Birth Control-Related Depression May Predict Greater Postpartum Depression Risk

Certain women may be more susceptible to hormonally driven episodes of depression, a Danish cohort study found.

In the analysis of over 188,000 first-time mothers who had used hormonal contraception (HC) in the past, those with a history of HC-related depression had a 35% higher chance of experiencing postpartum depression than those with a history of depression not related to HC (adjusted OR 1.35, 95% CI 1.17-1.56), reported Vibe Gedso Frokjaer, PhD, of Copenhagen University Hospital Rigshospitalet in Denmark, and colleagues.

As they explained in JAMA Psychiatry, this relationship also extended to perinatal depression, which was considered depressive episodes occurring during the third trimester of pregnancy until 6 months postpartum. Here, women with a history of HC-related depression had a 41% higher risk for having perinatal depression than those with a history of depression not related to HC use (aOR 1.41, 95% 1.23-1.60).

Models were adjusted for year of delivery and maternal age, educational level, familial disposition for depression, other major psychiatric disorder, civil status, preterm birth, pregestational or gestational diabetes, eclampsia or pre-eclampsia, instrument-assisted or cesarean delivery, and medical indication for HC use.

The risk for perinatal or postpartum depression was far lower for women without any prior depressive episodes. When also compared with women who had a history of depression unrelated to HC, women with no depression history at all had 77% and 75% reduced odds for perinatal and postpartum depression, respectively.

This suggests that certain women may be more sensitive to hormonal transitions throughout their reproductive lives, the researchers said. They emphasized that these findings don’t imply that HC leads to a higher risk for postpartum depression, but do indicate that certain women are simply more susceptible to hormonally related depressive episodes.

“Be aware of potential overlap between risk for depressive episodes when exposed to hormonal contraceptives and perinatal depression and possibly further across the reproductive lifespan,” Frokjaer advised in an email to MedPage Today. “Keep it in mind if a woman reports earlier depressive symptom side effects from using the pill or other hormonal contraceptives that she may need more clinical attention when pregnant and in the perinatal transition to secure sufficient clinical care and if needed support, preventive counseling, or treatment.”

“Since a majority of women over men get diagnosed with depressive episode particularly in the reproductive age, we wanted to test as a proof-of-concept whether we could support the notion of a ‘hormone-sensitive’ subgroup or risk profile of women more prone to develop depressive episodes when exposed to hormonal shifts, being it from medications (e.g., hormonal contraceptives) or endogenous (e.g., perinatal transition),” Frokjaer explained.

Researchers defined depression related to HC as any depressive episode that developed within 6 months after starting a new HC. This was experienced by 3% (n=5,722) of the first-time mothers included in the study. Another 9.8% (n=18,431) of mothers included had a history of depression not related to HC, and 87.2% (n=164,495) had no history of depression. There was a 1.3% incidence rate of postpartum depression, afflicting 2,457 of the 188,648 first-time mothers in the analysis.

Interestingly, nearly double the amount of women with a history of HC-related depression had multiple depressive episodes compared with those with non-HC associated depression (63.4% vs 38.6%).

The average age of the first depressive episodes was 21 for mothers with a history of depression (either HC-related or non-HC-related). Slightly more women with HC-associated depression also had another major psychiatric disorder (16.3% vs 12.1%) and a family disposition for depression (13.3% vs 11%).

Study limitations include the fact that the researchers may have captured only the most severe cases of depression, so the findings may not apply to mild depressive episodes.