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Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4351 (Published 18 October 2017) Cite this as: BMJ 2017;359:j4351

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Progestogen exposures cause depression Re: Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care

There is an obvious reason for the observations of Morgan and colleagues.1 The annual incidence of self-harm increasing three times more in girls (37.4 per 10 000) than boys (12.3 per 10 000), and, the sharp 68% increase in girls aged 13-16, from 45.9 per 10 000 in 2011 to 77.0 per 10 000 in 2014, are likely to reflect an increased exposure to progestogens in hormonal contraceptives.

We discovered in the 1960s that powerful progestogens increase endometrial, blood and brain levels of enzyme monoamine oxidase which increases the risk of depression.2,3

Mental illnesses such as depression, anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), eating disorders, personality disorders, and autism spectrum disorders, conduct disorder, schizophrenia spectrum disorders, obsessive compulsive disorder, bipolar disorder, tics, and social dysfunction, are also more common in children born to mothers who continue to take antidepressants during pregnancy and probably previously took progestogens for contraception.4

The cost of reducing teenage pregnancies is high as long-acting reversible contraceptives (LARCs) - injectables, implants, intrauterine devices and systems - are used to discourage early discontinuations of OCs for depression or weight gain. Very high progestogen doses given for morning after emergency contraception can cause severe migraine and vomiting in my experience. Steroid abuse has been added to sexual abuse. The numbers of teenage pregnancies increased sharply due to the Pill-induced “sexual revolution” as the age of first sex has reduced. Use of powerful carcinogenic. psychoactive progestogens has caused huge problems for future generations. Mental health services are failing to meet soaring demand.5

1 Morgan C, Webb RT, Carr MJ, et al. Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care. BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4351 (Published 18 October 2017). BMJ 2017;359:j4351
2 Grant ECG, Pryse-Davies J. Effect of oral contraceptives on depressive mood changes and on endometrial monoamine oxidase and phosphatases. BMJ 1968;3:777-80
3 Grant EC. Hormonal contraception and its association with depression. JAMA Psychiatry. Published online February 1, 2017. doi:10.1001/jamapsychiatry.2016.3701
4 Liu X, Agerbo E, Instrup KG, et al. Antidepressant use during pregnancy and psychiatric disorders in offspring: Danish nationwide register based cohort study
BMJ 2017; 358: j3668 (Published 06 Sep 2017)
5 Dubicka B, Bullock T. Mental health services for children fail to meet soaring demand. BMJ 2017;358:j4254

Competing interests: No competing interests

19 October 2017
Ellen C Grant
Physician and medical gynaecologist
Retired
Kingston-upon-Thames, UK