Depression and hormonal contraception
Further information – Published: 12.4.2017
- In this article, we will introduce results of scientific studies that have analyzed
the association between hormonal pregnancy contraception and depression or other mood
- First, two large cohorts, one from Denmark «Skovlund CW, Mørch LS, Kessing LV ym. Association ...»1 and one from Sweden «Lindberg M, Foldemo A, Josefsson A ym. Differences...»2, will be introduced.
- Then, a brief summary of other, smaller studies will be given.
A summary of the study by Skovlund et al. (2016) «Skovlund CW, Mørch LS, Kessing LV ym. Association ...»1
- A large Danish prospective cohort of all 15 to 34 year old women who lived in Denmark
between 2000 and 2013 (1 061 997 women in total).
- Exclusion criteria:
- Before entering study: diagnosis of depression, antidepressant medication, psychiatric
illness, cancer, venous thrombosis or fertility treatment.
- Moved to Denmark after 1995
- Starting first antidepressant medication
- First diagnosis of depression
- Confounding factors acknowledged:
- Level of education
- PCO and endometriosis
- BMI (available for only part of women)
- Smoking (yes or no, available for only part of women)
- Data sources: The National Prescription Register, Psychiatric Central Research Register,
Statistic Denmark, National Health Register, National Birth Register
- 55.5% of women used or had used hormonal contraception
- 133 178 women started their first antidepressant medication during study period
- Absolute risks: no hormonal contraception = 1.7%/yr; combined hormonal comtraception
= 2.1%/yr (NNH = 250); progestin-only contraception = 2.5%/yr (NNH = 125)
- 23 077 women were diagnosed with depression for the first time during study period
- Absolute risks: no hormonal contraception = 0.31%/yr; combined hormonal contraception
= 0.34%/yr (NNH = 3 333); progestin-only contraception = 0.40%/yr (NNH = 1 111)
- Risk ratios, when adjusted for age, calendar year, educational level, PCO and endometriosis
(compared to those who did not use hormonal contraception)
- Antidepressant medication:
- Combined hormonal contraception RR 1.2 (CI 1.22 – 1.25)
- Progestin-only contraception RR 1.3 (CI 1.27 – 1.40)
- Diagnosis of depression:
- Combined hormonal contraceptives RR 1.1 (CI 1.08 – 1.14)
- Progestin-only contraception RR 1.2 (CI 1.04 – 1.31)
- There seemed to be differences between products.
- Young women (aged 15 to 19) had the biggest risks.
- The strength of the study is that the exposure (hormonal contraception) has come before
the first antidepressant medication or depression treatment, and therefore the association
has been possible to analyze.
- The limitation of the study is that not all confounding factors could be addressed,
and therefore no definite conclusions on the causal relationship may be drawn.
Other, smaller studies
- In addition to the two large studies introduced above «Skovlund CW, Mørch LS, Kessing LV ym. Association ...»1, «Lindberg M, Foldemo A, Josefsson A ym. Differences...»2, several smaller studies have been performed.
- The results of these differ from each other, and no reliable conclusions may be drawn
- Two Finnish studies suggested that hormonal contraception does not affect mental well-being
«Toffol E, Heikinheimo O, Koponen P ym. Hormonal co...»3 or that women using combined hormonal contraception have less depression as compared
to non-users «Toffol E, Heikinheimo O, Koponen P ym. Further evi...»4.
- International studies from western countries havesuggested that users of hormonal
contraception have less depressions and anxiety than non-users «Cheslack-Postava K, Keyes KM, Lowe SR ym. Oral con...»5, «Keyes KM, Cheslack-Postava K, Westhoff C ym. Assoc...»6, or that their mood does not differ from that of non-users «O'Connell K, Davis AR, Kerns J. Oral contraceptive...»7, «Duke JM, Sibbritt DW, Young AF. Is there an associ...»8.
- In one Australian study «Duke JM, Sibbritt DW, Young AF. Is there an associ...»8 women, who used hormonal contraception for reasons other than contraception, had
more depressions than their comparisons.
- One American study «Joffe H, Cohen LS, Harlow BL. Impact of oral contr...»9 suggested that previous depression was the most significant risk factor for combined
hormonal contraception users to have adverse effects on mood.
- Skovlund CW, Mørch LS, Kessing LV ym. Association of Hormonal Contraception With Depression.
JAMA Psychiatry 2016;73:1154-1162 «PMID: 27680324»PubMed
- Lindberg M, Foldemo A, Josefsson A ym. Differences in prescription rates and odds
ratios of antidepressant drugs in relation to individual hormonal contraceptives:
a nationwide population-based study with age-specific analyses. Eur J Contracept Reprod
Health Care 2012;17:106-18 «PMID: 22385398»PubMed
- Toffol E, Heikinheimo O, Koponen P ym. Hormonal contraception and mental health: results
of a population-based study. Hum Reprod 2011;26:3085-93 «PMID: 21840911»PubMed
- Toffol E, Heikinheimo O, Koponen P ym. Further evidence for lack of negative associations
between hormonal contraception and mental health. Contraception 2012;86:470-80 «PMID: 22465115»PubMed
- Cheslack-Postava K, Keyes KM, Lowe SR ym. Oral contraceptive use and psychiatric disorders
in a nationally representative sample of women. Arch Womens Ment Health 2015;18:103-11
- Keyes KM, Cheslack-Postava K, Westhoff C ym. Association of hormonal contraceptive
use with reduced levels of depressive symptoms: a national study of sexually active
women in the United States. Am J Epidemiol 2013;178:1378-88 «PMID: 24043440»PubMed
- O'Connell K, Davis AR, Kerns J. Oral contraceptives: side effects and depression in
adolescent girls. Contraception 2007;75:299-304 «PMID: 17362710»PubMed
- Duke JM, Sibbritt DW, Young AF. Is there an association between the use of oral contraception
and depressive symptoms in young Australian women? Contraception 2007;75:27-31 «PMID: 17161120»PubMed
- Joffe H, Cohen LS, Harlow BL. Impact of oral contraceptive pill use on premenstrual
mood: predictors of improvement and deterioration. Am J Obstet Gynecol 2003;189:1523-30
- Castilho JL, Jenkins CA, Shepherd BE ym. Hormonal Contraception and Risk of Psychiatric
and Other Noncommunicable Diseases in HIV-Infected Women. J Womens Health (Larchmt)
2015;24:481-8 «PMID: 25751720»PubMed