Contraception, Depression, and Who Bears the Burden of Unwelcome Side Effects

I started taking hormonal birth control pills in September 2015. That entire past summer, I had begun to experience some early warning signs of a depressive relapse. As someone who’d battled mental illness throughout my adolescence, I dreaded that possibility intensely. Throughout my freshman year of college, I’d managed to keep depression at bay without even trying: I was living away from home for the first time, I was meeting new people and making friends, I was very much in the honeymoon phase with my new significant other, and I didn’t feel particularly stressed about my future just yet.

But that summer, my life started to shift. Because my housing scholarship had expired, I had to move into an apartment with five other people, several of whom I barely knew. Maintaining my new relationships, even healthy ones, caused me anxiety — I hadn’t had any close friendships or a romantic relationship in some time. And as my sophomore year approached, overachiever that I am, I began to worry that I wasn’t doing enough to ensure my future success. So when I started taking birth control, there was no dramatic change in my moods, at least not that I could perceive; I just assumed that my brain was functioning poorly for various external reasons.

Looking back on it now, I don’t know how I could have possibly overlooked the havoc that these hormones wrought on my mental health, but of course, hindsight is very much 20/20. That fall, I was so depressed and anxious that the stress weakened my immune system, causing me to contract various illnesses that I might otherwise have avoided. I dropped a class for the first — and thus far the only — time ever, and with it an entire second major (in psychology, ironically). I felt incredibly low in a way that I hadn’t since high school, and although there have been some fluctuations since then, my mental health has more or less been in stasis. And it has only been in the past several months that, after some resistance, I’ve begun to make the connection: hormonal birth control may not have caused my relapse, but it accelerated a downward slope that I might otherwise have been able to recover from.

My birth control “story” is the farthest thing from unique. In a recent Washington Post article on a fall 2016 Danish study exploring the connection between depression and hormonal birth control, Katie Mettler summarized the study’s findings:

Women who used the combined birth control pill, a mix of estrogen and progestin, were 23 percent more likely to be prescribed anti-depressants than nonusers, and progestin-only pills raised the likelihood by 34 percent. With the patch, antidepressant use doubled; risk increased by 60 percent for vaginal rings and 40 percent for hormonal IUDs.
“side effects” (Lee Royal/Flickr)

Those within the medical community were quick to cite the age-old scientific disclaimer that correlation does not equal causation, as though such a high correlation doesn’t effectively speak for itself. As Holly Grigg-Spall wrote in response for the Guardian, “It seems that no study will ever be good enough for the medical community to take women’s experiences seriously. As soon as this research dropped, the experts lined up to deliver their usual mix of gaslighting and paternalistic platitudes.”

At around the same time this study was publicized, vindicating the grievances and fears of those like me on hormonal birth control, another study came to a screeching halt: one testing a hormonal birth control shot for men, which had a 100 percent efficacy rate but caused the men involved in the study unpleasant, and occasionally even dangerous, side effects. The story exploded on social media, as women scorned these men for being unable to handle symptoms that they themselves had been dealing with since the invention of hormonal birth control. Quickly, the narrative became “Men are such babies,” prompting backlash from those who pointed out the very real health risks posed by the study.

But this viewpoint — that men shouldn’t be faulted for complaining about very real negative symptoms — is over-simplistic. The issue is not that these side effects weren’t valid justification for ceasing the study. Rather, the issue lies in the fact that scientists chose to protect men from these side effects while simultaneously shrugging their shoulders and deciding that women should be forced to endure them. Plus, in addition to this gendered dynamic of testing hormonal birth control, there is an even more insidious racial dynamic that has historically accompanied such testing.

In 1955, co-inventor of the combined oral contraceptive pill Gregory Pincus visited Puerto Rico, where he conducted trials for the pill using low-income, uneducated women as test subjects — without telling them that they were participating in a clinical trial. Like the male birth control shot in the 2016 study, the pill was proven to be 100 percent effective. However, nearly one in five of the women experienced severe side effects, with three of them even dying during the trials. Pincus did not investigate the cause of these deaths, instead attributing side effects to psychosomatic causes and declaring the trials a success. The FDA approved the use of the pill by 1960.

Portrait of Gregory Pincus. (Wikipedia)

Although, as Bethy Squires wrote for Broadly in October, “the ethically reprehensible and deeply racist Puerto Rican clinical trials led directly to the informed consent procedures that all medical studies must adhere to today,” the damage had already been done. By exploiting women of color who lacked power or the ability to give informed consent, scientists were able to put a birth control pill on the market that caused a variety of negative side effects, including depression. Reflecting on the recent Danish study, National Women’s Health Network executive director Cindy Pearson has stated, “The risk of depression has been recognized since women were able to get their hands on oral contraceptives. It makes sense biologically, and it’s been reported by women for 50 years.”

Even now, with concrete data to support this phenomenon, scientists continue to squabble over whether people on hormonal birth control are really depressed, and if so, whether there is really a correlation between these two factors. Meanwhile, people like me are forced to make a decision: remain on birth control and, in the meantime, pursue psychiatric treatment and antidepressants that ultimately put more money in the pockets of Big Pharma — or give up entirely on birth control and the reproductive security that it affords. This is to say nothing of those who rely on these prescriptions not for contraceptive purposes, but to treat other reproductive health issues.

No one should have to make this choice. People of all genders — of all races, classes, and levels of ability — deserve access to birth control that is as safe and healthy as it is effective. We should not have to endure side effects that are unpleasant at best and debilitating at worst, and the brunt of contraceptive responsibility should not be placed on those assigned female at birth. It is disheartening and disempowering to feel that I am at the mercy of the hormones I am putting into my body out of necessity, and I am tired of feeling compelled to take on such a burden.

It’s Undergraduate Week at Nursing Clio! All this week we’re proud to bring you amazing work written by students at Macaulay Honors College, CUNY. Students wrote their essays as part a course, “The Politics of Women’s Health,” taught by Elizabeth Reis.