Groningen, the Netherlands—Pharmacists and other healthcare professionals might want to check-in with teenagers using oral contraceptives to make sure they are not suffering from depressive symptoms, according to a new study.

The risk, according to a report in JAMA Psychiatry, is that depression could affect quality of life in those adolescents and put them at risk for nonadherence to their birth-control pills.

An observational study recently examined associations between depressive symptoms and oral-contraceptive use in adolescent girls and young women and how those associations might differ by age. Part of the impetus was that oral contraceptive use has been associated with increased risk of depression in adolescents.

Dutch researchers from the University of Groningen included about 1,000 girls and young women in the Netherlands who completed at least one of four assessments about their oral-contraceptive use and depressive symptoms at four ages—16, 19, 22, and 25 years.

Results indicate no association with depressive symptoms when all age groups were combined. Only 16-year-olds who used oral contraceptives reported higher depressive-symptom scores and were more likely to report crying, eating problems, and excessive sleepiness versus those who didn’t use oral contraceptives.

Researchers had set out to investigate the association between oral-contraceptive use and depressive symptoms, determine which specific symptoms are associated, and examine whether this association is affected by age. To do that, the study team used data from the third through sixth waves of the prospective cohort study Tracking Adolescents’ Individual Lives Survey (TRAILS), conducted from September 1, 2005, to December 31, 2016. Data analysis was performed from March 1, 2017, to May 31, 2019.

Depressive symptoms were assessed by the DSM-IV–oriented, affective-problems scale of the Youth (age 16 years) and Adult Self-Report (ages 19, 22, and 25 years).

“Oral contraceptive users particularly differed from nonusers at age 16 years, with nonusers having a higher mean (SD) socioeconomic status (0.17 [0.78] vs. -0.15 [0.71]) and more often being virgins (424 of 533 [79.5%] vs. 74 of 303 [24.4%]),” the authors write. “Although all users combined (mean [SD] ages, 16.3 [0.7] to 25.6 [0.6] years) did not show higher depressive symptom scores compared with nonusers, adolescent users (mean [SD] age, 16.5 [0.7] years) reported higher depressive symptom scores compared with their nonusing counterparts (mean [SD] age, 16.1 [0.6] years) (mean [SD] score, 0.40 [0.30] vs. 0.33 [0.30]), which persisted after adjustment for age, socioeconomic status and ethnicity (beta  coefficient for interaction with age, -0.021; 95% CI, -0.038 to -0.005; P = .0096).”

The study notes that adolescent contraceptive users reported more crying (odds ratio, 1.89; 95% CI, 1.38-2.58; P <.001), hypersomnia (odds ratio, 1.68; 95% CI, 1.14-2.48; P = .006), and eating problems (odds ratio, 1.54; 95% CI, 1.13-2.10; P = .009) than nonusers.

“Monitoring depressive symptoms in adolescents who are using oral contraceptives is important, as the use of oral contraceptives may affect their quality of life and put them at risk for nonadherence,” the authors conclude.

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