By Marilynn Larkin
NEW YORK—Teenage users of oral contraceptive pills (OCP), particularly 16-year-olds, had higher concurrent depressive symptoms than their nonuser peers in an observational study.
"This is important for pediatricians and gynecologists caring for teens to be aware of, since the mood and OCP association was observed in 16-year-olds, and not 19-, 22-, or 25-year-olds," Dr. Hadine Joffe of Brigham and Women's Hospital in Boston told Reuters Health by email.
"These are mild mood changes that were observed when the 16-year-olds were taking the OCP," she noted. "Any girl with a more substantial mood problem on an OCP should be referred for mental health support."
Dr. Joffe and colleagues analyzed data from the third to sixth wave of the Dutch prospective cohort study, Tracking Adolescents' Individual Lives Survey (TRAILS). The study was conducted from September 2005 through December 2016, among females ages 16 to 25 who had filled out at least one, and up to four, assessments of oral contraceptive use.
As reported online October 2 in JAMA Psychiatry, data from 1,010 girls were analyzed. The mean age at the first assessment was 16.3, and at the final assessment, 25.6.
OCP users differed from nonusers at age 16: nonusers had a higher mean socioeconomic status score (0.17 vs. -0.15) and more were virgins (79.5% vs. 74 24.4%).
Although all users combined did not show higher depressive symptom scores compared with nonusers, adolescent users (mean age, 16.5) reported higher depressive symptom scores compared with their nonuser counterparts (mean age, 16.1), as measured by the DSM-IV self-report version of the Child Behavior Checklist. Mean scores were 0.40 versus 0.33, and the difference persisted after adjustment for age, socioeconomic status and ethnicity.
Adolescent OCP users, in particular, reported more crying (odds ratio, 1.89), hypersomnia (OR, 1.68) and eating problems (OR, 1.54) than nonusers.
The authors conclude, "Monitoring depressive symptoms in adolescents who are using oral contraceptives is important, as the use of oral contraceptives may affect their quality of life and put them at risk for nonadherence."
Dr. Joffe added, "IUDs are important alternative reliable agents for contraception that do not release a significant amount of hormones throughout the body and brain that can be used in sexually active teens."
Dr. Beth Rackow, director of pediatric and adolescent gynecology at NewYork-Presbyterian Morgan Stanley Children's Hospital and Columbia University Irving Medical Center in New York City, commented by email, "The side effects of OCPs can include some mood symptoms. However, sometimes OCPs can improve mood disorders. Some women with premenstrual syndrome, premenstrual dysphoric disorder, anxiety and depression - especially if worsened with menses - improve when taking OCPs. So. clearly there is a lot of variability."
"The findings highlight an issue that is already apparent in my clinical practice, but there are some limitations that limit how this study impacts my practice," she told Reuters Health.
"One limitation is that the researchers do not know which OCP each patient took," she said, noting that different doses and pill pack structures may affect the response. "Some women have more mood side effects with higher-dose OCPs, or when the dose of pills in the pack is not consistent."
Another limitation is that most participants were of Dutch ethnicity, she noted, "and it can be difficult to generalize the results to a different and possibly more heterogeneous population."
"Healthcare providers should be aware that OCPs may cause some depressive symptoms in adolescents, and could worsen the symptoms if an adolescent already has depression," she said. "Screening for depression in the adolescent population is an important part of adolescent health care, and detailed counseling for adolescents about all available contraceptive options including benefits, risks and side effects is important."
"In practice," she said, "starting with the lowest dose OCP may be ideal for adolescents who are at risk of mood disorders, or who already have mood issues."
JAMA Psych 2019.
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