Oral contraceptive use and psychiatric disorders in a nationally representative sample of women

Abstract

Purpose Examine the association between oral contraceptive use (any current use, duration and type) and major depression disorder (MDD), generalized anxiety disorder (GAD), and panic disorder (PD) in a nationally representative sample of women in the United States. Methods Data were drawn from 1,105 women aged 20–39 in the National Health and Nutrition Examination Surveys from 1999 to 2004. The associations between self-reported use of oral contraceptives in the past year and DSM-IV diagnosed and sub-threshold MDD, GAD, and PD in the past year were assessed comparing oral contraceptive users to all non-users, former users and former long-term users. Results Women using oral contraceptives had a lower past-year prevalence of all disorders assessed, other than sub-threshold MDD. When adjusted for confounders, women using oral contraceptives in the past year had significantly lower odds of sub-threshold PD, compared to former users (OR=0.34, 95% C.I. 0.14–0.84). Effects estimates were strongest for monophasic (versus multiphasic) oral contraceptive users. Conclusions Hormonal contraceptive use was associated with reduced risk of subthreshold PD. A potential mental health benefit of hormonal contraceptives has substantial public health implications; prospective longitudinal studies are needed to confirm whether hormonal contraceptive use improves mental health.

Oral contraceptive use and depression among adolescents

“…Cheslack-Postava, for example, found OCPs to be either unassociated with or protective against multiple sub-threshold mood disorders [23]. A 2011 study of Finnish women found that OCP use modestly protected against most psychiatric disorders [25].…”

“…Other observational studies showed OCPs may protect against depressive disorders; others show no relationship [23]–[27]. These studies include individuals from the community, account for covariates such as baseline depressive symptoms, and use validated depression screeners.…”

Why is depression more prevalent in women?

“…20 Another study involving female macaques examined relocation stress-sensitive alterations in their menstrual cycles and showed depressionrelated behaviours and reductions in the function of the brain serotonin system. 21 In this light, a recent study has indicated that women who reported using an oral contraceptive (especially monophasic contraceptives) showed reduced rates of major depression and anxiety compared with nonusers, 22 suggesting that moderating the cycling of estrogen may be protective. Taken together these studies suggest that estrogen may have a protective effect on the pathology that underlies depression and that decreases in estrogen may increase the risk for depression.…”

The Role of Attachment on Adult Attitudes Toward Interacting With Children

“…However, it may be explained by our inability to parse out the effects from monophasic vs. triphasic OCs. It is known that monophasic OCs exert a much stron ger effect on mood than triphasic OCs (Cheslack Postava, Keyes, Lowe, & Koenen, 2015), thus, the combination of the two OCs may be interfering with a potentially larger effect. As such, results as they stand should be interpreted with caution given the small effect size.…”