Contraceptive use may benefit mental health of women with psychiatric disorders

Contraceptive use may optimize women’s mental and reproductive health, according to study results published in American Journal of Psychiatry.

“Unintended pregnancies pose significant health risks for women with poorly controlled mental illness,” Leanne R. McCloskey, MD, of the department of obstetrics and gynecology at Northwestern University in Chicago, and colleagues wrote. “Pregnancy, birth and infant care force adjustments in interpersonal, occupational and financial functioning that challenge coping skills and resources. Effective pharmacotherapy may be discontinued proximate to conception, which increases the risk for recurrence of psychiatric symptoms.”

In the current study, the researchers aimed to summarize the role of contraceptive choices among women with psychiatric disorders. They searched four databases for publications on contraception management among this population and selected those with data supporting evidence-based care they deemed important for psychiatrists who treat women desiring contraceptives.

Results showed most women chose combined oral contraceptives. Only 14% of women chose long-acting reversible contraceptives, such as implant and intrauterine devices, which are associated with low rates of failure, favorable safety profiles, few contraindications and rapid return to fertility following removal. The researchers noted that all methods are acceptable for women with depression, yet medical comorbidities may determine a specific type. Further, they highlighted controversy regarding the impact of hormonal contraceptives on depression risk; however, results of clinical studies and randomized placebo-controlled trials of women with psychiatric disorders have generally demonstrated lower or similar rates of mood symptoms among hormonal contraceptive users vs. nonusers. Although psychotropic drug and contraceptive interactions are rare, anticonvulsants, St. John’s Wort and clozapine are exceptions, according to the researchers.

“Important and unaddressed questions are whether antidepressant treatment prevents the emergence of mood symptoms in women who begin taking a hormonal contraceptive agent, and the rate at which (or whether) [combined hormonal contraceptive]-emergent depression responds to pharmacotherapy or psychotherapy,” McCloskey and colleagues wrote. “Research to explore risk factors that identify the vulnerable group of women who are sensitive to hormonal contraceptives would be an important advance in individualizing care. Simple and clear communication methods to address the sexual health and contraceptive needs of women with serious mental illness are needed.”