Compared with nonusers, users of combined oral contraceptives experienced a relative risk (RR) of a first use of antidepressants of 1.2, wrote Charlotte Wessel Skovlund, M.Sc., and colleagues from the Department of Gynecology at the University of Copenhagen. Women using medroxyprogesterone acetate depot had the highest relative risk at 2.7. The RRs of a first diagnosis of depression were slightly lower or similar. The authors noted an important age difference, as well.
“Our data indicate that adolescent girls are more sensitive than older women to the influence of hormonal contraceptive use on the risk for first use of antidepressants or first diagnosis of depression,” wrote Skovlund and colleagues. “This finding could be influenced by attrition of susceptibility, but also that adolescent girls are more vulnerable to risk factors for depression.”
Former APA President Nada Stotland, M.D., said the findings should not result in precipitate action by patients or their physicians. While the effects are significant, clinicians must compare them to what could happen if women were not on hormonal contraceptives, she added.
“Women, especially adolescents, who are not taking these contraceptives may instead experience anxiety about negotiating with partners or getting pregnant,” said Stotland. “We must take into account the importance of contraception as an important element of women’s overall health, including mental health.”
Maureen Van Niel, M.D., president of the APA Women’s Caucus and a private practitioner in Cambridge, Massachusetts, agreed. “The relative risk is indeed elevated in women who have used contraceptives but the degree of elevation is not alarming,” she said.