Influences of hormone-based contraception on depressive symptoms in premenopausal women with major depression

Young, Elizabeth A.; Kornstein, Susan G.; Harvey, Anne T.; Wisniewski, Stephen R.; Barkin, Jennifer; Fava, Maurizio; Trivedi, Madhukar H.; Rush, A. John

doi:10.1016/j.psyneuen.2007.05.013

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Volume 32, Issue 7 , Pages 843-853, August 2007

Influences of hormone-based contraception on depressive symptoms in premenopausal women with major depression

Elizabeth A. Young
- Department of Psychiatry and Molecular and Behavioral Neurosciences Institute, University of Michigan, MBNI, 205 Zina Pitcher place, Ann Arbor, MI 48109-0720, USA
- Corresponding author. Tel.: +17349362087; fax: +17346474130.
Susan G. Kornstein
- Department of Psychiatry and Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, P.O. Box 980710, Richmond, VA 23298-0710, USA
Anne T. Harvey
- Via Christi Research, Inc., 1100 N. St. Francis, Suite 300 Wichita, KS 67214, USA
Stephen R. Wisniewski
- Epidemiology Data Center, GSPH, University of Pittsburgh, 127 Parran Hall, 130 DeSoto Street, Pittsburgh, PA 15261, USA
Jennifer Barkin
- Epidemiology Data Center, GSPH, University of Pittsburgh, 127 Parran Hall, 130 DeSoto Street, Pittsburgh, PA 15261, USA
Maurizio Fava
- Massachusetts General Hospital, 55 Fruit Street-Bulfinch 351, Boston, MA 02114, USA
Madhukar H. Trivedi
- Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, 6363 Forest Park Road, Suite 13.354, Dallas, TX 75235, USA
A. John Rush
- Departments of Clinical Sciences and Psychiatry, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard Dallas, TX 75390-9066, USA

Received 20 February 2007; received in revised form 25 May 2007; accepted 25 May 2007. published online 28 July 2007.

Summary

Objective

Hormone-based contraceptives affect mood in healthy women or in women with premenstrual dysphoric disorder (PMDD). No study has yet examined their association with mood in women with major depressive disorder (MDD). The purpose of this study was to determine whether estrogen–progestin combination or progestin-only contraceptives are associated with depression severity, function and quality of life, or general medical or psychiatric comorbidity in women with MDD.

Methods

This analysis focused on a large population of female outpatients less than 40 years of age with non-psychotic MDD who were treated in 18 primary and 23 psychiatric care settings across the US, using data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Baseline demographic and clinical information was gathered and compared between three groups based on hormonal use: combination (estrogen–progestin)(N=232), progestin-only (N=58), and no hormone treatment (N=948).

Results

Caucasians were significantly more likely to use combined hormone contraception. Women on progestin-only had significantly more general medical comorbidities; greater hypersomnia, weight gain and gastrointestinal symptoms; and worse physical functioning than women in either of the other groups. Those on combined hormone contraception were significantly less depressed than those with no hormone treatment by the 16-item Quick Inventory of Depressive Symptomatology—Self-Rated. The combined hormone group also demonstrated better physical functioning and less obsessive-compulsive disorder (COCD) comorbidity than either of the other groups.