The first two years of oral contraceptive use may raise the risk of depression in women and adolescents compared with their peers who have never used oral contraceptives, a study in Epidemiology and Psychiatric Sciences has found.
Åsa Johansson, Ph.D., of Uppsala University in Sweden and colleagues analyzed data from 264,557 women from the UK Biobank, a population-based cohort that recruited participants aged 37 to 71 years from across the United Kingdom between 2006 and 2010. Among the women in the current study, 80.6% had used oral contraceptives. The median time from first initiation to last use of oral contraceptives was 10 years, and the median age at initiating and discontinuing use was 21 and 32 years, respectively. The incidence of depression was determined via interviews, inpatient hospital data, or primary care data.
Women who used oral contraceptives had a 79% increased risk of depression during their first two years of oral contraceptive use compared with their peers who had never used oral contraceptives. Adolescents—those who began using oral contraceptives at or before the age of 20 years—had a 95% increased risk of depression during their first two years of oral contraceptive use compared with their peers who had never used oral contraceptives. The increased risk of depression associated with oral contraceptive use declined over time, and the lifetime risk of depression was only 5% higher in women who had ever used oral contraceptives compared with those who had never used oral contraceptives.
To capture data from women with symptoms of depression that might not have come to clinical attention, the researchers analyzed data from a subcohort of 82,232 women who completed the online UK Biobank mental health questionnaire. In this secondary analysis, women who used oral contraceptives had twice the risk of having depressive symptoms in the first two years of oral contraceptive use compared with women who had never used oral contraceptives. Women who had begun using oral contraceptives at or before the age of 20 years had 130% higher risk of depressive symptoms during the first two years of oral contraceptive use. Women who began oral contraceptives at age 21 or older had a 92% increased risk of depressive symptoms.
“Our findings support that [oral contraceptive] use is causally associated with an increased risk of depression in adolescents as well as in adults, especially shortly after the initiation,” the researchers wrote. “It is important to emphasize that most women tolerate [oral contraceptives] well without experiencing adverse mood effects, making them a great option for many. However, educating [oral contraceptive] users, screening for depression, informing primary health care practitioners regarding the [oral contraceptive]–depression relationship, and conducting further research to determine the cause of hormone contraceptive–precipitated depression are warranted.”
