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Hormonal contraception not a cause of depression?

Sanne van der Heijden, Frans M. Helmerhorst, Irene M. van Vliet, Anja D. de Vries
Nr 5|2019 (53)|Page 54-60|Main article|doi: 10.35351/gebu.2019.5.11|19-06-2019

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Little research has been done into the association between the use of hormonal contraception and depression. The few studies that have been done have suffered from methodological shortcomings, and have reported conflicting findings. Many women use hormonal contraceptives at a period of their lives in which depressions are common. Hence, people often wonder whether hormonal contraceptives might be a cause of depression. We are not concerned here with mood changes or depressive feelings, but an actual diagnosis of depression. A systematic review found hardly any association between combined hormonal contraceptives and depression. There might be a (minimal) association for hormonal contraceptives that contain only progestogens. However, when applying the Bradford-Hill criteria, a causal relationship appeared unlikely.
  • Too few reliable studies have been done to prove a causal relationship between the use of hormonal contraceptives and depression.
  • Those studies into the association between hormonal contraceptives and depression that have been done have generally suffered from a high risk of bias and have yielded contradictory findings for the various preparations.
  • A weak association between depression and hormonal contraceptives has slightly more often been found for preparations containing only progesterone than for combined hormonal contraceptives.
  • The risk of depression is no reason to stop, or be reticent about, prescribing hormonal contraception.
  1. Skovlund CW, Morch LS, Kessing LV, Lidegaard O. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016;73(11):1154-62.
  2. Zorginstituut Nederland (GIPdatabank.nl). Aantal gebruikers 2013-2017 voor ATC-subgroep G03A : Hormonale anticonceptiva voor systemisch gebruik. Raming voor de totale Zvw-populatie 2018 [Available from: https://www.gipdatabank.nl/databank#/g/00-totaal/B_01-basis/gebr/G03A.
  3. Nederlands Huisartsen Genootschap. NHG-Standaard Anticonceptie 2011 [Available from: https://www.nhg.org/standaarden/volledig/nhg-standaard-anticonceptie.
  4. World Health Organization. Medical eligibility criteria for contraceptive use 2015 [Available from: http://apps.who.int/iris/bitstream/10665/181468/1/9789241549158_eng.pdf.
  5. The Faculty of Sexual & Reproductive Healthcare. UK medical eligibility criteria for contraceptive use 2016 [Available from: http://ukmec.pagelizard.com/2016#sectionb/cover.
  6. Worly BL, Gur TL, Schaffir J. The relationship between progestin hormonal contraception and depression: a systematic review. Contraception. 2018;97(6):478-89.
  7. Bradford Hill A. The environment and disease: association or causation? Proc R Soc Med. 1965;58(5):295-300.
  8. Shakir SA, Layton D. Causal association in pharmacovigilance and pharmacoepidemiology: thoughts on the application of the Austin Bradford-Hill criteria. Drug Saf. 2002;25(6):467-71.
  9. Bottcher B, Radenbach K, Wildt L, Hinney B. Hormonal contraception and depression: a survey of the present state of knowledge. Arch Gynecol Obstet. 2012;286(1):231-6.
  10. Fiest KM, Jette N, Quan H, St Germaine-Smith C, Metcalfe A, Patten SB, et al. Systematic review and assessment of validated case definitions for depression in administrative data. BMC Psychiatry. 2014;14:289.
  11. Nolen WA. Meetinstrumenten bij stemmingsstoornissen. Tijdschr Psychiatr. 2004;46(10):681-6.
  12. Graham CA, Ramos R, Bancroft J, Maglaya C, Farley TM. The effects of steroidal contraceptives on the well-being and sexuality of women: a double-blind, placebo-controlled, two-centre study of combined and progestogen-only methods. Contraception. 1995;52(6):363-9.
  13. Kulkarni J. Depression as a side effect of the contraceptive pill. Expert Opin Drug Saf. 2007;6(4):371-4.
  14. Berenson AB, Odom SD, Breitkopf CR, Rahman M. Physiologic and psychologic symptoms associated with use of injectable contraception and 20 microg oral contraceptive pills. Am J Obstet Gynecol. 2008;199(4):351 e1-12.
  15. Wirehn AB, Foldemo A, Josefsson A, Lindberg M. Use of hormonal contraceptives in relation to antidepressant therapy: A nationwide population-based study. Eur J Contracept Reprod Health Care. 2010;15(1):41-7.
  16. Akin B, Ege E, Aksüllü N, Demirören D, Erdem H. Combined oral contraceptives use and relationship with depressive symptoms in Turkey. Sex Disabil. 2010;28(4):265-73.
  17. Toffol E, Heikinheimo O, Koponen P, Luoto R, Partonen T. Hormonal contraception and mental health: results of a population-based study. Hum Reprod. 2011;26(11):3085-93.
  18. Lindberg M, Foldemo A, Josefsson A, Wirehn AB. Differences in prescription rates and odds ratios of antidepressant drugs in relation to individual hormonal contraceptives: a nationwide population-based study with age-specific analyses. Eur J Contracept Reprod Health Care. 2012;17(2):106-18.
  19. Toffol E, Heikinheimo O, Koponen P, Luoto R, Partonen T. Further evidence for lack of negative associations between hormonal contraception and mental health. Contraception. 2012;86(5):470-80.
  20. Elovainio M, Teperi J, Aalto AM, Grenman S, Kivela A, Kujansuu E, et al. Depressive symptoms as predictors of discontinuation of treatment of menorrhagia by levonorgestrel-releasing intrauterine system. Int J Behav Med. 2007;14(2):70-5.
  21. Grant EC. Hormonal Contraception and Its Association With Depression. JAMA Psychiatry. 2017;74(3):301-2.
  22. Joffe H, Cohen LS. Estrogen, serotonin, and mood disturbance: where is the therapeutic bridge? Biol Psychiatry. 1998;44(9):798-811.
  23. Schmidt PJ, Nieman LK, Danaceau MA, Adams LF, Rubinow DR. Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. N Engl J Med. 1998;338(4):209-16.
  24. Smith K, Nayyar S, Rana T, Archibong AE, Looney KR, Nayyar T. Do Progestin-Only Contraceptives Contribute to the Risk of Developing Depression as Implied by Beta-Arrestin 1 Levels in Leukocytes? A Pilot Study. Int J Environ Res Public Health. 2018;15(9).

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Authors

  • Sanne van der Heijden, Frans M. Helmerhorst, Irene M. van Vliet, Anja D. de Vries