Oral contraceptives and depression: impact, prevalence and cause.

One million American adolescents are currently using oral contraceptives. Sixty percent of those beginning the pill discontinue its use within a year. Concern that mood change might be contributing to the decision to stop the pill prompted a review of the literature on the association between oral contraceptive use and depression. Trends in adolescent pregnancy, contraceptive use, and compliance are discussed in the first section. In the second, 12 clinical studies are analyzed. Because there are no studies of mood change and oral contraceptive use in adolescents, some data from adults are presented. Biochemical theories to explain an association between oral contraceptive use and depression are discussed in section three. Nine of the 12 clinical studies reported depression in 16-56% of women using oral contraceptives. Three studies found no association between oral contraceptive use and depression. The major problems found in the clinical trials were selection bias, poor assessment of pre-therapeutic mood state and unclear definition or measurement of depression. Current biochemical research suggests that oral contraceptives induce tryptophan oxygenase, which leads to pyridoxine deficiency in some women. However, the use of pyridoxine to prevent or treat depression in women taking oral contraceptives requires further study.