Association of Hormonal Contraception
JAMA Psychiatry published this nationwide prospective cohort study online on September 28, 2016.
All women and adolescents aged 15 to 34 years who were living in Denmark were followed up from January 1, 2000, to December 2013, if they had:
- No prior depression diagnosis,
- Redeemed prescription for antidepressants,
- Other major psychiatric diagnosis,
- Venous thrombosis, or
- Infertility treatment
- n= 1 061 997 women.
- mean [SD] age, 24.4 [0.001] years.
- mean [SD] follow-up, 6.4 [0.004] years.
Compared with nonusers:
|Compared with nonusers||RR of first use of an antidepressant|
|Users of combined oral contraceptives||1.23 (95% CI, 1.22-1.25)|
|Users of progestogen-only pills||1.34 (95% CI, 1.27-1.40)|
|Users of a patch (norgestrolmin)||2.0 (95% CI, 1.76-2.18)|
|Users of a vaginal ring (etonogestrel)||1.6 (95% CI, 1.55-1.69)|
|Users of a levonorgestrel intrauterine system||1.4 (95% CI, 1.31-1.42)|
The relative risks generally decreased with increasing age:
|Adolescents (age range, 15-19 years) using||RR of a first use of an antidepressant|
|Combined oral contraceptives||1.8 (95% CI, 1.75-1.84)|
|progestin-only pills||2.2 (95% CI, 1.99-2.52)|
- Six months after starting use of hormonal contraceptives, the RR of antidepressant use peaked at 1.4 (95% CI, 1.34-1.46).
- When the reference group was changed to those who never used hormonal contraception, the RR estimates for users of combined oral contraceptives increased to 1.7 (95% CI, 1.66-1.71).
Use of hormonal contraception, especially among adolescents, was associated with subsequent use of antidepressants and a first diagnosis of depression, suggesting depression as a potential adverse effect of hormonal contraceptive use.
- The addition of progesterone to hormone therapy has been shown to induce adverse mood effects in women.
- The action of progesterone metabolites on the γ-aminobutyric acid A receptor complex, which is the major inhibitory system in the human central nervous system.
- The external progestins, probably more than natural progesterone, increase levels of monoamine oxidase, which degrades serotonin concentrations and thus potentially produces depression and irritability.
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Dr. Harvinder Singh, M.D. (Admin)
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