Wassay Srinivasan

Taking hormonal birth control might be associated with an increased risk for depression compared with those who don’t use contraception, according to a new study published in the journal JAMA Psychiatry last week.

The finding is something that users have long suspected, as about 30% of women who ever used the pill in the United States eventually quit because of dissatisfaction with side effects, according to a 2013 report from the Centers for Disease Control and Prevention (PDF).

“We have known for decades that women’s sex hormones estrogen and progesterone have an influence on many women’s mood. Therefore, it is not very surprising that also external artificial hormones acting in the same way and on the same centers as the natural hormones might also influence women’s mood or even be responsible for depression development,” said Dr. Øjvind Lidegaard, a professor at the University of Copenhagen in Denmark and lead supervisor of the study.

Lidegaard and his colleagues tracked the health of more than 1 million Danish women between the ages of 15 and 34 over 14 years, using data from the National Prescription Register and the Psychiatric Central Research Register in Denmark.

To ensure that depression was properly identified in connection with birth control use, women with a depression diagnosis before their 15th birthdays or the start of the data collection were excluded.

After analyzing the data, the researchers found that the use of hormonal birth control was positively linked to a subsequent depression diagnosis and use of antidepressants.

Among all hormonal birth control users in the study, there was a 40% increased risk of depression after six months, compared to women who did not use hormonal birth control, the researchers found. The mean age of birth control users in the study was 24.

The users of combined oral birth control pills experienced a 1.2-fold higher rate of subsequently taking antidepressants during the study period than those not using the birth control. Women who used progestin-only birth control pills experienced a 1.3-fold higher rate, according to the study.

As for non-oral forms of hormonal birth control, those who used the transdermal patch had a two-fold increased risk and those who used the vaginal ring had a 1.5-fold increased risk.

Similar rate increases were found for depression diagnoses, according to the study.

The researchers noted in their study that the difference in risk rates among women taking non-oral and oral forms of birth control might be due to a difference in dose rather than how the contraceptives are administered.

The researchers also noted that this association does not imply that birth control alone causes depression – and more research is needed to better understand the possible link.

“Adolescents seemed more vulnerable to this risk than women 20 to 34 years old. Further studies are warranted to examine depression as a potential adverse effect of hormonal contraceptive use,” the researchers wrote in their study.

One of the study authors has a history of consulting for two pharmaceutical companies, Lundbeck and AstraZeneca, and another author reported receiving funds for talks from Exeltis. No other conflicts of interest were disclosed.

Lidegaard said the study results could translate to women in the United States.

In the United States, about 62% of women 15 to 44 years old use some form of contraception (PDF).

Among those women, 16% use the pill, 15.5% use female sterilization, and 7.2% use long-acting reversible contraception, such as an IUD or implant, according to the National Center for Health Statistics.

What do other experts think of the new study? Dr. Kathryn Holloway, an ob-gyn practitioner at the Institute for Women’s Health in San Antonio, Texas, called it impressive.

However, while there may be a correlation between hormonal birth control with the prescription of antidepressants and perhaps a depression diagnosis, causation is hard to prove, she said.

“Although this study suggests an increased risk of depression with combined hormonal contraception, the increase does not seem so great as to significantly change how I counsel patients,” Holloway said, adding that, “Depression is not something to be taken lightly and should not be a missed diagnosis. It is important for physicians to monitor and evaluate for any possible side effects, even if rare, with any prescribed medication.”

While birth control comes with some negative side effects, from stomach cramps to increased risk of stroke, it can also provide some health benefits.

Hormonal birth control not only prevents unwanted pregnancies, but also can regulate menstrual cycles, treat endometriosis pelvic pain, control symptoms of fibroids, help acne breakouts, and reduce the risk of some cancers that affect reproductive organs.

There are some forms of birth control that are not hormonal, Holloway said.

As a developer, I’m often bouncing between numerous files, looking for a specific item in a massive codebase, or trying to remember that arcane command I ran once months ago.

There are a handful of fuzzy find tools, either from built-in editor features or via the shell, but they often suffer from unfortunate limitations. Whether slow performance or having cache results get out of date, they often require accepting tradeoffs.

Enter FZF, a modern fuzzy finder written in Go that is not only incredibly fast but also very customizable.

With shell bindings and the ability to tie into Vim, it’s sped up our workflow at Headway quite a bit. Searching for a file by name in a project is nearly instantaneous, and it’s easy to pull up a command in your shell history with a few keystrokes.

I manage my Vim plugins using vim-plug which is a simple manager that installs plugins in parallel. It also has the ability to run post-install hooks to manage external libraries. Using it to install and manage FZF is straightforward:

In your .vimrc:

Running :PlugInstall in Vim will then copy FZF into the .fzf directory in your home folder and then run its post-install script to configure the native executable. FZF comes with basic Vim bindings out of the box, but I like to make a few changes:

In your .vimrc:

This maps the FZF search to Ctrl-F, and sets up hotkeys for opening splits in Vim similar to others I’m used to using. With only those few lines, searching for any file within the root directory becomes a breeze.

When vim-plug installs FZF, it also makes it available for use on your PATH as well. With a few entries in Zsh’s config, we can tie command history search into FZF:

In your .zshrc:

This sets up Zsh’s history search on Ctrl-R and then runs the FZF zshell script to configure FZF for it.

Now that we have our fuzzy find in place, there’s a good chance we’ll want to exclude certain entries from the results. Library dependencies, the .git directory, and others can be easily left out by setting the FZF_DEFAULT_COMMAND environment variable:

In your .zshrc:

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