Oral hormonal contraceptive use increases the risk of depression in females with attention-deficit/hyperactivity disorder (ADHD).
Putting It Into Practice
Exogenous progesterone, whether a constituent of combination oral contraceptives (COCs) or progestin-only preparations is the dominant hormone associated with depression and mood changes. Indeed, depressive symptoms are an indication for discontinuing COC and progestin-only pill use.
The etiology of depression in females with ADHD has not been established given the increased prevalence of depression in females with ADHD who do not have an exogenous source of progesterone.
Why this study matters
Although adult females have a 2-fold greater prevalence of depression than adult males, prepubertal females have an equal or lower prevalence of depression than prepubertal males. These findings suggest that sex steroids influence emotion.
The current study adds support to the effect of sex steroids, especially exogenous progesterone, on cortical and sub-cortical regions.
Depression diagnoses data were obtained from the Swedish national register involving 29,767 females (15-24 years of age) with ADHD and 763,146 females without ADHD.
Results and conclusion
Among females with ADHD, the adjusted hazard ratio (aHR) for depression was 3.69 independent of COC use.
Among females with ADHD who used COCs, the aHR for depression was 6.10 and 5.19 compared to females who did not have ADHD and did or did not use COCs, respectively.
Among females with ADHD who used progestin-only OCs, the aHR for depression was 5.00.
Lundin C, Wikman A, Wikman P, et al. Hormonal contraceptive use and risk of depression among young women with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry 2022; doi.org/10.1016/j.jaac.2002.07.847.