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Hormonal Contraception and Treatment of Depression

JAMA Psychiatry; 2016 Nov 1; Skovlund, et al

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The use of hormonal contraception was associated with subsequent use of antidepressants and a first diagnosis of depression, especially among adolescents, a recent study found. This cohort included 1,061,997 women and adolescents aged 15 to 34 years and followed up from January 1, 2000, to December 2013 if they had no prior depression diagnosis, redeemed prescription for antidepressants, other major psychiatric diagnosis, cancer, venous thrombosis, or infertility treatment. Researchers found:

• Users of combined oral contraceptives had a relative risk (RR) of first use of an antidepressant of 1.23.

• Users of progestogen-only pills had an RR for first use of an antidepressant of 1.34; patch users, 2.0; users of a vaginal ring, 1.6; and users of a levonorgestrel intrauterine system, 1.4.

• Similar or slightly lower estimates were observed for depression diagnoses.

• Adolescents (aged 15 to 19 years) using combined oral contraceptives had an RR of a first use of an antidepressant of 1.8 and those using progestin-only pills, 2.2.

• RR of antidepressant use peaked at 1.4, 6 months after starting use of hormonal contraceptives.

Citation: Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of hormonal contraception with depression. JAMA Psychiatry. 2016;73(11):1154-1162. doi:10.1001/jamapsychiatry.2016.2387.

Commentary: This study, showing an increase in antidepressant use, particularly in teenagers, with the use of hormonal contraception, is a difficult study to interpret because the comparison group for young women on oral contraceptives is women who are not taking contraceptives. Women who are not taking contraceptives are less likely to be sexually active and sexual activity in adolescents is associated with a higher proportion of individuals who report lack of attentive and nurturing parents, lack of school or career goals, substance abuse, and poor school performance or dropping out of school.1 These associated factors are predictive of depression, so it is unclear in this large cohort whether it is the factors that contribute to sexual activity or the oral contraceptives that increase the risk for depression. Then of course, is the question of what to do with the information, even if the correlation is a true one. For young women who are going to be sexually active, contraception remains an important part of their care. It seems reasonable to counsel women that if they note changes in their mood it may be related to their contraceptive use. —Neil Skolnik, MD

1. Klein JD, et al. Adolescent pregnancy: Current trends and issues. Pediatrics. 2005;116:281–286. doi:10.1542/peds.2005-0999.

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