New research provides evidence that prior depression associated with the use of hormonal contraception may be a risk factor for subsequent postpartum depression. The study provides insights into the relationship between hormonal sensitivity, reproductive transitions, and the risk of depression in women. The new findings appear in JAMA Psychiatry.
Postpartum depression is a form of depression that occurs in women after giving birth. It is a common mental health condition that affects approximately 10-15% of women during the postpartum period, typically within the first few weeks to months after childbirth.
The exact cause of postpartum depression is not fully understood, but it is believed to be a combination of physical, hormonal, and emotional factors. Hormonal changes, such as a rapid drop in estrogen and progesterone levels after childbirth, can contribute to mood swings and emotional instability.
“We were interested in knowing if depressive episodes with potential hormonal contributes were linked across women’s reproduce lives and by such support the notion about the existence of a subgroup of women more sensitive to hormonal fluctuations,” said study author Søren Vinther Larsen of the Neurobiology Research Unit at Rigshospitalet and the University of Copenhagen.
“Such knowledge could help in meaningful risk profiling of women and guide precision psychiatry initiatives towards prevention and targeted treatment of e.g. perinatal depressive episodes.”
To conduct the study, the researchers utilized Danish national health registers, which provided comprehensive data on the study population. The study included all women in Denmark born after 1978 who delivered their first child between January 1, 1996, and June 30, 2017.
The researchers excluded women who had never used hormonal contraception, as well as those who immigrated at the age of 16 or older, had a depressive episode before 1996 or within 12 months prior to delivery, or had a multiple birth or stillbirth.
The final sample included 188,648 first-time mothers who had used hormonal contraception before their child was born.
The exposure of interest was defined as a depressive episode that developed within 6 months after the start of hormonal contraceptives. The outcome of interest was the development of postpartum depression, defined as filling a prescription for antidepressant medication or obtaining a hospital discharge diagnosis of depression within 6 months after childbirth.
The researchers found that women with a history of depression associated with hormonal contraception had a higher risk of postpartum depression compared to women with a history of depression that was not associated with hormonal contraception.
“We consider two important take-home messages from this work; first it indicates that women who develop a depressive episodes after initiation on hormonal contraception may be more susceptible to developing postpartum depression later in life; second it supports the notion about the existence of a subgroup of women who are more sensitive to hormonal changes across their reproductive lives,” Larsen told PsyPost.
The findings remained consistent even when adjusting for potential confounding factors and conducting sensitivity analyses.
“We found that the link between depression associated with hormonal contraceptive use and depression developed in relation to childbirth was also apparent, and not even diminished, when we included depressive episodes developed late in pregnancy,” Larsen noted.
“This indicates that both depressive episodes developed during highly hormone stimulated states in pregnancy as well as after the abrupt drop in hormonal levels after delivery may contribute to the mechanism by which depression emerges in women who may be sensitive to hormonal contraceptive exposure.”
But the study, like all research, includes some caveats.
“When we use the national health registers, we are only able to capture depressive episodes if registered as a hospital discharge diagnosis with depression or if filling a prescription of antidepressant medication, i.e., the more severe cases,” Larsen explained. “Thus, our results do not necessarily generalize to the less severe cases or even the cases where women may have experienced mood-related side effects to hormonal contraceptives use but never developed a depressive episode. Future research should investigate if the experience of such side-effects could reveal an underlying susceptibility to develop postpartum depression.”
“It is important to highlight, that the findings do not imply that previous use of hormonal contraception leads to a higher risk of postpartum depression but indicate that a history of hormonal contraceptive-associated depression may unmask postpartum depression susceptibility,” Larsen added. “Furthermore, the study is an observational study, so it is not able to infer causal relationships.”
The study, “Depression Associated With Hormonal Contraceptive Use as a Risk Indicator for Postpartum Depression“, was authored by Søren Vinther Larsen, Anders Pretzmann Mikkelsen, Øjvind Lidegaard, and Vibe Gedso Frokjaer.
