Studies have demonstrated an association between hormonal contraception use with subsequent depression and antidepressant use. This association has not been assessed among postpartum women.
Study Design
This study is a secondary analysis of insurance records from 75,528 postpartum women enrolled in the US military medical system, who delivered between October 2012 and September 2014. Our analyses excluded women who used antidepressants or had a diagnosis of depression in the 24months prior to delivery. We assessed the relationship of hormonal contraception use with subsequent antidepressant use or diagnosis with depression in the first 12months postpartum using Cox proportional hazards regression, with a time dependent covariate measuring exposure to hormonal contraception.
Results
Antidepressants were prescribed to 7.8% of women and 5.0% were diagnosed with depression. In multivariable analysis adjusting for demographics, both antidepressant use and diagnosis with depression were associated with: younger age, lower socioeconomic status, and a history of military service. Compared to women with no hormonal contraceptive use, use of etonogestrel containing contraception was associated with a higher risk of antidepressant use (Implant: adjHR:1.22(95%CI:1.06-1.41), p<0.001; Ring:1.45(1.16-1.80), p=0.001). Use of norethindrone-only pills was associated with a lower risk of antidepressant use (0.58(0.52-0.64), p<0.001) and depression diagnosis (0.56(0.49-0.64), p<0.001). Use of a levonorgestrel intrauterine system was associated with a lower risk of depression diagnoses (0.65(0.52-0.82), p<0.001).
Conclusion
The risk of major depression diagnosis and antidepressant use in the postpartum period varies with the type of hormonal contraception used. Further research is required to describe the mechanisms of these relationships.
hormonal contraception postpartum depression antidepressant use, Roberts Hansen postpartum contraception depression military, etonogestrel implant ring depression risk postpartum, norethindrone progestin-only pill lower depression risk postpartum, levonorgestrel IUS depression risk postpartum women, postpartum hormonal contraception mental health Cox regression, hormonal contraceptive type depression antidepressant association, postpartum contraception psychiatric side effects insurance records, progesterone progestin contraception mood depression postpartum, military women postpartum depression contraceptive method comparison
PMID 28867443 28867443 DOI 10.1016/j.contraception.2017.08.010 10.1016/j.contraception.2017.08.010
Cite this article
Roberts, C. M., & Hansen, S. (2017). Association of Hormonal Contraception with depression in the postpartum period. Contraception, 96(6), 446-452. https://doi.org/10.1016/j.contraception.2017.08.010
Roberts CM, Hansen S. Association of Hormonal Contraception with depression in the postpartum period. Contraception. 2017;96(6):446-452. doi:10.1016/j.contraception.2017.08.010
Roberts, Christina Marie, and Shana Hansen. "Association of Hormonal Contraception with depression in the postpartum period." Contraception, vol. 96, no. 6, 2017, pp. 446-452.
Keywords
Contraceptives, Oral, Hormonal
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