Use of hormonal contraceptives in relation to antidepressant therapy: A nationwide population-based study

Methods In a nationwide cross-sectional study among all women in Sweden aged 16-31, drug expenditure data on hormonal contraceptives and antidepressants were obtained from the Swedish Prescribed Drug Register. Odds ratios (ORs) for antidepressant use were calculated by logistic regression for progestin-only users versus non-users as well as for combined hormonal contraceptive (CHC) users versus non-users. Results In the study population (N = 917,993), 58.9% were hormonal contraceptive users, and 8.5% were antidepressant users. The age-pattern for antidepressant ORs differed between the two types of users of contraceptives; progestin-only users had significant ORs above 1 in all age groups whereas among CHC users the OR was above 1 solely in those aged 16-19. The largest difference between types of users was seen in the age group 16-19 in which women resorting to a progestin-only contraceptive had a 67% (95% confidence interval: 57- 78%) higher antidepressant use than women treated with a CHC. Conclusion Progestin-only contraceptive users resorted to antidepressants more than users of CHCs. This phenomenon is particularly pronounced among teenagers. Therefore, special attention should be given to young women's mental history when prescribing hormonal contraceptives and vice versa: the contraceptive history should be taken into account when prescribing antidepressants.