Birth Control and Depression: Is There a Link?

Birth control pills prevent pregnancy and treat conditions like irregular periods, endometriosis and premenstrual dysphoric disorder (PMDD). While they have lots of potential benefits, they can also have side effects — and some people say they can cause depression.

Is there an established link between birth control and depression? And if you take the pill, should you be concerned? Ob/Gyn Emily Freeman, DO, helps clear up the confusion.

Can birth control cause depression?

There was a link between the pill and depression with older formulations. Fortunately, today’s birth control pills don’t carry that same risk.

“Today’s oral contraceptives contain a much lower dose of hormones than the pills we had a few decades back,” Dr. Freeman clarifies. “These lower doses are just as effective at preventing pregnancy but come with a lower risk of side effects like mood changes or depression.”

Still, some research points to a possible link, especially in the first two years of using birth control pills. But we need more studies to determine why. It could be that the pill is one factor among many.

“Millions of women take the pill, and depression is also more common in women in their reproductive years,” Dr. Freeman points out. “It’s possible that, at least sometimes, there are other causes at play, not just the pill.”

Although the connection is up for debate, there’s no guarantee that the pill can never cause depression. Hormones affect everything in our bodies, from digestion to mental health — and your body is unique.

“Hormonal medications, including the pill, affect people differently,” she continues. “One person may have headaches or mood changes with a certain medication, and another will feel great.”

That’s why you need to tell your provider if you feel like your contraceptive isn’t a good fit for you.

“If you do feel sad or depressed after starting the pill, we want to know about it,” Dr. Freeman encourages. “Depression can be serious. And your experience is valid.”

Plus, there’s no reason to stick with a pill that’s making you feel depressed or just not like yourself.

“There are many different types of birth control, and another type might work better for your unique biology,” she notes. “Your provider can discuss your options and help you make an informed decision.”

Can birth control help treat depression?

On the flip side, some birth control methods may actually improve depression. But it depends on what’s causing the depression, so it definitely requires a discussion with your provider.

“Premenstrual syndrome (PMS) and PMDD cause hormonal swings that can trigger irritability, mood changes and crying spells, and in severe cases, depression,” Dr. Freeman explains. “Avoiding these hormonal shifts — especially estrogen fluctuations — can help stabilize moods.”

You can avoid the estrogen and progesterone ups and downs with:

Extended or continuous birth control pills

These pills don’t include inactive or “sugar” pills that you would usually take during the week of your period. Instead, you take the active pills continuously, sometimes for three months or longer. When you don’t take inactive pills, you have a steady stream of hormones, which may help you avoid PMS or PMDD.

“Continuous pills provide a steady flow of estrogen and progestin, rather than monthly ups and downs,” Dr. Freeman further explains. “For this reason, they can be a good choice if you experience mood changes with other birth control pills.”

Progestin-only birth control

You can also try birth control methods that contain only progestin, rather than the combination of estrogen and progestin found in many pills. Sometimes, the absence of estrogen can be the key to stabilizing moods.

Progestin-only options include:

• Birth control shot. This method is a progestin injection you receive every three months. “Depo-Provera® (the birth control shot) can help treat heavy menstrual periods, and you don’t have to remember to take a pill every day,” Dr. Freeman says. “But it can take up to 18 months to get pregnant after stopping it.”
• Hormonal IUD. This is a small device that your provider places in your uterus during a minor in-office procedure. “The hormonal IUD provides steady progestin levels for up to several years, and there’s very little maintenance involved,” Dr. Freeman reports.
• Progestin-only pill. Like other birth control pills, you take this by mouth. You have to remember to take it at the same time every day, but it offers some additional versatility. “You can get pregnant immediately after a progestin-only pill,” she says.

Can going off birth control cause depression?

If some birth control methods help your mood, will you then feel depressed when you stop taking it? It’s possible, but — again — it depends on your unique situation.

“Most women don’t experience a big change in mood when they stop taking birth control,” Dr. Freeman reassures. “But if you were taking contraception for mood stabilization, the symptoms might come back when you stop.”

The easiest way to avoid issues? Before you stop taking birth control, tell your provider.

“We can help you manage any changes you experience as your body adjusts,” she continues. “We can also help you get depression treatment if needed.”

Talk with your healthcare provider

There are dozens of birth control options out there, and there’s no one-size-fits-all solution.

“Your healthcare provider can explain the pros and cons of different contraceptives so you can make a decision that feels right to you,” Dr. Freeman reiterates.

“And if you do notice side effects, let your provider know. Your feelings are real, and you don’t have to live with unwanted side effects. You deserve to feel your best.”