Mood problems caused by the pill are not a figment of your imagination
UvA student Margot Morssinkhof did not feel like herself while taking the contraceptive pill. Now she is doing her PhD on the link between depression and the pill at Amsterdam UMC. We asked Margot seven questions on the (un)usefulness and side effects of the pill.
As a PhD student doing research on the pill, Margot Morssinkhof is regularly questioned at parties at 3:30 a.m. about which contraceptive pill is currently the best. During the day, people do not broach the subject as easily, she notices. It even gets uncomfortable sometimes. “You get right into three taboos: depression, menstruation, and sex. People sometimes say they don't think it’s appropriate to talk about these topics.”
When she was still studying psychobiology 10 years ago, she experienced for herself what taking the pill can do to you. “I noticed that I felt different: I no longer became happy about things that normally made me happy and was easily irritated.”
She had nowhere to turn with her complaints. Her GP referred her to the student psychologist, and in the scientific literature and online she could hardly find anything. Only when she decided to stop taking the pill for a while did she feel like her old self again. “Still, the subject intrigued me, so I decided I wanted to do a PhD on it.”
So can the pill depress you or not?
“There are lots of studies with different set-ups. For instance, some studies show that there is no demonstrable difference between women on the pill and those who are not. Here you have to remember that satisfied users continue on the pill and dissatisfied users might quit sooner.”
“A study from Scandinavia was able to use population register data to find out whether women who started on the pill had an increased risk of depression in the following years. In the first year after starting the pill, that risk was indeed one and a half times higher than before, with outliers among teenagers, in whom the risk doubled in the first year after pill use. In subsequent years, there was no increased risk.”
Is there a link between pill use and depression or does the pill even cause depression?
“It is association research. A cause is very difficult to demonstrate. Only a placebo-controlled study can do that. That is being done but in smaller groups. One of the objections to the Scandinavian study is that we also see that teenagers from lower socio-economic classes are more likely to start taking the pill. Those are the same girls who are also more at risk of depression. There is always noise in the data throughout. So no, a causal relationship cannot be demonstrated.”
So there is no direct evidence that people develop symptoms of depression from the pill?
“There are some indications. It has everything to do with how you look at the data. In my PhD research, we used data from the Dutch Depression and Anxiety Study (NESDA), which tracked 3,000 women over years. If you split the data into pill users and non-pill users, you don’t see any differences. But if you look within the subgroup of women who switched between pill use and no pill use, you do see mood symptoms. That was a moment of insight for me, being one of those switchers. So maybe women will start experimenting themselves with what works.”
“There was also a placebo-controlled study conducted on a group of women who had previously suffered from taking the pill. Half were given a placebo, the other half the pill. The women who got the pill noticed the difference, while the placebo group did not experience any adverse symptoms. That’s an indication that you can indeed experience side effects from the pill.”
Does it depend on the individual whether the pill causes side effects or not?
“Yes, that’s what we suspect. Some women are probably extra sensitive to hormone fluctuations, while others are not affected at all. So there must be something in the body that is extra sensitive to hormones or not.”
Do you worry about the pill?
“I don’t worry about it for myself, but I do worry about teenage girls. As a group, they are already vulnerable to mood and anxiety problems and going on the pill potentially doubles that risk. Another study that shocked me showed that women who take the pill as teenagers are more likely to be depressed in adulthood. What if the pill, like alcohol, affects brain development and makes women who take it more likely to get depressed? It that’s the case, then teenagers will no longer be prescribed the pill so easily.”
“What I do think is a good development is that I see more and more conversations around me about the pill. And that women are quitting the pill because they have side effects. That’s also my advice: Talk about it with friends or your mother.
Aren’t you afraid that it will become less scientific if women start discussing the pros and cons of the pill among themselves?
“Yes, I have also spoken to people who say, for example, that everyone gets depressed from the pill and loses their libido. I think that is unjustified. Some people don’t suffer from anything when on the pill. I think there should be room for nuance here: some suffer, some don’t. Both are right. And research is needed for that nuance.”
Do you still use the pill yourself?
“No, I switched to a hormonal coil. Unlike the pill, which gives off different kinds of synthetic hormones to your body, the hormone coil only gives off one kind of hormone and in a lower dosage. This is because the IUD releases the hormones directly into the uterus and physically prevents the embryo from nesting.”
Which is better - the pill or an IUD?
“That is up to the individual. IUDs have been on the rise in recent years, while pill use is declining a bit. There are also excellent contraception choice guides like the one from the Rutgers Foundation. But it is often overlooked that there are several types of pills and you can opt for one with a lower dosage. For example, I know people who switched from Microgynon to another pill, such as Yasmin.”
“Whatever you choose, just take care of yourself for the first six months. During that period, the ‘risk’ of side effects is highest. What can help is to keep a menstrual app during that period to see if you have mood swings. And don’t let people tell you it’s a figment of your imagination if something is bothering you!”
