There is nothing easy about being a teenage girl. School, friends, boyfriends, acne, braces, social media, college prep, and life’s usual everyday challenges — all could contribute to symptoms of depression.

After a new study, however, families may want to hone in on another factor: their daughters’ birth control methods.

Teens who took oral contraceptives were 80 percent more likely than their peers to end up depressed.

Researchers at the University of Copenhagen last week released the results of a massive study done over the last 19 years. More than 1 million women shared whether or not they were diagnosed with depression during that time, or if they began taking antidepressants. The results show that both pills and longer-acting hormonal controls such as an intrauterine device (IUD) are associated with higher rates of depression, especially among those 15 to 19 years of age.

Teens who took oral contraceptives were 80 percent more likely to end up depressed (which is defined as someone who had either started taking antidepressants, or been diagnosed with depression by a doctor). Those who took a progestin-only form of contraception were more than twice as likely to be depressed compared to their peers who did not use hormonal contraception.

Among older women, those taking oral contraceptives were 23 percent more likely to be diagnosed with depression, and those using progestin-only pills 34 percent more likely.

Related: Signs Your Teen May Be Depressed

While the study is interesting and could help women become more informed about their mental health, others say the connection between the two remains murky.

This study was designed to find an association, not a direct cause and effect.

“There is a connection but not a clear one,” said Mohamed Jalloh, Pharm.D., with the School of Pharmacy & Health Professions at Creighton University in Omaha, Nebraska, and a spokesman for the American Pharmacists Association.

“The only study type to specifically identify a cause-effect is the randomized control trial. This study was designed to find an association, not a direct cause and effect,” Jalloh told LifeZette. “Meaning there may be other factors that could not be accounted for. A major limitation of this study was that it didn’t extensively account for the marital status of the women, family history, and past major experiences of major life events (e.g. trauma, medical illness) — all which are risk factors for depression.”

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Jalloh said the new research should help guide birth control treatment. He said prescribers might be more cautious in offering such birth control options in patients who already have various risk factors for depression or an extensive family history of it. The latest research, he said, is an opportunity for prescribers to weigh the risks and benefits with patients to devise an informed and collaborative treatment plan.

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Young women, in the meantime, should monitor their feelings of depression, especially within a year after starting a hormonal contraceptive.

Related: No Easy Answers for Depression

“Should they begin to experience symptoms (depressed mood and lack of seeking previously pleasurable activities) during a two-week period, they should definitely speak to their prescriber to identify other [birth control] options, or ways to manage their feelings of depression,” said Jalloh.