Depression Associated With Hormonal Contraceptive Use as a Risk Indicator for  Postpartum Depression

Søren Vinther Larsen; Anders Pretzmann Mikkelsen; Øjvind Lidegaard; Vibe Gedso Frokjaer

doi:10.1001/jamapsychiatry.2023.0807

Postpartum Mental Health

Depression Associated With Hormonal Contraceptive Use as a Risk Indicator for Postpartum Depression

Larsen SV, Mikkelsen AP, Lidegaard Ø, Frokjaer VG

Published July 2023 JAMA Psychiatry, 80(7), 682-689

DOI 10.1001/jamapsychiatry.2023.0807 PMID 37099310 PMC PMC10134043

RRM Academy Synopsis

Depression on hormonal contraception linked to postpartum depression

In Danish national registers, earlier depression starting within 6 months of hormonal contraception (HC) went with higher postpartum depression risk. The cohort had 188 648 first-time mothers who had used HC. Researchers compared women with HC-linked earlier depression to women with unlinked earlier depression. The adjusted odds ratio was 1.35.

Key Findings

Of 188 648 first-time mothers, 5722 (3.0%) had earlier depression linked to starting HC and 18 431 (9.8%) had earlier depression unlinked to it.
For postpartum depression (PPD), the HC-linked group had a crude odds ratio of 1.42 (95% CI, 1.24-1.64) and an adjusted odds ratio of 1.35 (95% CI, 1.17-1.56).
Women with no earlier depression had an adjusted odds ratio of 0.25 (95% CI, 0.23-0.27) against women with earlier depression unlinked to HC.
Counting depression from late pregnancy through 6 months after birth gave an adjusted odds ratio of 1.41 (95% CI, 1.23-1.60).
Defining the groups by each woman's first depressive episode only, the adjusted odds ratio for PPD was 1.19 (95% CI, 1.00-1.40).

Interpretation

This cohort study followed first-time mothers in Denmark's national registers. Earlier depression that started within 6 months of beginning hormonal contraception was linked with higher odds of postpartum depression, even after adjusting for other factors. The authors note that depression was identified from antidepressant prescriptions and hospital diagnoses. The findings support larger studies of this history as a postpartum depression risk marker.

RRM Context

Hormonal contraception is a suppressive medication. Restorative reproductive medicine takes a full history, including how a woman felt on each hormonal exposure she has had. The authors propose a history of HC-linked depression as a possible marker of postpartum depression risk. They suggest future risk models include it.

Our editorial summary of this paper, not the article's abstract.

Abstract

Importance

Hormonal sensitivity may contribute to the risk of depression in some women, as observed during the premenstrual, postpartum, and perimenopausal phases, and when initiating hormonal contraception (HC). However, little evidence exists to support that such depressive episodes are linked across the reproductive life span.

Objective

To determine whether prior depression associated with HC initiation is coupled with a higher risk of postpartum depression (PPD) than prior depression not associated with HC initiation.

Design, Setting, and Participants

This cohort study used Danish health registry data collected from January 1, 1995, through December 31, 2017, and analyzed from March 1, 2021, through January 1, 2023. All women living in Denmark born after 1978 with their first delivery between January 1, 1996, and June 30, 2017, were eligible for inclusion; 269 354 met these criteria. Women were then excluded if they had never used HC or if they had a depressive episode before 1996 or within 12 months prior to delivery.

Exposures

Prior depression associated with vs not associated with HC initiation, ie, if developed within 6 months after start of an HC exposure or not. Depression was defined as a hospital diagnosis of depression or filling a prescription for antidepressant medication.

Main Outcomes and Measures

Crude and adjusted odds ratios (ORs) were calculated for the incidence of PPD defined as the development of depression within 6 months after first delivery.

Results

Of 188 648 first-time mothers, 5722 (3.0%) (mean [SD] age, 26.7 [3.9] years) had a history of depression associated with initiation of HC use, and 18 431 (9.8%) (mean [SD] age, 27.1 [3.8] years) had a history of depression not associated with the initiation of HC. Women with HC-associated depression had a higher risk of PPD than women with prior non-HC-associated depression (crude OR, 1.42 [95% CI, 1.24-1.64]; adjusted OR, 1.35 [95% CI, 1.17-1.56]).

Conclusions and Relevance

These findings suggest that a history of HC-associated depression may be associated with a higher risk of PPD, supporting that HC-associated depression may indicate PPD susceptibility. This finding offers a novel strategy in clinical PPD risk stratification and points to the existence of a hormone-sensitive subgroup of women.

Topics

Postpartum › Mental Health › Postpartum Depression · Contraception › Adverse Effects › Mood and Libido

Søren Vinther Larsen, Anders Pretzmann Mikkelsen, Øjvind Lidegaard, Vibe Gedso Frokjaer

S Larsen, A Mikkelsen, Ø Lidegaard, V Frokjaer

PMID 37099310 37099310 DOI 10.1001/jamapsychiatry.2023.0807 10.1001/jamapsychiatry.2023.0807 Larsen et al. 2023, Larsen 2023

Keywords

Contraceptive Agents