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Antidepressant use, depression more common in women using hormonal contraception

Use of hormonal contraception was associated with increased rates of first use of antidepressants and diagnosed depression, particularly among adolescents aged 15 to 19 years.

“Few studies have quantified the effect of modern low dose hormonal contraceptive use on the risk for depression. Two studies found teenage users of progestin-only contraception to be more frequent users of antidepressants than nonusers of hormonal contraceptives. One study found no association between oral contraceptive use and mood symptoms, and 3 studies suggested that the use of hormonal contraception was associated with better mood,” Charlotte Wessel Skovlund, MSc, of University of Copenhagen, Denmark, and colleagues wrote. “We found few prior studies that assessed the effect of hormonal contraceptives on the risk for subsequent depression in a prospective cohort design and none that took into account the temporality between use of hormonal contraceptives and development of depression.”

To determine associations between hormonal contraception and subsequent antidepressant use and diagnosis of depression, researchers analyzed data from the National Prescription Register and the Psychiatric Central Research Register in Denmark for 1,061,997 women and adolescents aged 15 to 34 years. Study participants were followed for a mean of 6.4 years from 2000 through 2013. The cohort had a mean age of 24.4 years.

First use of an antidepressant was more common among participants who used combined oral contraceptives (IRR =1.23; 95% CI, 1.22-1.25), progestogen-only pills (IRR = 1.34; 95% CI, 1.27-1.4), a norelgestromin transdermal patch (IRR = 2; 95% CI, 1.76-2.18), an etonogestrel vaginal ring (IRR = 1.6; 95% CI, 1.55-1.69) and a levonorgestrel intrauterine system (IRR = 1.4; 95% CI, 1.31-1.42), compared with non-users.

Researchers found similar or slightly lower estimates for depression diagnoses.

Generally, relative risks decreased as age increased.

Analyses of participants aged 15 to 19 years indicated those using combined oral contraceptives had a 1.8-fold higher rate (95% CI, 1.75-1.84) of first use of antidepressants and those using progestin-only pills had a 2.2-fold higher rate (95% CI, 1.99-2.52). Adolescents who used non-oral products had a 3-fold increased risk for first use of antidepressants, according to researchers.

Incidence rate ratios peaked 6 months after starting use of hormonal contraceptives at 1.4 (95% CI, 1.34-1.46).

When the reference group included individuals who never used hormonal contraception, incidence rate ratios increased to 1.7 (95% CI, 1.66-1.71) among users of combined oral contraceptives.

“Use of hormonal contraceptives was associated with subsequent antidepressant use and first diagnosis of depression at a psychiatric hospital among women living in Denmark. Adolescents seemed more vulnerable to this risk than women 20 to 34 years old,” the researchers wrote. “Further studies are warranted to examine depression as a potential adverse effect of hormonal contraceptive use.” – by Amanda Oldt

Disclosure: Wessel Skovlund reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.