Despite the clinical evidence of an influence of
hormonal contraception on some women’s mood,
associations between the use of hormonal
contraception and mood disturbances remain
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 a nationwide
prospective cohort study combined data from the
National Prescription Register and the Psychiatric
Central Research Register in Denmark.
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,
cancer, venous thrombosis, or infertility treatment.
Data were collected from January 1, 1995, to
December 31, 2013, and analyzed from January 1,
2015, through April 1, 2016.
With time-varying covariates, adjusted incidence
rate ratios (RRs) were calculated for first use of
an antidepressant and first diagnosis of depression
at a psychiatric hospital.
A total of 1,061,997 women were included in the
Compared with nonusers, users of combined oral
contraceptives had an RR of first use of an
antidepressant of 1.23 (95% CI, 1.22-1.25).
Users of progestogen-only pills had an RR for first
use of an antidepressant of 1.34 (95% CI,
Users of a patch (norgestrolmin), 2.0 (95% CI,
Users of a vaginal ring (etonogestrel), 1.6 (95% CI,
Users of a levonorgestrel intrauterine system, 1.4
(95% CI, 1.31-1.42).
For depression diagnoses, similar or slightly lower
estimates were found.
The relative risks generally decreased with
Adolescents (age range, 15-19 years) using combined
oral contraceptives had an RR of a first use of an
antidepressant of 1.8 (95% CI, 1.75-1.84) and those
using 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.
For more information
Association of Hormonal Contraception With
Charlotte Wessel Skovlund, Lina Steinrud Mørch, Lars
Vedel Kessing, Øjvind Lidegaard.