The content of this website is intended for healthcare professionals only

Women using hormonal contraception at higher depression risk

Raised risk of depression and first use of antidepressant, especially in adolescents

Louise Prime

Thursday, 29 September 2016

Women using hormonal contraception are at increased risk of developing depression and of first-time use of an antidepressant compared with those not using it, research* published online in JAMA Psychiatry has shown. The relative risk of depression varied between different types of contraception, and was particularly high among adolescent girls.

Researchers in Denmark realised that associations between the use of hormonal contraception and mood disturbances remain inadequately addressed despite the clinical evidence of an influence of hormonal contraception on some women’s mood, and the fact that millions of women use them worldwide. They analysed data from two national Danish registries in their study to investigate whether the use of hormonal contraception is positively associated with subsequent use of antidepressants and a diagnosis of depression at a psychiatric hospital.

They followed up all women and adolescents aged 15-34 who were living in Denmark and had no previous diagnosis of depression, and who redeemed a prescription for antidepressants, had other major psychiatric diagnosis, cancer, venous thrombosis, or infertility treatment. There were a total 1,061,997 women with a mean age of 24.4 years.

During a mean 6.4 years’ follow up, 55% of these women were current or recent users of hormonal contraception; and there were 133,178 first prescriptions for antidepressants and 23,077 first diagnoses of depression.

The researchers found that, compared with non-users, users of combined oral contraceptives had a relative risk (RR) of a first use of antidepressants of 1.23. Women using progestin-only pills had an RR of 1.34; those using a transdermal patch (norgestrolmin), 2.0; a vaginal ring (etonogestrel), 1.6; an implant, 2.1; a levonorgestrel intrauterine system, 1.4; and medroxyprogesterone acetate depot, 2.7. They reported that RRs of a first diagnosis of depression were slightly lower or similar.

They also found that the excess risk of depression with hormonal contraceptive use varied by users’ age. They reported: “Compared with before use, the relative risk (RR) of antidepressant use 1 year after initiation of combined oral contraceptive use was 1.6. Stratified by age groups, adolescents aged 15-19 years who started use of hormonal contraceptives had an RR of 1.8. Women aged 20-30 years who started use of hormonal contraceptives had an RR of 1.4.”

Although the study authors noted that it had limitations, they said these were likely to materially affect their findings. They concluded: “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. Further studies are warranted to examine depression as a potential adverse effect of hormonal contraceptive use.”

* Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of hormonal contraception with depression. JAMA Psychiatry. Published online September 28, 2016. doi:10.1001/jamapsychiatry.2016.2387.

Registered in England and Wales. Reg No. 2530185. c/o Wilmington plc, 5th Floor, 10 Whitechapel High Street, London E1 8QS. Reg No. 30158470