Intended for healthcare professionals

Rapid response to:


Mental health funding to rise by at least £2bn a year by 2023-24, chancellor announces

BMJ 2018; 363 doi: (Published 29 October 2018) Cite this as: BMJ 2018;363:k4576

Rapid Response:

Hormonal contraception increases mental illness in young women

The government increase in National Health Service funding for mental health services by at least £2bn a year is welcome.1 However, the reasons for increases in preventable mental health problems should not be ignored. Progesterone dominant hormonal contraceptives can cause depression but are given freely to teenagers from young ages.2,3 In 2014 an NHS mental health survey found 26% of young women aged 16 to 24 years in England had mental health problems compared with 9.1% of young men.4

A Danish population study of over one million young women (mean age 24.4 years) found first use of antidepressants increased significantly in users of hormonal contraceptives, or recent users for more than six months, compared with nonusers.3 Relative risks were 1.7 for combined oral contraceptives compared with never users, 2.3 for progestin only pills used by adolescents aged 15 to 19 years, 1.4 for a levonorgestrel intrauterine system, 1.6 for a levonorgestrel vaginal ring, 2.0 for a norgestrolmin transdermal patch, 2.1 for an implant and 2.7 for depot medroxyprogesterone acetate.5

Continuous use of today’s potent progestogen only contraceptives cause most depression as expected due to prolonged increases in monoamine oxidase activity. The enzyme monoamine oxidase inactivates, or stores, monoamines which control mood and behaviour and vascular reactivity. Monoamine oxidase inhibitor drugs were found to be anti-depressants in the 1950s. We discovered in the 1960s that endometrial monoamine oxidase activity increased six-fold in the human menstrual cycle from <4000 cpm/mg in proliferative and early secretory phases to 10,000-21,000 cpm/mg in the late secretory phase.3 This increase coincides with the timing of the premenstrual syndrome (PMS). All OCs act mostly like progesterone and monoamine oxidase activity remains high causing depression in susceptible women. The first-year incidence of depressive mood changes increases with increasing progestogenic potency. Depressive mood changes including loss of libido have long been a main reason, along with headaches and weight gain, for first year discontinuations of OCs.

It is wrong to pour in money while just ignoring basic scientific facts.

I Iacobucci G. Mental health funding to rise by at least £2bn a year by 2023-24, chancellor announces.: BMJ 2018;363:k4576
2 Grant ECG, Pryse Davies J. Effect of oral contraceptives on depressive mood changes and on endometrial monoamine oxidase and phosphatases. Brit Med J 1968;3:777-780.
3 Grant EC. Hormonal Contraception and Its Association With Depression. JAMA Psychiatry 2017 Mar 1;74(3):301-302. doi: 10.1001/jamapsychiatry.2016.3701.
4 Digital NHS. Mental Health and Wellbeing in England: Adult Psychiatric Morbidity Survey 2014. September 2016.
5 Skovlund C, Mørch LS, Kessing LV, Lidegaard Ø. Association of hormonal contraceptives with depression JAMA Psychiatry. 2016 Sep 28. doi: 10.1001/jamapsychiatry.2016.2387.

Competing interests: No competing interests

31 October 2018
Ellen C G Grant
Physician and medical gynaecologist
Kingston-upon-Thames, Surrey, UK