






























Mythili et al. Body Template.docx


Berkeley
Pharma Tech
Journal of Medicine

Correspondence: 
mynair@ucsc.edu 

Keywords:
oral contraceptives (OC)
depression
estrogen
progesterone
synaptic pruning
prefrontal cortex
hypothalamic-pituitary-adrenal 
(HPA) axis

Submitted December 11, 2023 
Accepted July 14, 2024
Published December 27, 2024

Full Open Access

Creative Commons Attribution 
License 4.0

Abstract
Adolescence is a critical stage of development marked by profound physical, 
emotional, and psychological changes. During this period, many adolescents turn to 
contraceptives for various reasons, including birth control, menstrual regulation, and 
addressing medical conditions. However, the potential impact of contraceptives on the 
mental health of adolescents remains a topic of significant concern and debate. 
This paper serves as a review of current literature on oral contraceptives (OCs), 
which are the most commonly prescribed form to adolescents, and concentrates 
on research that correlates contraceptives with heightened depression symptoms. The 
synthesis of findings in this review aims to inform healthcare professionals and 
researchers about the importance of further research and to help young individuals 
acquire a deeper comprehension of the long-term mental health implications 
associated with OC use during adolescence.

Long-Term Effects of Hormonal Oral 
Contraceptives on Adolescents’ Mental 
Health
By: Mythili Nair, Isabelle Pappas, and Sahithi Lingala



1. Introduction

This paper aims to delve into the pharmacological and psychological
mechanisms of oral contraceptives and their role in the onset or
exacerbation of depression in adolescents. It will examine scientific reviews
and primary articles to discuss how oral contraceptives work and alter
adolescent physiology. Additionally, it will provide insights into what
depression is and how SSRIs and oral contraceptives can interact. This
paper serves as an information guide for adolescents, raising awareness about
the effects of birth control and emphasizing their increased vulnerability to
depressive symptoms. It also serves as a call to action, advocating for further
research to create effective contraceptive methods with a reduced risk of
mood disorders.

Contraceptives encompass a diverse range of devices and drugs designed to
prevent pregnancy, and they also serve several purposes like menstrual
regulation, pain management, and addressing medical concerns such as
endometriosis. In today's market, contraceptives are broadly categorized
into two main groups: hormonal and non-hormonal. Hormonal birth
control includes emergency contraception (typically in pill form), oral
contraceptives, implants, the vaginal ring, and estrogen/progestin patches.
Hormonal contraceptives function by introducing synthetic hormones that
mimic the body's naturally occurring sex hormones, estrogen, and
progesterone. Oral contraceptives are taken daily by mouth, while implants,
rings, and patches are placed inside the body and slowly release hormones
into the bloodstream.1

Non-hormonal birth control methods consist of condoms, spermicides, and
natural family planning/fertility awareness. Condoms, which can be made
of latex, polyurethane, or lambskin, act as a barrier to prevent sperm from
entering the uterus. Spermicides are chemical agents that kill or immobilize
sperm, often used in conjunction with other barrier methods. Family
planning involves cycle tracking and avoiding intercourse during ovulation
to prevent unwanted pregnancy. Additionally, intrauterine devices (IUDs)
are a popular choice, available in both hormonal (progestin IUD) and
non-hormonal (copper IUD) variations. The progestin IUD functions

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similarly to other hormonal contraceptives, while the copper IUD creates a
toxic environment for sperm, effectively killing them before fertilization.1

In 2018, a study unveiled that 38.7% of adolescents utilized contraception
for medical purposes and to prevent unwanted pregnancies. Among the
various options, oral contraceptives stood out as the most frequently
prescribed for young women due to their effectiveness and user-friendly
nature.2 Typically, the combination pill, incorporating both estrogen and
progesterone, constitutes the most prevalent type, administered over a
28-day cycle comprising 21 active pills followed by a week of placebos,
inducing menstruation. Doses are personalized by physicians upon
prescription. These pills work by mimicking a pregnancy-like state, fooling
the pituitary gland into halting hormone release for ovulation, thus
preventing pregnancy. Progesterone, meanwhile, thickens cervical mucus,
hampering sperm access to the uterus, and alters the uterine lining,
impeding egg attachment. While crucial for maintaining stable hormone
levels and aiding in addressing medical conditions, the introduction of
synthetic hormones can disrupt the body's natural equilibrium, leading to
various side effects. It is especially vital to discuss these potential effects with
adolescents, given their heightened susceptibility to hormonal and bodily
changes.3

Among these side effects, the deterioration of mental health and worsening
of mood disorders is one of the most studied. Over the years, multiple
studies have explored the correlation between oral contraceptives and
depression, particularly in adolescents.4 Depression has been linked to low
serotonin, dopamine, and norepinephrine levels, influenced by genetic
predisposition rather than solely inheritance. To address depression,
selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed,
enhancing serotonin transmission by blocking its reabsorption into
neurons. It is worth noting that SSRIs can also impact estrogen and
progesterone levels due to their interaction with the body's hormones,
potentially affecting those using both antidepressants and birth control. In
adolescents, the onset of depression is associated with increasing levels of
gonadal hormones, including estrogen and progesterone. Contraceptive
pills introduce synthetic sex hormones into the body, potentially elevating

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these hormone levels and worsening depression symptoms. The connection
between depression and oral contraception remains a subject of ongoing
research.5

Figure 1. A Visual Representation of the Different Types of Contraceptives. The
figure highlights the distinctions between oral contraceptives, implants, IUDs, and barrier
methods, emphasizing their mechanisms and clinical applications. This visualization
underscores the diverse choices available for managing reproductive health.

2. Literature Review

2.1 Studies Show that the Link Between OC Use and Depression in
Women is Not Entirely Straightforward

The link between oral contraceptive pill (OCP) use and depression is not
entirely straightforward and has been a topic for debate for decades since the
conception of the pill. More recent studies (from 2020 onward) tend to
agree that oral contraceptive use can cause depressive symptoms in those
with no history of psychiatric illness as well as exacerbate symptoms in those
with a history of mental illness. According to a pilot study conducted by
Jayashri Kulkarni, depressive symptoms that result from oral contraceptive
use was the single most reason for discontinuation of the pill.6 However,
there are several earlier studies that show no correlation between OCP use
and depressive symptoms, suggesting that our knowledge about the link
between the two is limited.

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B. Bottcher et al. analyze several studies from 1960-2005 that examine the
effects of OCP use on mood. Bottcher et al. contribute the misattribution
of OCP use to depression with “the inconsistent use of the term
‘depression’ and the large number of combined contraceptives which vary in
their compositions.”7 According to the DSM, “A major depression is not
equivalent to negative mood changes, tension, irritability, anxiety, or
sadness,” and, as a result, the results of the studies analyzed in this article do
not necessarily indicate OCP use as a cause of depression.8 Bottcher et al.
also claim that depression is more common in women than it is in men, and
the “median age for diagnosis was 31, which is within the reproductive
age.”9 Thus, it may not be entirely true that OCP use directly causes
depression but rather that women are more likely than men to show signs of
depressive symptoms. Additionally, the majority of women who use oral
contraceptives are likely to be of reproductive age, which is the most
common age at which depression is diagnosed in both women and men.
Ultimately, B. Bottcher at al. concluded that there is no significant
correlation between OCP use and depressive symptoms. That being said,
Bottcher et al. also recognize the limitations of their analysis, as “the
composition of hormonal contraceptives has also changed dramatically– the
dose of ethinyl estradiol has been consistently reduced over the years and is
less than half of that used in the early years of hormonal contraception.”10

The researchers analyzed studies from around the late 20th century, and the
compositions of present-day OCPs have changed significantly since then.
This change may have something to do with the conflicting results in later
studies that often find a correlation between OCP use and depression in
women.

Another study conducted by T. Johannson et al. examined the long-term
mental health effects of birth control on women and found that OCP use is
“causally” related to risk of depression. The study utilized medical
information from more than 250,000 women in the UK Biobank (UKB)
and looked particularly at the risk of depression in adolescents and adults
during and after OCP use. The study found that “the first 2 years of OC use
were associated with a higher rate of depression compared to never users.”11

Even more, their findings “showed that women who used OCs during
adolescence remained at a heightened risk even after they discontinued,

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whereas such a risk was not apparent among adult OC users.”12 Johannes et
al. explain the results of their findings by suggesting that adolescents are
more sensitive to hormonal changes, putting them at an increased risk for
depression with OCP use. According to Johannson, sensitivity to hormonal
changes is greatest “during crucial developmental periods that affect the
organization of the brain structures and may lead to long-lasting changes.”13

This article confirms the causal relationship between OCP use and an
increased risk of depression in adolescents. However, the researchers’
discussion of their results suggests that adolescents are inherently vulnerable
to depressive symptoms due to puberty and environmental changes and that
OCP use may only exacerbate these symptoms.

While T. Johannson et al. discovered a causal relationship between an
increased risk of depression and OCP use, a study conducted by Anouk E.
de Wit et al. (2021) suggests that it is not clear whether the relationship is
causal or not. The researchers conducted a meta-analysis of clinical trials
consisting of over 5000 women who were given either a hormonal
contraceptive pill or a placebo pill. Only one trial consisted of adolescent
women; thus, the researchers concluded that they “cannot rule out that
first-time use is a risk factor for experiencing depressive symptoms with
hormonal contraceptive use.”14 The hormonal contraceptives that were
given to the women included combined oral contraceptive pills,
progestin-only pills, contraceptive patches, combined injectable
contraceptives, progestin-only injectable contraceptives, intrauterine
devices, and more. Thus, the pill was not the only hormonal contraceptive
method that was studied here but also other forms of hormonal
contraception, like the patch and injectables. The results of the study
suggest that not a single form of hormonal contraception showed a greater
risk of depression over another or the placebo. This conclusion is in direct
opposition to that of several observational studies, which have found a
significant increase in incidence of depression in OCP users and particularly
in adolescent OCP users.15

A year earlier, the same researcher Anouk E. de Wit co-authored a different
article that looked at the association of oral contraceptive use with
depressive symptoms among young women and adolescents. The

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researchers “did not find support for an overall association between OCP
use and depressive symptoms among young women. However, 16 year old
girls using OCPs did report higher concurrent depressive symptom scores
compared with their nonusing counterparts.”16 16-year-old users of OCPs
reported a greater incidence of crying, hypersomnia, and eating problems,
which symptoms are more associated with adolescent depression as opposed
to adult depression. The researchers also discuss several confounding
variables that may explain this trend. Anouk de Wit et al. suggest that there
may be a higher prevalence of depression in 16-year-old OCP users not only
due to the hormonal changes that the drug itself induces but also because
“treatment with OCPs is standard care for cycle-related mood problems and
for polycystic ovarian syndrome, which is associated with depressive
symptoms.”17 Thus, the increased prevalence of depression in 16 year-old
OCP users as compared to nonusers of that same age group might be related
to the fact that those 16 year-olds who use OCPs are more likely to have
suffered from depression and other mood disorders even before they started
the pill.

In an article published in 2004, Stephen A. Robinson et al. set out to
determine whether psychological or pharmacologic mechanisms were
responsible for the adverse emotional side effects of the pill in OC users.
The researchers conducted a study in which half of the women were given
OC pills and the other half placebo pills. The results of study show that
women on the placebo pill “experienced a similar side effect profile of OCP
users.”18 Psychiatrist Johan Culberg proposed that the psychological side
effects of OC use were due to the “symbolic property of contraception:” “it
is something that prevents sexual intercourse from being followed by
pregnancy and an unwanted child.”19 Additionally, the blood levels of
estrogen and progesterone in the OCP users were measured, and researchers
found no significant correlation between hormone blood levels and
depressive symptoms in these women. This is to suggest that the adverse
mental and emotional side effects from OC use are largely due to
psychological, not pharmacologic, mechanisms. Robinson et al. conclude,
“it is not the pharmacodynamics that primarily impact the individual’s
psyche and subsequent emotions and behavior, but rather the belief that
one is contracepting is causing such a phenomenon.”20 Additionally, the

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authors introduce the idea that “contraception leads to a complete
dissociation from the pleasurable/ relational and procreational components
which, in turn, places a different value on sexuality itself.”21

It turns out that the use of oral contraceptives is not the only factor that
changes the “value of sexuality.” In fact, the “value of sexuality” has been
changing since the sexual revolution of the 60s and, even more so, with the
advent of the modern hook-up culture. According to an article published by
Justin R. Garcia et al. in the National Library of Medicine, “hook-ups” are
defined as “uncommitted sexual encounters [which] are becoming
progressively more ingrained in popular culture, reflecting both evolved
sexual predilections and changing social and sexual scripts.”22 Since sexual
encounters are becoming more non-committal, and, thus, more frequent,
the use of products such as oral contraceptives to prevent lifelong
consequences is much more prevalent today than it was even only a decade
ago. As such, there have been several articles published within the last four
years that aim to discuss both the physical and mental-emotional side effects
of oral contraceptives in women, particularly adolescents. Perhaps this is
why more recent studies, by deWit et al. in 2020-21 and by Johannson et al.
in 2023, are largely focused on the effects of OC use in adolescent women or
first time users as compared to older women or women who have been using
OCs for more than two years. As it turns out, all scientific inquiries are
influenced by the social phenomena that plague the particular period of
time in which they are made.

Figure 2. A Graphical Representation of the Correlation Between Oral
Contraceptive Use and the Prevalence of Depression in Adolescent Users.OC users
have a higher depression symptom score from approximately ages 16 to 21 than do
non-users. A higher depression symptom score indicates more depression symptoms

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overall. The graph highlights the higher risk during the first two years of use, providing
evidence of increased vulnerability in younger populations.

2.2 Chemistry/ Pharmacology of Oral Contraceptives Associated
with Depressive Symptoms in Adolescent Users

Oral contraceptive pills (OCPs) are a commonly used form of birth control,
and while they are generally considered safe and effective, there is growing
concern regarding their potential link to mood disorders, particularly in
adolescent users. To understand the plausible chemical and pharmacologic
explanations for depression in adolescent OCP users, it is essential to
examine the intricate relationship between the hormones present in these
pills, namely estrogen and progesterone, and their impact on
neurochemistry and brain function.

These hormones exert their effects through specific receptors, with estrogen
acting primarily through estrogen receptors (ER)-alpha and ER-beta, and
progesterone through progesterone receptors alpha and beta, distributed
throughout the brain. ER-alpha is prominently found in the hypothalamus,
hippocampus, amygdala, and brainstem,34 while progesterone receptors
alpha and beta are most abundant in the amygdala, cerebellum, cortex,
hippocampus, and hypothalamus.35 Estrogen, in particular, has been
associated with neuroprotection in various regions of the brain, such as the
hypothalamus, hippocampus, amygdala, and brainstem. Several studies have
suggested that estrogen can safeguard the brain against neurodegenerative
diseases, such as Alzheimer’s and Parkinson’s disease, cognitive decline, and
affective disorders.36 Functional brain imaging studies have revealed that
estrogen plays a role in regulating the activation of brain regions involved in
emotional and cognitive processing, such as the amygdala and dorsolateral
prefrontal cortex.37 Additionally, in animal studies, estrogen has been shown
to modulate several neurotransmitters, including serotonin, dopamine, and
noradrenaline, all of which have significant implications for mood
regulation and depression. Estrogen can also influence the release of
adrenocorticotropic hormone, further impacting stress responses and
mood.38

In contrast to estrogen, progesterone does not exhibit the same
neuroprotective properties. In fact, evidence suggests that progesterone can

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exacerbate mood symptoms and potentially contribute to the development
of mood disorders. Plausible mechanisms for this include progesterone's
augmentation of GABA-induced inhibition of glutamate transmission and
its ability to increase the concentrations of monoamine oxidase. These
actions can lead to decreased serotonin levels, which are often associated
with depressive symptoms.39 Moreover, a study has shown a positive
association between the use of levonorgestrel-containing intrauterine
devices (IUDs) and the development of depression, anxiety, and sleep
problems in women who did not have these conditions before using the
IUD.40 Levonorgestrel is a synthetic progestogen, and the two formulations
of progestogen-releasing IUDs, containing 19.5 mg and 52 mg of
levonorgestrel, may have varying effects on mood.41 The former, which
releases smaller amounts of levonorgestrel, may be more tolerable in terms
of mood disturbances. However, it is crucial to note that there is a lack of
comprehensive data regarding the relationship between this specific IUD
and the development or exacerbation of depression.

Selective Serotonin Reuptake Inhibitors (SSRIs) and oral contraceptives can
have notable interactions when used concurrently, which is essential to
consider for individuals who are prescribed both medications. SSRIs,
commonly used to treat depression and anxiety disorders, work by
increasing the levels of serotonin in the brain, a neurotransmitter that affects
mood and emotional state.42 On the other hand, oral contraceptives contain
synthetic hormones, typically a combination of estrogen and progestin,
which are used for birth control and to regulate menstrual cycles.43 When
taken together, these medications can influence each other's metabolism and
effectiveness. For instance, some SSRIs can increase the levels of estrogen in
the body by inhibiting enzymes responsible for estrogen metabolism. This
elevation could potentially increase the risk of side effects associated with
oral contraceptives, such as blood clots, especially in individuals with other
risk factors. Conversely, certain oral contraceptives can affect the
metabolism of SSRIs, potentially altering their efficacy and leading to either
increased or decreased levels of the antidepressant in the bloodstream. This
interaction might necessitate adjustments in SSRI dosages to maintain
therapeutic effectiveness and minimize side effects.44 It's crucial for
individuals taking both SSRIs and oral contraceptives to have close

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monitoring by healthcare professionals to manage these potential
interactions effectively.

Figure 3. Molecular Structures of Estrogen and Progesterone, the Primary
Hormones in Oral Contraceptives. The figure demonstrates their chemical composition
and structural differences, helping to explain their unique roles in contraceptive efficacy and
potential effects on mood regulation.

3. Discussion

3.1 Higher Risk of Depression in Adolescents

Adolescence is a period marked by a higher risk of depression, a risk deeply
rooted in biological factors. Firstly, the ongoing development of the
adolescent brain plays a crucial role. During this stage, the brain undergoes
synaptic pruning, a process that eliminates unnecessary connections to
increase efficiency. This phase involves the removal of neural connections
that are less frequently used, while strengthening those that are more active.
This selective pruning helps in optimizing brain efficiency and
functionality. However, it is important to note that this process is not
uniform across the brain. Different areas of the brain undergo this pruning
at different times, which can lead to imbalances in cognitive and emotional
processing during adolescence.23 Additionally, the prefrontal cortex, a part
of the brain responsible for higher-order functions like decision-making,
impulse control, and emotional regulation, is one of the last areas to mature.
This delayed development can contribute to characteristic adolescent
behaviors. Adolescents might struggle with impulse control, making them
more prone to risk-taking behaviors. They might also experience challenges
in decision-making, leading to choices that seem irrational or poorly

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thought out from an adult perspective.24 The combination of an
underdeveloped prefrontal cortex and ongoing synaptic pruning can lead to
heightened emotional experiences in adolescents. They might face
difficulties in managing their emotions, leading to mood swings or intense
emotional reactions to situations that adults might find more manageable.
This heightened emotional sensitivity is often compounded by hormonal
changes that occur during puberty, further complicating the emotional
landscape of adolescence.

The adolescent phase marks a significant surge in sex hormones, primarily
estrogen in females and testosterone in males. These hormones do more
than just drive physical development; they profoundly influence the brain's
chemistry, particularly the neurotransmitter systems.25 A key player in this
scenario is serotonin, a neurotransmitter that plays a critical role in
regulating mood and emotional well-being. The surge in sex hormones
during adolescence directly impacts serotonin levels in the brain. Serotonin
is known for its role in feelings of happiness and emotional stability, and its
fluctuating levels can significantly affect an adolescent's mood. These
hormonal changes can make adolescents more vulnerable to mood
disturbances. For instance, a dip in serotonin levels can lead to feelings of
sadness or a depressed mood, contributing to the increased incidence of
depressive symptoms observed in this age group.26 Notably, these hormonal
fluctuations also interact with the adolescent's stress response system.

The stress response system, which includes the
hypothalamic-pituitary-adrenal (HPA) axis, becomes more reactive during
adolescence. This heightened reactivity, combined with fluctuating
serotonin levels, can make adolescents particularly sensitive to stress. They
may experience more intense reactions to stressful situations, and their
ability to cope with these stressors may be compromised due to the ongoing
developmental changes in their brains. Moreover, these biological factors do
not function independently. They are intricately connected to and
influenced by the adolescent's environment, including their social
interactions, family dynamics, and life experiences. Stressful or negative
environments can exacerbate the impact of hormonal changes on mood and
stress response, leading to a higher risk of developing mental health issues

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such as anxiety or depression.27 The intricate relationship between the
hypothalamic-pituitary-adrenal (HPA) axis and adolescent development
plays a pivotal role in understanding the increased vulnerability to stress and
depression during this critical life stage. The HPA axis, a central part of the
body's stress response system, becomes highly sensitive during adolescence.
This sensitivity is largely due to the significant hormonal changes occurring
during this period, which interact with and can potentially dysregulate the
HPA axis. Typically, the HPA axis helps the body manage stress by releasing
cortisol, a hormone that prepares the body to handle stressful situations.
However, during adolescence, this system can become overactive or remain
active for longer periods due to the heightened hormonal fluctuations. This
dysregulation of the HPA axis in adolescents leads to an enhanced stress
response, making them more reactive to stressors that might seem
manageable to adults.

This heightened stress reactivity is not just a momentary experience; it can
have prolonged effects on the adolescent's emotional and psychological
well-being. The continual overexposure to cortisol and other stress
hormones can lead to various adverse outcomes, one of the most concerning
being an increased susceptibility to depression.28 Adolescents, already
dealing with various physical, social, and emotional changes, may find this
added stress reactivity overwhelming, pushing them towards depressive
states. Moreover, this heightened vulnerability is not just a matter of
increased emotional sensitivity; it has biological underpinnings that can lead
to long-term patterns of stress response and emotional regulation. The
ongoing stress and potential for depression during adolescence can, in turn,
affect the brain's development and functioning, particularly in areas
responsible for mood regulation and stress management. This creates a
feedback loop where dysregulation of the HPA axis exacerbates stress and
depression, which further affects the HPA axis's functioning.29

Importantly, these biological processes do not exist in isolation; they are
closely intertwined with the social and environmental factors that
adolescents face. Peer relationships, academic pressures, family dynamics,
and the quest for self-identity all influence an adolescent's emotional
well-being.30 A biological predisposition to depression refers to the inherent

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tendency, often influenced by genetic and physiological factors, that makes
certain individuals more susceptible to developing depression compared to
others. Genetics indeed play a significant role in this predisposition.31

Research has identified several genes associated with an increased risk of
depression, although it is important to note that no single gene causes the
disorder. Instead, depression is a complex trait influenced by multiple genes,
each contributing a small effect. These genes often affect neurotransmitter
systems in the brain, such as serotonin, dopamine, and norepinephrine
pathways, which are crucial for mood regulation.32 In adolescents, the
interplay between these genetic predispositions and the rapid physiological
changes they undergo becomes particularly impactful. The brain is still
developing during adolescence, and hormonal fluctuations are significant.
These hormonal changes can influence the expression of genes related to
mood regulation and stress response, potentially triggering or exacerbating
depressive symptoms in those with a genetic predisposition.33

Understanding these intricate biological underpinnings is essential in
developing effective interventions and support systems to help adolescents
navigate this challenging period and reduce the risk of depression.

3.2 Practical Applications

The following section discusses the practical applications of the research
that attempts to demystify the mental health effects of oral contraceptives
on adolescents. Since the sexual revolution in the 60s, the stigma
surrounding sexual health and pleasure has declined significantly. The
advent of a hook-up culture in more recent years means that women are
having sexual experiences at a younger age today than ever before. Of course,
the value of sex has changed over time as well, as more women choose to
engage in sex acts not only for procreative purposes but also for pleasure.
Patentors of birth control packaging should make a clear list of not only the
physical but also the mental-emotional side effects of the pill on its
packaging. With the recent rise in abortion bans across the US,
administering safe and effective forms of birth control to adolescent women
is more important now than ever before.1 More recently, the FDA approved
a non-prescription, over-the-counter birth control pill The Opill, to be
released in early 2024.2 This means that birth control will be much more

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accessible to women of all age groups. Adolescents may benefit most from
The Opill as neither a prescription nor parental consent will be required to
obtain birth control. Since adolescents will soon have easier access to
hormonal contraception, it is particularly important to educate adolescents
on the mental and emotional side effects of the pill. Additionally, before
prescribing birth control pills to their patients, healthcare providers should
take into account the psychiatric history and age of their OC candidates.
Both parties, the prescriber and the patient, need to be informed of the
physical and mental side effects of the oral contraceptive they choose to
administer and take, respectively, as if it were any other drug. Knowledge
about the ways in which both prescription and non-prescription
medication can affect our emotional-well-being is paramount to using
hormonal contraceptive safely and effectively.

Figure 4. The Opill, a Progestin-Only Birth Control Pill Now Available Over the
Counter. This marks a major step forward in making contraception more accessible and
empowering individuals to take charge of their reproductive health.

4. Future Directions

Scientists are engaged in extensive research and development efforts to
address the risk of depression and mood disorders associated with oral
contraceptive pills. One promising avenue involves fine-tuning the hormone
formulations in these contraceptives. By modifying the types and quantities
of hormones, researchers aim to create pills with reduced mood-altering

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effects while maintaining their effectiveness in preventing pregnancy. For
instance, scientists are working on progestins with a lower propensity to
affect mood.47 Additionally, the use of transdermal patches or hormonal
intrauterine devices (IUDs) is being explored as alternative delivery methods
that might limit systemic hormone exposure and, consequently,
mood-related side effects. Personalized medicine is emerging as a key
strategy. Researchers are investigating ways to identify genetic, hormonal,
and psychological factors that make certain individuals more susceptible to
mood disturbances when using oral contraceptives.48 This approach allows
healthcare providers to match women with contraceptives that are less likely
to negatively impact their mood based on their unique profiles.

To delve deeper into this issue, scientists are conducting extensive research
into the mechanisms underlying the connection between hormonal
contraceptives and mood disorders. This includes studying how these
medications affect the brain, neurotransmitter systems, and the endocrine
system. By understanding the exact mechanisms at play, researchers can
develop more targeted interventions and, ideally, identify biomarkers that
can predict which individuals are at a higher risk of experiencing
mood-related side effects. Furthermore, the future of contraceptive care is
set to encompass behavioral and psychological support. Integrated
counseling, resources, and strategies will be provided to women both before
and during contraceptive use, empowering them to manage mood changes
and mental health concerns more effectively. This support can include
coping strategies, stress management techniques, and interventions to
address any mood disturbances that may arise.49 Long-acting contraceptives
are gaining attention as alternatives for some women. Hormonal IUDs and
implants release hormones in a more controlled and localized manner,
potentially reducing the systemic impact on mood. Researchers are working
on expanding the availability and improving the safety of these long-acting
options.50 In this digital age, telemedicine and digital health tools are
becoming invaluable. They enhance access to healthcare providers and
mental health resources for women using oral contraceptives. Real-time
monitoring and digital platforms can facilitate early identification of mood
changes and enable timely interventions, contributing to improved mental
well-being during contraceptive use.

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4. Conclusion

In conclusion, this review paper has addressed the critical issue of the
long-term effects of hormonal oral contraceptives on adolescents' mental
health. The research highlights the complex and multifaceted relationship
between oral contraceptives and mood disorders, particularly in adolescent
users. While the topic remains a subject of debate, it is clear that various
factors, both biological and psychological, can contribute to the
development or exacerbation of depressive symptoms. This paper has shed
light on the biochemical processes at play, elucidating how hormones like
estrogen and progesterone interact with the brain, potentially impacting
mood regulation. It has also explored the role of psychological mechanisms,
demonstrating that beliefs and societal attitudes about contraception can
influence emotional well-being. Furthermore, the increased vulnerability of
adolescents to mood disorders, owing to ongoing brain development,
hormonal fluctuations, and heightened stress reactivity, has been discussed.
The interplay between biological factors and the social and environmental
challenges that adolescents face underscores the need for comprehensive
support and interventions to mitigate the risk of depression during this
crucial stage of development.

Looking ahead, scientists and healthcare providers are actively pursuing
strategies to minimize the potential risks of hormonal contraceptives,
emphasizing personalized medicine, alternative delivery methods, and the
integration of behavioral and psychological support. Long-acting
contraceptives and digital health tools are emerging as promising options to
enhance mental well-being for contraceptive users. As we move into the
future, it is imperative to continue research in this field to gain a more
comprehensive understanding of the implications of oral contraceptive use
on adolescents' mental health. The goal is to provide young individuals with
safer and more effective contraceptive choices while prioritizing their
emotional and psychological well-being. With an informed approach and
tailored interventions, we can empower adolescents to make educated
decisions about their reproductive health, ultimately leading to improved
mental health outcomes.

Berkeley Pharma Tech Journal of Medicine | 17



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