Women With ADHD at Increased Risk for Depression With Hormonal Contraceptive Use

Young women and girls with ADHD have an increased risk for developing depression when using oral hormonal contraceptives (HC) compared with HC users who did not have ADHD.

Women or girls who were using hormonal contraceptives (HCs) and had attention-deficit/hyperactivity disorder (ADHD) were associated with increased risk for depression compared with HC users who did not have ADHD. These findings were published in the Journal of the American Academy of Child & Adolescent Psychiatry.

Data for this study were sourced from national databases in Sweden. Swedish-born women and girls (N=792,913) aged 15-24 years who used HCs between 2010 and 2017 were evaluated for a diagnosis of depression or antidepressant prescription fill on the basis of having an ADHD diagnosis.

A total of 3.8% of the population was diagnosed with ADHD. The ADHD and control cohorts had a mean age of 17.97±3.26 and 19.75±3.6 years, 84.2% and 84.9% had both parents with Nordic origins, 47.2% and 25.8% had a parent with a psychiatric diagnosis, and 0.8% and 0.5% had a parent who died by suicide, respectively.

During the study, the ADHD cohort had a higher rate of depression (41.9% vs 10.5%; P <.001) in which 32.5% and 9.1% were prescribed antidepressants (P <.001) and 13.6% and 2.1% were diagnosed with depression (P <.001) compared with controls, respectively.

Our findings suggest that information on risks with HCs as well as potential benefits with user independent long-acting reversible contraception needs to be an integrated part of the shared decision making and contraception counseling for young women with ADHD.

Risk for depression was associated with ADHD (adjusted hazard ratio [aHR], 3.69); nine years (aHR, 2.16), 10-12 years (aHR, 1.34), and unknown (aHR, 1.39) educational attainment compared with attending university; dysmenorrhea (aHR, 1.80), endometriosis (aHR, 1.66), dysfunctional bleeding (aHR, 1.40), polycystic ovary syndrome (aHR, 1.36), or acne (aHR, 1.29) indication for HC use; ADHD-by-any HC use interaction (aHR, 1.39); age (aHR, 1.06); calendar year (aHR, 1.06); and other (aHR, 0.59) or both outside Europe (aHR, 0.50) parental origin compared with both parents from Nordic origin.

Stratified by type of HC, depression among the ADHD cohort was associated with hormonal intrauterine device (aHR, 1.41; P <.001), patch and vaginal ring (aHR, 1.24; P <.001), and implant (aHR, 1.23; P <.001). Risk for depression was negatively related with combined oral contraceptive among the ADHD cohort (aHR, 0.85; P <.001). Significant interaction effects between HC and ADHD were observed for combined oral contraceptives (aHR, 1.60; P <.001) and the progestogen-only pill (aHR, 1.22; P <.001).

This study may have been biased, as ~10% of the ADHD cohort was categorized as having ADHD on the basis of prescriptions and not by diagnosis codes.

The study authors concluded, “Our findings suggest that information on risks with HCs as well as potential benefits with user independent long-acting reversible contraception needs to be an integrated part of the shared decision making and contraception counseling for young women with ADHD.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

References:

Lundin C, Wikman A, Wikman P, Kallner HK, Sundström-Poromaa I, Skoglund C. Hormonal contraceptive use and risk of depression among young women with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2022;S0890-8567(22)01894-9. doi:10.1016/j.jaac.2022.07.847