Hormonal contraceptives further increase risk for depression in young women with ADHD

A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that girls and young women with attention deficit hyperactivity disorder (ADHD) have a high risk of depression, which is increased with the use of oral contraceptive pills. Women aged 15-24 with ADHD had a three-fold higher risk of developing depression overall and were at least five times more at risk than their peers not affected by ADHD irrespective of oral contraceptives.

Overall, 41.9% of women with ADHD developed depression or were prescribed antidepressants during the study period, whereas, the corresponding number in women without ADHD was 10.5%. Girls and young women with ADHD had three times increased risk of developing depression compared to those without ADHD. Other independent risk factors for depression were age, education levels, parental history of mental health diagnoses or suicide, and each of the medical indications for hormonal contraceptive use-acne, dysfunctional bleeding, dysmenorrhea, endometriosis, and PCOS.

In this large nationwide Swedish register study, the researchers set out to explore potential adverse effects of hormonal contraception, including depression, that may affect adherence to user-dependent contraception and increase the risk for unplanned pregnancies and teenage birth in women with ADHD.  In this sample, 29,767 girls and young women with ADHD aged 15 to 24 years and 763,146 without ADHD provided were included through diagnostic codes for ADHD and prescription of stimulant medication, contraceptives, and antidepressant medication.

Young women have the highest risk to develop psychiatric conditions in comparison with women and men of all age groups. Unintended early pregnancies overlap with formative academic and occupational years, interfering with the economic and psychosocial life trajectory of individuals experiencing this risk factor.

It is not known if these young women are more susceptible to adverse effects of hormonal contraceptives, compared to women without ADHD. This study is important as the most tolerable contraceptive methods should be used to prevent the risk of unplanned and unwanted pregnancies in vulnerable groups such as young women with ADHD. Teenage parents are at risk for low educational attainment, welfare dependency, and becoming single parents.

In addition, their children are at increased risk for perinatal morbidity and mortality, low socioeconomic status, and low quality of life, effectively transmitting psychosocial vulnerability across generations. Other types of non-oral contraceptives (e.g. – patches, implants, injections) were not associated with an elevated risk for depression in women with ADHD. Thus, integrating information on risks with hormonal contraceptives as well as the potential benefits of long-acting reversible contraceptives in shared decision-making and contraception counseling for young women with ADHD has the potential to affect public mental health in generations to come.

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Notes for editors

The article is "Hormonal Contraceptive Use and Risk of Depression Among Young Women With Attention-Deficit/Hyperactivity Disorder," by Cecilia Lundin, MD, PhD, Anna Wikman, PhD, Per Wikman, PhD, Helena Kopp Kallner, MD, PhD, Inger Sundstrom-Poromaa, MD, PhD, Charlotte Skoglund, MD, PhD (https://doi.org/10.1016/j.jaac.2022.07.847). It appears in the Journal of the American Academy of Child and Adolescent Psychiatry, volume 62, issue 6 (June 2023), published by Elsevier.

Copies of this paper are available to credentialed journalists upon request; please contact Charlotte Skoglund, MD, PhD, at [email protected].

About JAACAP

Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today's psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families.

The Journal's purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psychodynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and psychopharmacological treatment efficacy, and mental health services effectiveness are encouraged. The Journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families.

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