Hormonal contraceptive use and depressive symptoms: systematic review and network meta-analysis of randomised trials

Abstract

Background Observational studies suggest that hormonal contraceptive use may increase depressive symptoms in women, but it is unclear whether the effect is causal. Aims To quantitatively examine the evidence from randomised clinical trials for the link between hormonal contraceptive use and depressive symptoms. Method We performed a systematic review and network meta-analysis of randomised clinical trials comparing women randomised to any form of a hormonal contraceptive with women randomised to any other form of a (non-)hormonal contraceptive or placebo. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Web of Science, PsycINFO, EMCare and EMBASE, from inception to 1 May 2020. Certainty of the evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation approach. A random-effect Bayesian network meta-analysis was conducted, with change in depressive symptoms between baseline and three cycles as outcome. Results This review identified 3492 records, of which 14 trials were eligible and 12 could be included in the network meta-analysis. These trials included 5833 participants (mean age per study range: 16.8–32.4 years) and compared 10 different interventions. Compared with placebo, hormonal contraceptive use did not cause worsening of depressive symptoms (standardised mean difference: median, −0.04; range, −0.17 [95% credible interval −0.46 to 0.13] to 0.13 [95% credible interval −0.28 to 0.56]). Conclusions This study suggests that hormonal contraceptive use does not lead to an increase in depressive symptoms in adult women. Future studies should include first-time users, to confirm the results in young women.

The effect of depression and anxiety on nonbarrier contraception in adolescents and young adults: A scoping review.

“…While depressive symptoms as an outcome was beyond the scope of the current study, it is important to note that the association between hormonal contraception use and the subsequent development of depressive symptoms has been mixed (de Wit et al, 2021; Zettermark et al, 2018). In understanding this relationship, it may be important to consider the role of baseline depression.…”

“…Articles were excluded if they did not meet the above criteria. In addition, because research has found associations between the use of hormonal contraception and subsequent depression to be mixed (de Wit et al, 2021; Zettermark et al, 2018) and unrelated to the scope of the current review, we excluded articles that analyzed data with depression or anxiety as an outcome variable. We also excluded articles in which the outcome only assessed the consistency of condom use as there have been many studies looking at this outcome variable, and this review was focused on females’ use of nonbarrier contraception.…”

Contraceptive use in women with mental illness in Soweto, South Africa

“…This study was unable to comment on why women on mood stabilisers preferentially used non-hormonal contraception; however, a possible explanation may have concerns regarding potential effects on mood as previously discussed. 24 , 25 Teratogen use was common, with 41.8% ( n = 79) of women prescribed a teratogen; however, teratogen prescription did not influence contraception usage (Fisher’s exact test, p = 0.531) ( Table 2 ). International guidelines recommend that women using teratogenic medication receive FPE and some teratogenic medication, such as valproate, is contraindicated unless women have had FPE as part of the valproate pregnancy prevention plan.…”

Hormonal Contraceptives Do Not Influence Concussion Recovery in Collegiate Athletes: Data from the NCAA-DoD CARE Consortium

“…There is a lack of consensus in previous studies as to the effect of HC on psychological well-being, with evidence existing for both adverse and favorable mental health outcomes after HC use (34,35). Recent reviews have reported a general lack of association between HC use and depression symptoms (36,37). Our findings agree with this position as we did not observe differences in depression or anxiety symptoms between HC+ and HC− groups at any time point.…”