Use of antidepressants in women after prophylactic bilateral oophorectomy: A Danish national cohort study

Abstract

Objective: To investigate the association between prophylactic bilateral oophorectomy and use of antidepressants in women with a family history of cancer.Methods: Nationwide population-based cohort study using Danish National Registries including women oophorectomized due to a family history of cancer (n = 2,002) and an age matched reference group (n = 18,018). Analyses were stratified by age at time of bilateral oophorectomy and use of hormone replacement therapy (HRT).Results: Women oophorectomized at age ≤ 45 years were more likely to use antidepressants from the first year after bilateral oophorectomy (OR = 1.34; 95 % CI: 1.08-1.65) compared to the reference group. Women oophorectomized at age 46-55 years and at age >55 years had no significantly increased use of antidepressants (OR = 0.90; 95 % CI: 0.68-1.18 and OR = 1.14; 95 % CI: 0.81-1.61). The increased use of antidepressants in women oophorectomized at age ≤ 45 years was limited to women treated with HRT (OR = 1.51; 95 % CI: 1.18-1.94) whereas women oophorectomized at age ≤ 45 years not treated with HRT had no increased use of antidepressants (OR = 1.03; 95 % CI: 0.70-1.51). Conclusions:Women oophorectomized due to a family history of cancer at age ≤ 45 years were more likely to use antidepressants after bilateral oophorectomy.The increased use of antidepressants was limited to women treated with HRT. The study calls for further large-scale studies to understand how bilateral oophorectomy and concomitant HRT affects risk of depression in women with a family history of cancer. K E Y W O R D SCancer, oncology, family history of cancer, prophylactic bilateral oophorectomy, antidepressants, hormone replacement therapy 1 | BACKGROUND Women with a family history of breast and/or ovarian cancer have a substantially increased risk of these cancers 1,2 and germline mutations in BRCA 1 and 2 genes leads to a cumulative breast cancer risk of above 60 % and an ovarian cancer risk of between 10-45 %. 3 Cancer risk increases considerably with age. 3 Thus, prophylactic bilateral oophorectomy is recommended prior to natural menopause leading to a significant reduction in risk of cancer. 4,5 High risk of hereditary cancer is associated with an increased frequency of disabling concerns and cancer related worries, which may be relieved by bilateral oophorectomy. 6 Contrary to this, surgical menopause leads to troublesome vasomotor symptoms. 6-8 and sexual dysfunction 6-9 Furthermore, studies indicate that bilateral oophorectomy may have mood-lowering effects. 10-13 Depression seems to be related to declining levels of estrogen, and sudden estrogen withdrawal in perimenopause 14,15 and postpartum 16 is associated with an increased risk of depression. In contrast to this,

The long-term association between bilateral oophorectomy and depression: a prospective cohort study

“…Among nurses who reported no HT use at baseline, depression was more common in nurses who underwent bilateral oophorectomy. Previous studies have reported inconsistent findings in the association between oophorectomy, HT use and depression; either no effect modification by HT use 11,12 or an increased risk of depression in HT users following premenopausal oophorectomy 23,48 . However, since our measures of HT use were limited to baseline, we cannot conclude that HT use after oophorectomy is protective against depression.…”

“…Previous studies have reported inconsistent findings in the association between oophorectomy, HT use and depression; either no effect modification by HT use 11,12 or an increased risk of depression in HT users following premenopausal oophorectomy. 23,48 However, since our measures of HT use were limited to baseline, we cannot conclude that HT use after oophorectomy is protective against depression. It is also possible that there are non-hormonal explanations for the associations between bilateral oophorectomy and depression.…”