Hormonal contraception-associated depression linked to higher postpartum depression risk

Key takeaways :

• Prior depression that is associated with hormonal contraception increases odds for postpartum depression.
• Postpartum depression is less likely for women with no vs. any history of depression.

Among women with a history depression, risk for postpartum depression was greater for those whose prior depression was associated with use of hormonal contraception, according to a cohort study published in JAMA Psychiatry.

“Women experiencing depressive episodes associated with hormonal transitions may comprise a certain hormone-sensitive subgroup of women within the broader diagnostic category of major depressive disorder,” Søren Vinther Larsen, MD, a PhD student in the department of clinical medicine at the University of Copenhagen and the neurobiology research unit at Copenhagen University Hospital, Denmark, and colleagues wrote. “We examined whether such depressive episodes are associated with one another across a woman’s reproductive life span; specifically, we examined whether a history of a depressive episode associated with initiation of hormonal contraception poses a higher risk for later postpartum depression compared with a history of depression not associated with hormonal contraception initiation.”

Researchers analyzed Danish health registry data collected from 1995 to 2017 on 188,648 first-time mothers who were living in Denmark, born after 1978 and had their first birth between January 1996 and June 2017. Researchers evaluated data from women with prior depression developed within 6 months after starting hormonal contraception and compared them with data from women with depression not associated with hormonal contraception. Researchers defined depression as a hospital diagnosis or filling a prescription for antidepressants.

The primary outcome was postpartum depression incidence defined as developing depression within 6 months after delivery.

Overall, 3% of women (mean age, 26.7 years) included in this study had a history of depression that was associated with hormonal contraception, and 9.8% of women (mean age, 27.1 years) had a history of depression not associated with hormonal contraception.

Women with hormonal contraception-associated depression had a higher risk for postpartum depression compared with women with prior depression not associated with hormonal contraception (adjusted OR = 1.35; 95% CI, 1.17-1.56). Postpartum depression risk was lower among women with no previous depression compared with women with depression not associated with hormonal contraception (aOR = 0.25; 95% CI, 0.23-0.27).

In a sensitivity analysis excluding women who initiated hormonal contraception after delivery but before postpartum depression, 40.8% of women with depression not associated with hormonal contraception initiated hormonal contraception postpartum vs. 42% of women with depression associated with hormonal contraception (aOR = 1.44; 95% CI, 1.23-1.69).

“Importantly, the findings do not imply that hormonal contraception use leads to a higher risk of postpartum depression but do indicate that a history of hormonal contraception-associated depression may unmask postpartum depression susceptibility, which may prove useful as a clinical tool in postpartum depression risk stratification,” the researchers wrote.