Stable Anxiety and Depression Trajectories in Late Adolescence for Oral Contraceptive Users

Abstract

BackgroundThe use of oral contraceptives (OCs) has been associated with increased incidences of anxiety and depression, for which adolescents seem to be particularly vulnerable. Rather than looking at singular outcomes, we examined whether OC use is associated with depressive and anxiety symptom trajectories from early adolescence into early adulthood.Materials and MethodsData from 178 girls were drawn from the Research on Adolescent Development and Relationships (RADAR-Y) younger cohort study. We used assessments on 9 waves from age 13 until 24. Developmental trajectories of ratings on the Reynolds Adolescent Depression Scale (RADS-2) and the Screen for Child Anxiety Related Emotional Disorders (SCARED) were compared between never and ever users of OCs.ResultsNever users showed increases in depressive and anxiety symptoms in late adolescence, whereas OC users showed a stable level of symptoms throughout adolescence. This effect remained after adjusting for baseline differences between groups in romantic relationships, sexual debut, educational level, smoking, drinking, and drug use. Age of OC use onset did not significantly predict symptom development.ConclusionsOC use in adolescence was related to an altered developmental trajectory of internalizing symptoms, in which OC users did not show an increase in depressive and anxiety symptoms in late adolescence, whereas never users did. The question remains whether this altered symptom trajectory can be considered a protective effect of OC use on psychopathology. Additional research is needed to improve our understanding of the long-term consequences of OC use on mental health.

Acne and its association with internalizing problems

“…In this sample, those who reported using OC at some point had stable trajectories of depressive and anxiety symptoms compared to never‐users who showed increasing trajectories in late adolescence, indicating possible mediating effects of HC on internalizing symptoms 120 . The results remained stable when covariates (e.g., first sexual debut) were added, though this study did not report information on OC type, limiting inferences in this area and about COCs specifically 120 . Generally, there appears to be varying risk for depressive symptoms that differ by age or type of HC, with COC use typically showing the least depressive risk 62 .…”

“…Isotretinoin is a well‐known third‐line treatment for severe acne that has been implicated in the development of internalizing symptoms including depression and suicidal ideation and behavior 119 . Similarly, combined oral contraceptives (COC; e.g., Ortho Tri Cyclen) are often used to treat acne in women with no medical contraindications and have also been linked with depression and anxiety 120,121 . Although isotretinoin and COC remain effective for many in reducing acne, their role in the presentation of internalizing side effects cannot be overlooked if acne treatment is to address all acne symptoms.…”

“…119 Similarly, combined oral contraceptives (COC; e.g., Ortho Tri Cyclen) are often used to treat acne in women with no medical contraindications and have also been linked with depression and anxiety. 120,121 Although isotretinoin and COC remain effective for many in reducing acne, their role in the presentation of internalizing side effects cannot be overlooked if acne treatment is to address all acne symptoms. Broadly, COC are a class of HC that typically contain varying ratios of the exogenous hormones estrogen and progestin.…”

“…However, when stratified by type of HC, COC specifically showed no increase in depression. 117 In another study, Doornweerd et al 120 assessed general oral contraception (OC) use and internalizing symptom trajectories in a sample of (n = 178 at Wave 1 in 2006) Dutch girls who were followed from age 13-24 years old. 120 In this sample, those who reported using OC at some point had stable trajectories of depressive and anxiety symptoms compared to never-users who showed increasing trajectories in late adolescence, indicating possible mediating effects of HC on internalizing symptoms.…”

“…117 In another study, Doornweerd et al 120 assessed general oral contraception (OC) use and internalizing symptom trajectories in a sample of (n = 178 at Wave 1 in 2006) Dutch girls who were followed from age 13-24 years old. 120 In this sample, those who reported using OC at some point had stable trajectories of depressive and anxiety symptoms compared to never-users who showed increasing trajectories in late adolescence, indicating possible mediating effects of HC on internalizing symptoms. 120 The results remained stable when covariates (e.g., first sexual debut) were added, though this study did not report information on OC type, limiting inferences in this area and about COCs specifically.…”