The Pill's link to depression still unclear

By Anne Harding

NEW YORK (Reuters Health) - Young women using hormone-based contraceptives, including the Pill, were no more likely to be depressed than other women in a new U.S. study.

In fact, the women in their 20s and 30s on hormonal contraceptives had fewer symptoms of depression than their peers using other types of contraception or no contraception at all, researchers found.

"This counters somewhat some of the prevailing wisdom that hormone contraceptive use in general is associated with adverse mental health outcomes in women," lead author of the study Dr. Katherine Keyes of the Mailman School of Public Health at Columbia University in New York told Reuters Health.

"When you look at it on a national scale, certainly there's no evidence that at a population level hormonal contraceptive use is associated with an increased risk of mood problems," Keyes added.

Still, Keyes and her colleagues caution, it's also true that depressed women are less likely to use hormone-based contraceptives.

Scientists have suspected that estrogen and progesterone levels play a role in mood disturbances, but studies looking at the effects of hormonal contraception on mood have had mixed results, Keyes and her team note in their report, published .in the American Journal of Epidemiology.

To investigate, they looked at data on 6,654 sexually active women between 25 and 34 years old who participated in four surveys between1994 and 2008.

Contraceptive methods used by women in the group included hormone-based pills, patches, vaginal rings or implants. Non-hormonal methods included IUDs and barriers like diaphragms and condoms.

The women who used hormonal contraceptives were younger, less likely to have children, less likely to smoke, and more likely to have graduated from college, to engage in individual sports like running and in healthy behaviors like getting regular dental and medical checkups.

After adjusting for those differences, the researchers found that women using hormonal contraceptives were less likely to report symptoms of depression in the week preceding the survey.

They were also 32 percent less likely than the other women to have high levels of depressive symptoms and 63 percent less likely to report having attempted suicide in the past year.

Hormonal contraception could improve women's mood by helping to even out menstrual cycle mood swings, Keyes told Reuters Health. "We're definitely following this up and hoping to get at the mechanism," she said.

About 30 percent of women do experience emotional and sexual side effects while using hormonal contraception, Dr. Ellen Wiebe, the medical director of the Willow Women's Clinic in Vancouver, British Columbia, told Reuters Health.

A major problem with the new study, said Wiebe, who wrote an accompanying commentary, is that the hormonal contraceptive users really are a different group from non-users. The "non-users" group also likely includes many women who quit taking hormonal contraception due to mood and sexual side effects.

In their paper, Keyes and her team point out that women with a history of depression are less likely to start taking hormonal contraception, and less likely to stay on it, which could help explain why the risk of depressive symptoms was lower in women who were taking hormonal birth control.

Wiebe also questioned the way depressive symptoms and sexual problems were identified. "A screen for clinical depression does not capture the actual problems that we see with the mood side effects with hormonal contraception, and the same thing with the sexual side effects," she said.

Sexual side effects include having fewer sexual thoughts and lower arousability, Wiebe said, while mood problems typically include irritability.

Given how widely hormonal contraceptives are used in the U.S. and worldwide, "systematic investigation" of the role of outside hormones in mood is warranted, Keyes and her team write. So is study of how mood issues predict who will stick with prescribed hormonal contraception, they conclude.

Decisions on what type of contraception to use and how birth control choices might affect mental health are critical issues for young women, yet there has been very little research into "this intersection of family planning and psychiatric disorders," Keyes said.

SOURCE: http://bit.ly/1dMBOHk American Journal of Epidemiology, online September 15, 2013.

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Danger at Home Lurks in Pills, Plants, Chemicals and More

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AppId is over the quota

FRIDAY, June 8 (HealthDay News) -- If you have children or pets, you've probably looked around your house to see what potential hazards you need to lock up or move, like the cleaning products under the sink. But it's easy to overlook something a child might find appealing.

That windshield washer fluid in the garage might look like a big jug of blue fruit drink to a child. Medication that's red and round can look a lot like a candy to a youngster.

No home can be 100 percent safe, but you can take steps to protect your family from the most serious threats in your home.

"You have to anticipate what kids might do," said Rose Ann Soloway, a clinical toxicologist with the National Capital Poison Center in Washington, D.C. "They're smart and fast, and they like to imitate us."

"I compare children getting into medicines and poisons to a young child rolling over for the first time and falling off a bed or couch," Soloway said. "How often do you hear parents say, 'I didn't know he could do that' when a child rolls over for the first time? While it's not possible to be with a child 24 hours a day, it's important that the things that can really hurt them have as many barriers as possible. Keep anything dangerous locked up and out of reach. Children rely on us to provide a safe environment."

So what are the biggest problems that could be lurking in your home?

"The most dangerous are probably medications," said Dr. Jennifer Lowry, a medical toxicologist at Children's Mercy Hospitals and Clinics in Kansas City. "Parents don't always put them away. Grandparents don't always remember that they could be an issue. Their medications may be in pill boxes that are easy to open. And, older adults are on more medications that can be toxic to children."

Soloway said that the medications of greatest concern when taken by those who don't need them are blood pressure and heart medications, as well as narcotic medications to relieve pain. It's also not always children who are an issue with medications. Poison control centers get lots of calls from older adults who've mixed up their medications.

But even pills people might think are safe can be an issue if the dose is large enough.

"Everything can be a poison depending on the dose," said Lowry. People might not be concerned about leaving vitamins accessible, but iron can be extremely toxic, she noted.

Soloway said that personal care products also prompt a lot of calls to poison control centers. "The ones we worry about are those with alcohol in them," she said. "Children can get alcohol poisoning from mouthwash. Children see adults putting it in their mouths, so why wouldn't they? But, they don't get the swish-and-spit part."

Then there are pesticides, which can be dangerous if they're swallowed, breathed in or gotten on the skin. "It's so important to understand that these products are intended to kill an organism," Soloway noted.

Products called hydrocarbons, such as gasoline, kerosene, lighter fluid and lamp oil, are also a concern. Though they generally pass through the digestive system without causing too much damage, they can get into the lungs, causing a serious condition called aspiration pneumonia, if a child swallows one of the products and then vomits it up.

Immediate harm can come from products that can cause chemical burns on contact, including drain openers, toilet bowl cleaners and dishwasher detergent.

But preventing poisonings at home really boils down to common sense, Lowry said. Store cleaning products and other chemicals in their original containers and store them on a high shelf. The same goes for medications -- or, even better, keep them in a locked box. Replace childproof caps tightly after you use a medication.

If you have to use a pesticide or a cleaning product, use them in well-ventilated areas and follow the label instructions. "If a warning is there, pay attention to it," advised Soloway. She also recommended using just the amount of product that you need.

People who have plants in their homes need to know exactly what they are, as some can be irritating and others safe, Lowry said. And without knowing the kind of plant, it's difficult for poison control to help.

She also suggested getting down on your hands and knees and crawling around your house to get the same view your child might have. "That's when you'll see grandma's heart medicine that fell under the couch," Lowry said.

If the worst happens and you or a child has come into contact with a poisonous substance or ingested it, the first thing to do is to call 1-800-222-1222. That's a nationwide number that will link you to a poison control center, which has experts who can judge whether the situation can be handled at home or whether an ER visit is needed.

More information

The U.S. Centers for Disease Control and Prevention has more tips on preventing poisoning.

For more on the risks of poisonings at home, read a companion article on one woman's story.

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