Association of Hormonal Contraception With Depression

Abstract

Use of hormonal contraception, especially among adolescents, was associated with subsequent use of antidepressants and a first diagnosis of depression, suggesting depression as a potential adverse effect of hormonal contraceptive use.

FSRH Guideline (January 2019, amended October 2023) Combined Hormonal Contraception

“…However a recently published Danish nationwide prospective cohort study reported a significant association between CHC use and depression. The study followed over 1.06 million women aged 15–34 years with no prior diagnosis of depression 331. Compared with non-users, current users of COC had a RR of first use of an antidepressant of 1.23 (95% CI 1.22–1.25), users of a CTP (RR 2.0; 95% CI 1.76–2.18) and users of a CVR (etonogestrel) (RR 1.6; 95% CI 1.55–1.69).…”

Management of perinatal depression with non-drug interventions

“…Although most women do not have onset of psychiatric symptoms with modern contraceptives,61 whether women who have a history of mood disorder are more sensitive to oral contraceptives remains controversial, as some reviews have suggested an increased risk of mood destabilization whereas others have not 6162. A nationwide prospective study of 1 061 997 women found that oral contraceptive users had higher rates of first diagnosis of depression (rate ratio 1.1, 95% confidence interval 1.08 to 1.14) and antidepressant treatment (1.23, 1.22 to 1.25) compared with non-users63; consequently, psychiatric response to oral contraceptives should be considered in postpartum women who are starting to use them. The 2016 United States Medical Eligibility Criteria for Contraceptive Use recommendation is that women use progesterone-only contraceptives rather than combined progesterone and estrogen preparations in the early postpartum period of up to 42 days and consider duration post partum and breastfeeding status when changing to preparations containing estrogen 64.…”

The Role of Endotoxin in the Setting of Cardiorenal Syndrome Type 5

“…Based on this concept, it is reasonable to antagonize and/or to remove endotoxin when treating patients with sepsis [52,53]. Unfortunately, clinical trials focused on antagonizing a single mediator, such as LPS, TNF-α, IL-1β, and TLR4, did not show any promising results [54]. …”