Those who take the pill are less suicidal

Those who take the pill are less suicidal

At the beginning of June, at the European Psychiatry Congress - which took place virtually this year - Elena Toffol and her team from the University of Helsinki presented the surprising results of their new study. Researchers reported that they found that rates of suicide attempts in women who use hormonal methods of contraception are lower than in those who do not. For the latter, the likelihood of attempting suicide would be 40 percent higher.

It is possible that these results (which have not yet been peer-reviewed, are reviewed by experts with specific expertise in same field of the authors of the study) indicate the opposite of what you have heard or experienced firsthand: is it not known that hormonal birth control methods aggravate mental disorders? Your confusion is understandable. You may remember the headlines of 2017, when a Danish study reported that hormonal contraception was linked to an increase in suicide attempts.

Confused debate The giant contradiction is just one of many that have emerged in research over the years. try to determine whether hormonal methods of contraception have psychological side effects or not. In September 2016, The New York Times ran an article titled Contraceptives are Related to Depression Risk; six months later, the same newspaper ran a story with the headline Do contraceptives cause depression? Calm down.

Oral contraceptives, introduced to the market over sixty years ago, are surprisingly popular. It is estimated that more than 100 million women around the world currently use it. The pill, as the drug is commonly known, comes in two forms: a progesterone-only version and a combined version that contains estrogen and progesterone. Both types of pills contain synthetic hormones designed to block or reduce ovulation, which is the expulsion of the egg from the ovary.

WiredLeaks, how to send us an anonymous report But the decision to use a hormonal contraceptive is not it is always due to the desire not to get pregnant. The name "contraceptive pill" is in fact improper; a more appropriate denomination would be "hormonal drugs, often used as methods of contraception". Hormonal contraception is prescribed for a large number of ailments, including migraines, cystic acne, chronic menstrual pain, polycystic ovary syndrome, and endometriosis. a growing trend that has emerged in recent years, now that the satisfaction for the hard-won victories in women's self-determination has run out: the widespread distrust of hormonal contraception and its disadvantages. Over the past decade, a number of books have been published that analyze the impact of hormonal contraception on women. Mood swings are at the top of expert concerns, and are the main reason why women stop taking the pill.

However, we still don't have an answer that definitively clarifies what there is a link between the pill and mood. The main problem is that most of the studies conducted so far have been conducted on a cross-sectional sample, that is, they have monitored a group ofa> women who use the pill, comparing them with a group that does not use the drug. "It is not taken into account that women who have tried the pill and experienced negative effects on mood or sexuality then stopped taking it," said Cynthia Graham, professor of sexual and reproductive health at the University of Southampton and editor of the Journal. of Sex Research - This is the so-called survival bias, or healthy user bias ".

Studying whether a drug causes disorders such as depression and suicidal instincts is very complicated. External factors such as socioeconomic background, marital status, a family history of mental disorders, for example, are all elements that influence the research conclusions.

The impact of the 2016 Danish study The most famous research on theme is a 2016 Danish study, led by Charlotte Wessel Skovlund, which has followed over one million women between the ages of 15 and 34 for over 14 years. The study reported that women between the ages of 15 and 19 who took oral contraceptives were about 80 percent more likely to be diagnosed with depression or prescribed antidepressants. Participants who took progesterone-only contraceptives were twice as likely to develop depression.

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Arrow The study made headlines internationally, and several women saw their experiences with the drug confirmed. It wasn't just people taking the pill - other long-term contraceptive methods such as hormone implants, patches, and intrauterine devices also seemed to have a negative effect on mood. The Danish study, however, did not put an end to the saga.

"It was a well done study for what it is possible to do with observational data", explains Ruben Arslan, psychologist at personality of the University of Leipzig. The key term in this case is "observational": the main problem of the study can be summarized with the well-known principle according to which "correlation does not imply causality": a link was found between contraceptives and depression, but not definitive proof that the second is caused by the former. The study authors checked for some factors that could affect their results: they excluded women who had been diagnosed with depression prior to the study and women who were pregnant or who had given birth in the past six months (to avoid including people potentially prone to postpartum depression). To identify depression, the study used a medical diagnosis or a prescription for an antidepressant as indicators; in many cases, however, depression is neither diagnosed nor treated.

More effective studies The best way to answer any scientific question is to carry out a randomized placebo-controlled study, the gold standard in the field research. Instead of looking at the behavior of the pill in the world - where other factors of all kinds might come into play - this type of study involves dividing the participants into two very similar groups; one group is given the pill and the other a placebo, without telling the participants which of the two groups they belong to. In this way it is possible to be much more sure that any differences found between groups are caused by the Pill and not by other factors. However, these studies are very challenging. Only about six or seven in total have been taken on the pill, spread over the roughly sixty years since the drug has existed, explains Graham. This gap is due to a number of different factors: the lack of funding for women's health research, the fear that such research could be seen as a "pill attack" and the fact that many insiders, according to Graham, they argue that the issue is too difficult, too subjective or too trivial to study.

"I am a little uneasy about the great media attention that Skovlund's studies have received and the poor coverage that Randomized Controlled Trials have," says Arslan. In the most recent of these studies, which was conducted in 2017 by Swedish researchers and involved 340 women between the ages of 18 and 35, one group was given the combination pill and the other a placebo. The women were monitored for three months, and it was found that the pill had caused a general decrease in quality of life, but not an increase in depressive symptoms. "This is one of the best evidence we have - Arslan says -. I think the reason why the media has not given much prominence to these studies is that these effects do not lend themselves to an engaging narrative".

In any case - regardless of which of the two theses proved correct - an injustice would have been committed. In one case, they would have been prescribed drugs that can generate or exacerbate mental disorders, with insufficient warnings or research. In the other, women may have given up on effective contraception based on unfounded fears. The real answer probably lies somewhere in between.

It is evident that some women experience emotionally negative side effects; the problem is, we have no way of predicting who this will happen to, explains Graham. "But what we don't have are really good studies that can establish that the odds are higher for women who have a certain type of characteristics, or for a certain type of pill or a certain type of progesterone," he continues. For Graham, the ideal study should be controlled and randomized, and detect depression using both medical diagnoses and a validated questionnaire.

Arslan reiterates that experience varies from woman to woman: "Many women have more relevant data for their experience of how many scientists can collect, because we know that reality is heterogeneous - she says -. I think it is really difficult to formulate an answer that represents useful advice for single women ".

This article is originally featured on UK.

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