Summary: A new study indicates a connection between hormonal birth control use and increased risk of postpartum depression.
Women who experienced depressive episodes after starting hormonal birth control were found to be at higher risk of developing postpartum depression compared to those who suffered depression unrelated to hormonal birth control.
This finding suggests some women may be more susceptible to hormonal changes linked to both birth control and pregnancy. This knowledge could aid healthcare professionals in identifying women at risk of postpartum depression.
- The research suggests that women who had a medically treated depressive episode after starting hormonal birth control are more likely to develop postpartum depression.
- The study is the first to link postpartum depression with depression related to hormonal changes, such as those triggered by hormonal birth control.
- The study involved health data from nearly 200,000 first-time mothers, but the researchers note the findings may not apply to milder cases of depression.
Source: University of Copenhagen
Inability to feel happy, low spirits, fatigue, and loss of appetite. These are common symptoms of postpartum depression. When left untreated, postpartum depression can affect infant development or in worst case result in the mother committing suicide.
New research from the University of Copenhagen shows that we may be able to help some of the mothers at risk of developing postpartum depression by knowing if hormonal birth control had affected their mental health in the past.
“The results of the study suggest that women who developed a medically treated depressive episode shortly after they started hormonal birth control are at greater risk of developing postpartum depression than women who also suffered from depression in the past, but not in related to initiation of hormonal birth control,” says first author of the new study, Doctor and PhD Student Søren Vinther Larsen from the Department of Clinical Medicine at the University of Copenhagen and the Neurobiology Research Unit at Rigshospitalet.
According to the researchers behind the new study, this may be because some women are more susceptible to both the hormonal changes caused by hormonal birth control as well as in relation to pregnancy and delivery.
This knowledge may be able to help midwives and doctors identify women at risk of developing postpartum depression.
“When women start hormonal birth control, their body and brain are exposed to synthetic sex hormones and the body’s own production of sex hormones is suppressed. Some women appear to be more susceptible to these changes than others – in some, it may lead to a depressive episode.
“Women undergo great hormonal changes in relation to pregnancy and delivery, and it is believed that these changes can contribute to the development of some postpartum depressive episodes,” says Søren Vinther Larsen.
The fact that postpartum depression is associated with a history of depression is not news to the researchers. But this is the first time it has been associated with depression related to hormonal changes, e.g., in relation to initiation of hormonal birth control.
“We wanted to determine whether some women of child-bearing age are more susceptible to hormonal changes than others. And the results of the study suggest that this is indeed the case,” says Søren Vinther Larsen.
The study is a so-called register study including health data on almost 200,000 primiparous women. The researchers were only able to identify the most severe cases, i.e., when the doctor prescribed medical drug treatment or the woman were diagnosed with depression at the hospital.
Therefore, the results do not necessarily apply to milder cases, Søren Vinther Larsen explains.
“It could be interesting to explore whether this also applies to those who experience mental side effects such as mood deterioration from hormonal birth control, but which not necessarily developed into a full-scale depression.
“Such knowledge could really make a difference with regard to the possibilities of preventive strategies. It could help us identify the women we should keep an eye on in relation to pregnancy and delivery,” he says.
About this postpartum depression research news
Original Research: Open access.
“Depression Associated With Hormonal Contraceptive Use as a Risk Indicator for Postpartum Depression” by Søren Vinther Larsen et al. JAMA Psychiatry
Depression Associated With Hormonal Contraceptive Use as a Risk Indicator for Postpartum Depression
Hormonal sensitivity may contribute to the risk of depression in some women, as observed during the premenstrual, postpartum, and perimenopausal phases, and when initiating hormonal contraception (HC). However, little evidence exists to support that such depressive episodes are linked across the reproductive life span.
To determine whether prior depression associated with HC initiation is coupled with a higher risk of postpartum depression (PPD) than prior depression not associated with HC initiation.
Design, Setting, and Participants
This cohort study used Danish health registry data collected from January 1, 1995, through December 31, 2017, and analyzed from March 1, 2021, through January 1, 2023. All women living in Denmark born after 1978 with their first delivery between January 1, 1996, and June 30, 2017, were eligible for inclusion; 269 354 met these criteria. Women were then excluded if they had never used HC or if they had a depressive episode before 1996 or within 12 months prior to delivery.
Prior depression associated with vs not associated with HC initiation, ie, if developed within 6 months after start of an HC exposure or not. Depression was defined as a hospital diagnosis of depression or filling a prescription for antidepressant medication.
Main Outcomes and Measures
Crude and adjusted odds ratios (ORs) were calculated for the incidence of PPD defined as the development of depression within 6 months after first delivery.
Of 188 648 first-time mothers, 5722 (3.0%) (mean [SD] age, 26.7 [3.9] years) had a history of depression associated with initiation of HC use, and 18 431 (9.8%) (mean [SD] age, 27.1 [3.8] years) had a history of depression not associated with the initiation of HC. Women with HC-associated depression had a higher risk of PPD than women with prior non–HC-associated depression (crude OR, 1.42 [95% CI, 1.24-1.64]; adjusted OR, 1.35 [95% CI, 1.17-1.56]).
Conclusions and Relevance
These findings suggest that a history of HC-associated depression may be associated with a higher risk of PPD, supporting that HC-associated depression may indicate PPD susceptibility. This finding offers a novel strategy in clinical PPD risk stratification and points to the existence of a hormone-sensitive subgroup of women.