Hormonal Contraception and Depression: Updated Evidence and Implications in Clinical Practice

Fruzzetti, Franca; Fidecicchi, Tiziana

doi:10.1007/s40261-020-00966-8

Cited by 38 publications

(24 citation statements)

References 87 publications

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“…[ 14 , 15 ] These altered levels can affect the activity of the γ-aminobutyric acid (GABA)-A receptors by inducing γ 2 subunit gene expression, which has been associated with the development of anxiety and depression. [ 16 ] However, these changes in neurosteroid levels and GABA responses do not always seem to be related to the risk of depression in progestin users. Rapkin et al [ 17 ] reported no association between decreased neurosteroids levels and adverse mood changes, and Huber et al [ 18 ] suggested a positive effect of progestins on depressed mood.…”

Section: Discussionmentioning

confidence: 99%

Dienogest-induced major depressive disorder with suicidal ideation

Lee

Park

2021

Medicine

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Rationale: Dienogest is a type of progestin used for the treatment of endometriosis (EM). However, a significant adverse effect of dienogest is depression; therefore, assessing for a history of mood disorders is recommended before prescribing the drug. Herein, we present the case of a patient with no history of psychiatric disorders who was diagnosed with dienogest-induced major depressive disorder. This case emphasizes the importance of close monitoring for negative mood changes in patients taking dienogest. Patient concerns: A 41-year-old woman underwent surgery for EM. Postoperatively, her gynecologist prescribed dienogest (2 mg/d) to control EM symptoms. Two months after the initiation of dienogest, she manifested insomnia almost daily, gradually became depressed, lost interest in all activities, had incessant cries, and repeatedly thought of death. She had no history of major physical or psychiatric disorders. Diagnosis: Major depressive disorder, single episode, severe. Interventions: A psychiatric consultation was recommended, an antidepressant was prescribed, and dienogest was discontinued. Outcomes: Two weeks later, there was significant improvement in the symptoms, and after 4 weeks, she remained in a stable mood with no suicidal thoughts. She was followed up for 13 months with a maintenance dose of escitalopram (5 −10mg/d), until the psychiatrist recommended treatment discontinuation, with a confirmed state of remission. Lessons: This was a case of dienogest-induced depression in a patient with no history of mood disorders. Clinicians should be aware of the possibility of the occurrence of severe depression in progestin users regardless of their previous history.

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Section: Discussionmentioning

confidence: 99%

Dienogest-induced major depressive disorder with suicidal ideation

Lee

Park

2021

Medicine

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“…Depression appears to be linked with cardiometabolic features of PCOS, including obesity, insulin resistance, and dyslipidemia [ 99 ]. However, contradictory results have been reported regarding how COCs affect psychological symptoms in women with PCOS [ 96 , 99 ].…”

Section: Concerns Regarding the Use Of Cocs In Pcosmentioning

confidence: 99%

“…Studies in the general population suggest that COC use might occasionally be associated with mood alterations, particularly in younger patients and those with previous mental health problems [94][95][96][97]. In PCOS, the risk of having symptoms related to depression (odds ratio [OR], 3.78; 95% CI, 3.03 to 4.72) or anxiety (OR, 5.62; 95% CI, 3.22 to 9.80) is already increased [98].…”

Section: Psychological Impactmentioning

confidence: 99%

An Update on Contraception in Polycystic Ovary Syndrome

Oğuz

Yildiz

2021

Endocrinol Metab

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Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductive-aged women, characterized by hyperandrogenism, oligo/anovulation, and polycystic ovarian morphology. Combined oral contraceptives (COCs), along with lifestyle modifications, represent the first-line medical treatment for the long-term management of PCOS. Containing low doses of estrogen and different types of progestin, COCs restore menstrual cyclicity, improve hyperandrogenism, and provide additional benefits such as reducing the risk of endometrial cancer. However, potential cardiometabolic risk associated with these agents has been a concern. COCs increase the risk of venous thromboembolism (VTE), related both to the dose of estrogen and the type of progestin involved. Arterial thrombotic events related to COC use occur much less frequently, and usually not a concern for young patients. All patients diagnosed with PCOS should be carefully evaluated for cardiometabolic risk factors at baseline, before initiating a COC. Age, smoking, obesity, glucose intolerance or diabetes, hypertension, dyslipidemia, thrombophilia, and family history of VTE should be recorded. Patients should be re-assessed at consecutive visits, more closely if any baseline cardiometabolic risk factor is present. Individual risk assessment is the key in order to avoid unfavorable outcomes related to COC use in women with PCOS.

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“…As they are delivered at static or once daily bolus concentrations that differ from the endogenous, multiscale rhythmic pattern of release(84–86), hormonal contraceptives can be considered a form of temporal endocrine disruption(87, 88). Hormonal contraceptive use is associated with elevated body temperature(89), decoupling of follicular maturation cycles within the ovary(88, 90), weight change(91, 92), mental health risks(93–95), lasting luteal phase deficiency(96), and a variety of other off target effects(97–100). Furthermore, women under 21 are more likely to exhibit anovulatory cycles following birth control cessation than are older indivdiuals(101), suggesting that contraceptives taken during late adolescence may be more disruptive than in adulthood.…”

Section: Introductionmentioning

confidence: 99%

Adolescent Development of Biological Rhythms: Estradiol Dependence and Effects of Combined Contraceptives

Grant¹,

Wilbrecht

Kriegsfeld

2021

Preprint

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Purpose: Adolescence is a period of continuous development, including the maturation of endogenous rhythms across systems and timescales. Although these dynamic changes are well recognized, their continuous structure and hormonal dependence have not been systematically characterized. Given the well-established link between core body temperature (CBT) and reproductive hormones in adults, we hypothesized that high-resolution CBT can be applied to passively monitor pubertal development and disruption with high fidelity. Methods: To examine this possibility, we used signal processing to investigate the trajectory of CBT rhythms at the within-day (ultradian), daily (circadian), and ovulatory timescales, their dependence on estradiol, and the effects of hormonal contraceptives. Results: Puberty onset was marked by a rise in fecal estradiol (fE2), followed by an elevation in CBT and circadian power. This time period marked the commencement of 4-day rhythmicity in fE2, CBT, and ultradian power marking the onset of the estrous cycle. The rise in circadian amplitude was accelerated by E2 treatment, indicating a role for this hormone in rhythmic development. Contraceptive administration in later adolescence reduced CBT and circadian power and resulted in disruption to 4-day cycles that persisted after discontinuation. Conclusions: Our data reveal with precise temporal resolution how biological rhythms change across adolescence and demonstrate a role for E2 in the emergence and preservation of multiscale rhythmicity. These findings also demonstrate how hormones delivered exogenously in a non-rhythmic pattern can disrupt rhythmic development. These data lay the groundwork for a future in which temperature metrics provide an inexpensive, convenient method for monitoring pubertal maturation and support the development of hormone therapies that better mimic and support human chronobiology.

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Hormonal Contraception and Depression: Updated Evidence and Implications in Clinical Practice

Cited by 38 publications

References 87 publications

Dienogest-induced major depressive disorder with suicidal ideation

Dienogest-induced major depressive disorder with suicidal ideation

An Update on Contraception in Polycystic Ovary Syndrome

Adolescent Development of Biological Rhythms: Estradiol Dependence and Effects of Combined Contraceptives

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