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 Based on data about prescription drug use for more than 1 million
women, researchers found that those who started using hormonal
contraception were significantly more likely to subsequently get a
first-time prescription for antidepressant medication, compared to
women not on hormonal contraception.
For adolescent girls, starting on hormonal contraception was tied to
an even greater increased risk of antidepressant use. Depending on
the type of hormonal contraception, there may have also been a link
to risk of being diagnosed with depression.
"Such a comprehensive study on this issue hasn’t been made before,"
said senior author Dr. Ojvind Lidegaard, of the University of
Copenhagen.
Previous studies have tried to clarify connections between
contraceptive hormones and depression, Lidegaard and his colleagues
write in JAMA Psychiatry, but these produced mixed results.
The authors point out that the lifetime prevalence of depression is
about double among women compared to men. That difference doesn't
emerge until after puberty, though. Two female sex hormones -
estrogen and progesterone - are thought to be factors in that
increased risk once the reproductive years begin.
Lidegaard and his colleagues used data from the ongoing Danish Sex
Hormone Register Study, which includes all women living in Denmark.
The new piece of research includes women who were ages 15 to 34
years from 2000 through 2013.
Any women with a diagnosis of depression that occurred prior to 2000
were excluded from the analysis, as were women with any other major
psychiatric diagnosis.
The included women were followed for around seven years each. About
55 percent used hormonal contraception during the study period.
During that time, 133,178 women were first prescribed antidepressant
medications and 23,077 were first diagnosed with depression.
Compared to women who didn't use hormonal contraception, those who
used birth control pills were 23 percent more likely to be
prescribed an antidepressant medication for the first time during
the study period.
Those using birth control pills that only contained the hormone
progestin were 34 percent more likely to be prescribed
antidepressant medications. For women using a birth control ring,
the increased risk was 60 percent and it was doubled among those
using a birth control patch.
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These risks were also slightly higher among adolescents, the
researchers found.
Compared to girls 15 to 19 years not using hormonal contraception,
the researchers found an 80 percent increased risk of being
prescribed antidepressant medication for the first time among girls
using birth control pills.
The risk was about 120 percent higher among those using
progestin-only birth control pills.
While the overall risk of being diagnosed with depression was
generally the same or lower regardless of the type of birth control
women used, the researchers did find some increases in the first
diagnosis of depression for women using specific types of hormonal
contraception.
Lidegaard said past studies of women on hormonal contraception may
not have found differences in depression treatment or diagnosis
because women who experience mood changes after starting hormonal
contraception often stop taking the pills and become non-users
again.
The researchers caution that their findings are limited by several
factors, though. For example, the fact that antidepressant
medications are sometimes prescribed for reasons other than
depression. Also, depression is listed as a potential side effect of
hormonal contraception, they write, so these drugs and devices might
not be prescribed as often to women already at risk, which would
mean the real depression risk is higher than indicated by these
results.
"All women, doctors and contraception advisers should realize we
have this potential side effect in the use of hormonal
contraceptives," Lidegaard said.
SOURCE: http://bit.ly/2dhErIb JAMA Psychiatry, online September 28,
2016.
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