage boys; and that suicide is the third leading cause of death for young men and women between the ages of 15 and 24, this study raises real questions about who should be using these contraceptives and when they should start.

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It is important to realize that the risk of depression must be weighed against the risk of unplanned pregnancy. The place to start is with a conversation with your physician about your overall mental health, as well as the risks indicated by this study. Additionally, while the increased risk of depression indicated by the study is statistically significant, and seems alarming, overall the risk of developing depression is still fairly low. Twelve-and-a-half percent of the study participants were prescribed antidepressants for the first time during the study (meaning that before the study they presumably had no indication of depression), and 2 percent were given a first-time diagnosis of depression. Moreover, a prescription for an antidepressant is not always given for depression (there are off-uses for the medication, like insomnia that may not be linked to depression, for instance).