While the link between hormonal birth control and depression in the general population is still up for debate, recent research shows that teens and young adults with attention-deficit/hyperactivity disorder (ADHD) may have an even higher risk of developing depression when using hormonal birth control as compared to their peers without an ADHD diagnosis.
Unplanned pregnancies are more common in teens with ADHD than in those without ADHD. But the reasons why are not well understood: It could be related to reduced access to contraception, poor reproductive health counseling or a lack of adherence, researchers state. But there’s also just a lack of research in general—women and girls with psychiatric conditions are often excluded from clinical trials on hormonal birth control.
In a study published in the Journal of the American Academy of Child and Adolescent Psychology, a group of researchers sought to understand whether the increase in teen pregnancies among those with ADHD could be due to side effects from taking the pill, like depression, which might make some teens less likely to consistently take the pill, or to stop trying to find a pill they can tolerate.
Related: 8 common myths about ADHD—debunked
“Young women, aged 18 to 25 years, have the highest risk for common psychiatric conditions in comparison with women and men of all age groups, which in turn may have consequences for their reproductive health,” write the study authors. “Indeed, research suggests a vicious spiral whereby women with mental health problems are less likely to use effective contraceptive methods.”
To help shed more light on the phenomenon, they set out to determine whether teens with ADHD are more prone to developing depression as a result of taking hormonal contraceptives than those who didn’t have ADHD.
Exploring the link between birth control and depression in teens with ADHD
In a large-scale study based on population records in Sweden, the researchers identified women who were between the ages of 15 to 24 from Jan. 1, 2010, to Dec. 31, 2017. They identified 29,767 women with ADHD and 763,146 without, based on diagnosis codes and prescription data. They were then able to determine if those women used oral or non-oral hormonal contraceptives.
They also identified those who were later diagnosed with depression and/or received an antidepressant prescription during the study period.
In Sweden, where the cohorts were based, despite the availability of hormonal contraceptives and low overall rates of teen pregnancies, teens with ADHD are 6 times more likely to give birth compared to their peers without ADHD, the study authors note.
After controlling for confounding factors, such as education and birth country, they found that young women with ADHD who used combined oral contraceptives were 6 times more likely to develop depression than those without ADHD who also took birth control. Those who took a progestin-only form of oral contraception had a 5-fold risk.
The analysis did not show an association with depression in women using oral contraception who didn’t have ADHD. For non-oral hormonal contraceptives, such as the patch or ring, the increased risk of depression was only moderate, and was not found to be higher in women with ADHD specifically.
Fluctuating hormone levels with oral contraception
As for the mechanism behind the increased risk of depression with oral contraceptives? It could be due to fluctuating hormone levels with a pill method, as opposed to the patch or ring, which offer a more consistent flow of hormones; or it could be related to the break in hormone levels during the pill-free week.
But because some of the core symptoms of ADHD are distractibility and disorganization, having ADHD could also mean some women are more likely to forget to take a pill, which could lead to a greater risk of mood changes.
The study authors instead recommend long-acting reversible contraception measures (LARC), such as intrauterine devices (IUDs) and implants—they could be more effective in those with ADHD with fewer mental health side effects. LARCs offer a more consistent hormone delivery, but non-hormonal IUDs such as the copper IUD might also be a good option.
Finding the right birth control can be a lengthy process. The study authors hope these research findings can be used as a talking point between doctors and teens when discussing contraception options, especially for those who have ADHD or who may be more susceptible to depression or other mental health conditions.
“… Our findings suggest that information on risks with [hormonal contraceptives] as well as potential benefits with user-independent long-acting reversible contraception needs to be an integrated part of the shared decision making and contraception counseling for young women with ADHD,” write the authors.
Lundin C, Wikman A, Wikman P, Kallner HK, Sundström-Poromaa I, Skoglund C. Hormonal contraceptive use and risk of depression among young women with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry. 2022 Nov 1. doi:10.1016/j.jaac.2022.07.847
Odlind V, Haglund B, Pakkanen M, Otterblad Olausson P. Deliveries, mothers and newborn infants in Sweden, 1973-2000. Trends in obstetrics as reported to the Swedish Medical Birth Register. Acta Obstet Gynecol Scand. 2003;82(6):516-528.
Skoglund C, Kopp Kallner H, Skalkidou A, et al. Association of attention-deficit/hyperactivity disorder with teenage birth among women and girls in Sweden. JAMA Netw Open. 2019; 2e1912463. doi:10.1001/jamanetworkopen.2019.12463
Zethraeus N, Dreber A, Ranehill E, et al. A first-choice combined oral contraceptive influences general well-being in healthy women: a double-blind, randomized, placebo-controlled trial. Fertil Steril. 2017; 107: 1238-1245. doi:10.1016/j.fertnstert.2017.02.120