There is no association between combined oral hormonal contraceptives and depression: a Swedish register-based cohort study.
Antidepressant treatment
combined oral contraceptives
depression
hormonal contraceptives
mental effects
pharmaco-epidemiology
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
May 2022
May 2022
Historique:
revised:
09
11
2021
received:
24
01
2021
accepted:
16
11
2021
pubmed:
28
11
2021
medline:
23
4
2022
entrez:
27
11
2021
Statut:
ppublish
Résumé
To investigate whether users of hormonal contraceptives (HCs) are at increased risk of depression compared with non-users. Register-based cohort study. Sweden. Women aged 15-25 years between 2010 and 2017 with no prior antidepressant treatment, psychiatric diagnose or contraindication for HCs (n = 739 585). Women with a prescription of HC were identified via the Swedish Prescribed Drug Register (SPDR). Relative risks (RRs) for first depression diagnosis in current HC-users compared with non-users were modelled by Poisson regression. Adjustments included age, medical indication for HC-use and parental history of mental disorders, among others. Depression, captured by a redeemed prescription of antidepressant treatment, or a first depression diagnosis in the SPDR and the National Patient Register. Compared with non-users, women on combined oral contraceptives (COCs) and oral progestogen-only products had lower or no increased risk of depression, relative risk (RR) 0.89 (95% CI 0.87-0.91) and 1.03 (95% CI 0.99-1.06) after adjustments, respectively. Age-stratified analyses demonstrated that COC use in adolescents conferred no increase in risk (RR 0.96, 95% CI 0.93-0.98), whereas use of progestogen-only pills (RR 1.13, 95% CI 1.07-1.19), contraceptive patch/vaginal ring (RR 1.43, 95% CI 1.30-1.58), implant (RR 1.38, 95% CI 1.30-1.45) or a levonorgestrel intrauterine device (RR 1.59, 95% CI 1.46-1.73) were associated with increased risks. This study did not find any association between use of COCs, which is the dominating HC in first time users, and depression. Non-oral products were associated with increased risks. Residual confounding must be addressed in the interpretation of the results. There is no association between combined hormonal contraceptives and depression.
Identifiants
pubmed: 34837324
doi: 10.1111/1471-0528.17028
doi:
Substances chimiques
Antidepressive Agents
0
Contraceptives, Oral, Combined
0
Contraceptives, Oral, Hormonal
0
Progestins
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
917-925Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
Références
Christin-Maitre S. History of oral contraceptive drugs and their use worldwide. Best Pract Res Clin Endocrinol Metab 2013;27:3-12.
United Nations Department of Economic and Social Affairs. Contraceptive use by method 2019 [Data Booklet]. 2019 [cited 2020 Oct 12]. Available from: https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/documents/2020/Jan/un_2019_contraceptiveusebymethod_databooklet.pdf
Lindh I, Skjeldestad FE, Gemzell-Danielsson K, Heikinheimo O, Hognert H, Milsom I, et al. Contraceptive use in the Nordic countries. Acta Obstet Gynecol Scand 2017;96:19-28.
McKetta S, Keyes KM. Oral contraceptive use and depression among adolescents. Ann Epidemiol 2019;29:46-51.
Robakis T, Williams KE, Nutkiewicz L, Rasgon NL. Hormonal contraceptives and mood: review of the literature and implications for future research. Curr Psychiatry Rep 2019;21:57.
Lindh I, Hognert H, Milsom I. The changing pattern of contraceptive use and pregnancies in four generations of young women. Acta Obstet Gynecol Scand 2016;95:1264-72.
Oinonen KA, Mazmanian D. To what extent do oral contraceptives influence mood and affect? J Affect Disord 2002;70:229-40.
Lundin C, Danielsson KG, Bixo M, Moby L, Bengtsdotter H, Jawad I, et al. Combined oral contraceptive use is associated with both improvement and worsening of mood in the different phases of the treatment cycle-A double-blind, placebo-controlled randomized trial. Psychoneuroendocrinology 2017;76:135-43.
Zethraeus N, Dreber A, Ranehill E, Blomberg L, Labrie F, von Schoultz B, et al. A first-choice combined oral contraceptive influences general well-being in healthy women: a double-blind, randomized, placebo-controlled trial. Fertil Steril 2017;107:1238-45.
Skovlund CW, Morch LS, Kessing LV, Lidegaard O. Association of hormonal contraception with depression. JAMA Psychiatry 2016;73:1154-62.
Zettermark S, Perez Vicente R, Merlo J. Hormonal contraception increases the risk of psychotropic drug use in adolescent girls but not in adults: a pharmacoepidemiological study on 800 000 Swedish women. PLoS One 2018;13:e0194773.
Hyland P, Shevlin M, Elklit A, Christoffersen M, Murphy J. Social, familial and psychological risk factors for mood and anxiety disorders in childhood and early adulthood: a birth cohort study using the Danish Registry System. Soc Psychiatry Psychiatr Epidemiol 2016;51:331-8.
Sullivan PF, Neale MC, Kendler KS. Genetic epidemiology of major depression: review and meta-analysis. Am J Psychiatry 2000;157:1552-62.
Karina IM, Sivakumaran P. Hormonal contraception and its association with depression. JAMA Psychiatry 2017;74:301.
Wettermark B, Hammar N, Fored CM, Leimanis A, Otterblad Olausson P, Bergman U, et al. The new Swedish Prescribed Drug Register-opportunities for pharmacoepidemiological research and experience from the first six months. Pharmacoepidemiol Drug Saf 2007;16:726-35.
Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, et al. External review and validation of the Swedish national inpatient register. BMC Public Health 2011;11:450.
The Swedish medical birth register: a summary of content and quality. Stockholm, Sweden: Centre for Epidemiology, National Board of Health and Welfare; 2003 (article no. 2003-112-3) [cited 2020 Feb 20].
Brooke HL, Talback M, Hornblad J, Johansson LA, Ludvigsson JF, Druid H, et al. The Swedish Cause of Death Register. Eur J Epidemiol 2017;32:765-73.
Centralbyrån: Statistics Sweden. Statistiska centralbyrån (Statistics Sweden). Multi-Generation Register. [cited 2020 Apr 20]. Available from: https://scb.se/vara-tjanster/bestalla-mikrodata/vilka-mikrodata-finns/individregister/flergenerationsregistret/
Ludvigsson JF, Otterblad-Olausson P, Pettersson BU, Ekbom A. The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. Eur J Epidemiol 2009;24:659-67.
World Health Organization. International statistical classification of diseases and related health problems: ICD-10. Vol. 1. Geneva: World Health Organization; 1992.
Harrell FE. Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. New York: Springer; 2001.
R Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2019 [cited 2020 Apr 20]. Available from: https://www.R-project.org/
Bendix Carstensen MP, Laara E, Hills M. Epi: a package for statistical analysis in epidemiology. R package version 2.40. 2019 [cited 2020 Apr 20]. Available from: https://CRAN.R-project.org/package=Epi
Martyn Plummer BC. Lexis: an R class for epidemiological studies with long-term follow-up. 2011. p. 1-12. [cited 2020 Apr 20]. Available from: http://www.jstatsoft.org/v38/i05/
Harrell FE Jr. rms: regression modeling strategies. R package version 5.1-3.1. 2019 [cited 2020 Apr 20]. Available from: https://CRAN.R-project.org/package=rms
STROBE. 2019 [cited 2020 Apr 20]. Available from: https://www.strobe-statement.org/index.php?id=available-checklists
Lagerberg T, Molero Y, D’Onofrio BM, Fernandez de la Cruz L, Lichtenstein P, Mataix-Cols D, et al. Antidepressant prescription patterns and CNS polypharmacy with antidepressants among children, adolescents, and young adults: a population-based study in Sweden. Eur Child Adolesc Psychiatry 2019;28:1137-45.
Wehry AM, Beesdo-Baum K, Hennelly MM, Connolly SD, Strawn JR. Assessment and treatment of anxiety disorders in children and adolescents. Curr Psychiatry Rep 2015;17:52.
Poromaa IS, Segebladh B. Adverse mood symptoms with oral contraceptives. Acta Obstet Gynecol Scand 2012;91:420-7.
van den Heuvel MW, van Bragt AJ, Alnabawy AK, Kaptein MC. Comparison of ethinylestradiol pharmacokinetics in three hormonal contraceptive formulations: the vaginal ring, the transdermal patch and an oral contraceptive. Contraception 2005;72:168-74.
Steinberg JR, Adler NE, Thompson KM, Westhoff C, Harper CC. Current and past depressive symptoms and contraceptive effectiveness level method selected among women seeking reproductive health services. Soc Sci Med 2018;214:20-5.
Francis J, Presser L, Malbon K, Braun-Courville D, Linares LO. An exploratory analysis of contraceptive method choice and symptoms of depression in adolescent females initiating prescription contraception. Contraception 2015;91:336-43.
Lara LAS, Abdo CHN. Age at time of initial sexual intercourse and health of adolescent girls. J Pediatr Adolesc Gynecol 2016;29:417-23.
Lundin C, Wikman A, Bixo M, Gemzell-Danielsson K, Sundstrom PI. Towards individualised contraceptive counselling: clinical and reproductive factors associated with self-reported hormonal contraceptive-induced adverse mood symptoms. BMJ Sexual Reprod Health 2021;47:e1.1-e8.
Gieler U, Gieler T, Kupfer JP. Acne and quality of life-impact and management. J Eur Acad Dermatol Venereol 2015;29:12-4.
Duke JM, Sibbritt DW, Young AF. Is there an association between the use of oral contraception and depressive symptoms in young Australian women? Contraception 2007;75:27-31.