The reporting of this trial is a nightmare that could easily cause unintended pregnancies THE PILL ISN'T MAKING EVERYONE DEPRESSEDpic.twitter.com/3TOiMkA9ww
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Basically, the researchers took a group of people who'd been part of the NHANES data collection in both 2004 and 2017, and split them into 3 groups: - started oral contraceptives as a teen - started oral contraceptives as an adult - never used oral contraceptives
They then compared these groups in terms of their risk of depression at the final follow-up in 2017 They found that the risk of depression was associated with whether people used oral contraceptives, and when they started (teen vs adult)
Essentially, the pill caused people to be depressed Scary!pic.twitter.com/yaly9YwSus
HOWEVER, there are some major limitations to this piece of research Firstly, there's the issue of confoundingpic.twitter.com/niHgv4Ex57
The groups of women that they looked at were different in some very important ways - people who had used the pill as adolescents were on average older, more likely to smoke, more likely to have endometriosis, poorer, etc etc
Now, the researchers used what's known as a propensity model to try and control for this, but as ever it's really hard to account for every factor in studies like this We can only control for what we know and measure!
There's also a big issue with what's known as reverse causality Basically, it's hard to know whether pills = depression or depression = pills Potentially, this study showed that people who are experiencing depression might be more likely to go on the pillpic.twitter.com/I6pOGeptF3
This is somewhat supported by the study, because people who started using oral contraceptives in their teens were less likely to use them as adults - it's not unlikely that their mental health influenced the decision to use contraceptives rather than the other way around
It's also worth noting that, while the headline statistic is TRIPLE THE RISK, the absolute risk of depression associated with oral contraceptives was more like 5-10%
Even more importantly, a large meta-analysis that came out last year looked at some specific types of oral contraceptive and found no relationship with depression at allpic.twitter.com/WjMyaPM7vi
Does the pill have side-effects (sometimes really nasty ones)? Absolutely. I don't for a second want to diminish the impact that oral contraceptives can have
That being said, the fearmongering in these headlines is a massive headache. There may be ~some~ association between oral contraceptive use and depression, but it's not nearly as scary as you might've seen reported
Also, the side-effects of oral contraceptive use usually pale in comparison to the side-effects of pregnancy, so it's a bit of a challenging argument
I wrote a blog about a similar study a while back, with almost identical issueshttps://medium.com/@gidmk/why-is-the-pill-so-depressing-1b429d271d33 …
I should also add - the authors of the paper were very upfront about all of this, and emphasized that women should still use contraceptives, so I think it's very much the media's problem here
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