Hormonal Contraceptive Use Increases Risk of Depression
Researchers explored whether or not hormonal contraceptive initiation is associated with increased risk of developing depression within 12 months of child delivery.
After hormonal contraceptive initiation postpartum, study participants exhibited an instantaneously increased risk of depression, according to data published in JAMA Network Open.1
“Hormonal contraceptive (HC) initiation has been associated with an increased risk of developing depression,” wrote the authors. “It is unclear whether this also applies in the postpartum period, when women are already at a heightened risk of developing depression.”
Perinatal, or postpartum, depression occurs in over 14% of patients during pregnancy or the first year after giving birth. “Perinatal depression stems from a combination of hormonal changes, genetic predisposition, and environmental factors, yet up to 50% of cases remain undiagnosed due to the stigma surrounding the condition and patients' reluctance to disclose symptoms,” according to StatPearls.2
Researchers explored whether or not new mothers filled prescriptions for antidepressant medications. | image credit: Elena / stock.adobe.com
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In Denmark, where the current study was conducted, up to 40% of new mothers initiate HC within the first year of giving birth. Furthermore, for the past 20 years, these same mothers started HC earlier and earlier throughout a 24-year period, according to a study published in Sexual & Reproductive Healthcare.3
With HC initiation previously showing evidence of increased depression risks, the trends in faster HC introduction may raise routine practice issues in the women’s health space. Amid these trends, standards of practice, and general postpartum approaches, researchers wanted to understand the association between HC initiation and postpartum depression risk.
“We use the Danish national health registers to investigate HC initiation postpartum and depression risk in a large, unselected population with a 1-year follow-up time while accounting for various potential confounders, such as medical indications for HC use,” continued authors of the study.1 “Specifically, the objective is to examine whether HC initiation postpartum is associated with an increased risk of depression in the postpartum period compared with no HC exposure and whether it depends on age, HC type, and timing of initiation postpartum.”
All within 12 months of participants delivering their children, researchers explored whether or not new mothers filled prescriptions for antidepressant medications. Participants were only included if they were living in Denmark at least 2 years before birth between 1997 and 2022. The study population also only included women who gave birth for the first time. Researchers only included new cases of depression after participants gave birth.
“HC use postpartum was treated as a time-varying exposure such that all women contributed to nonexposed time until the day they filled an HC prescription after giving birth and thereafter contributed to the exposed time for the rest of the follow-up period,” they wrote.1 “The exposure was differentiated by the following HC types: combined oral contraceptives (COCs), combined nonoral contraceptives (CNOCs) (patch and vaginal ring), progestogen-only pills (POPs), and progestogen-only nonoral contraceptives (PNOCs) (implant, depot injection, and levonorgestrel-releasing intrauterine system [LNG-IUS]).”
Among the overall study population, a total of 610,038 first-time mothers in Denmark were identified, with 40.7% initiating HC use (mean age, 27.6 for HC users and 29.6 for nonusers). Of the participants that initiated HC use, 143,751 (23.6%) initiated COC; 5465 (0.9%) CNOC; 66,612 (10.9%) POP; and 32,446 (5.3%) PNOC. The participants’ mean follow-up time was 11.7 months after delivery.
A total of 9251 (1.5%) women using HC developed depression during the study period, highlighting a crude incidence rate of 21 per 1000 person-years. For participants not using HCs, their incidence rates were a bit lower at 14 per 1000 person-years.
“This study observed that HC initiation postpartum was associated with an increased risk of depression 1 year postpartum across all age groups,” wrote the authors.1 “This was more pronounced for women with no prior mental disorder. The risk was increased for COCs, CNOCs, and PNOCs, but not for POP exposure.”
When adjusting outcomes to explain the variations between use of COCs, CNOCs, PNOCs, and POPs, previous data is skewed when compared with the current study. However, the overall risk of depression that was identified encouraged researchers to suggest further attention on HC initiation in first-time mothers. Because patients who just gave birth are already at risk of developing depression, HC initiation could further exacerbate those risks.
“In this cohort study of 610,038 first-time mothers, HC initiation was associated with an increased risk of depression in the postpartum period,” concluded the authors.1 “These findings raise the issue of whether the incidence of depression postpartum may be inflated by routine HC initiation, which is important information to convey at postpartum contraceptive counseling.”
READ MORE: Women's Health Resource Center
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