According to the World Health Organization, 4% of men and 6% of women experience depression globally. Women are more vulnerable to depression, with rates doubling in women after puberty compared with men. Many biological, societal, and psychological risk factors have been proposed to explain this difference, one of which includes hormonal fluctuations. This is significant as hormonal contraceptives (HCs), which impact hormone levels, have been shown to be associated with increased depression risk. Additionally, women have an increased risk of depression during the postpartum period, in which there are significant hormonal changes until pre-pregnancy levels are reached. Although the effects of HCs and postpartum on depression have been assessed separately, the effects of using HCs during postpartum are unclear. In research published in March 2025 in JAMA Network Open, Søren Vinther Larsen and colleagues used Danish registry data to examine whether HC use during postpartum increased depression risk. The study found that HC use during postpartum was associated with a 49% higher risk of depression compared to no HC use.
To observe the effects of HC use on the risk of depression, this population-based cohort study collected healthcare data from multiple Danish registries. The Danish Civil Registration System and the Medical Birth Registry were used to identify the study population of women who gave birth for the first time in Denmark between 1997 and 2022. Those who had a diagnosis of depression or a prescription for antidepressants within 24 months before birth were excluded, as were those who could not use HCs for safety reasons and those who had multiple births or stillbirths. The Danish Prescription Register was used to assess HC use, categorised by HC type. Depression within 12 months after birth was defined as either filling an antidepressant medication prescription or receiving a hospital discharge diagnosis of depression, as obtained through the National Prescription Registry and the National Patient Register, respectively. In total, 610,038 first-time mothers were recruited into the study, 248,274 of which began using HCs. Within the 12-month period, 9,251 participants developed depression. The crude incidence rate of depression for those taking HCs was 21 per 1,000 person-years and for those not taking HCs was 14 per 1,000 person-years. This resulted in an adjusted hazard ratio of 1.49 for HC users, corresponding to a 49% higher risk of depression.
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This study by Larsen and colleagues exemplifies the role that HCs have in heightening depression risk in postpartum women, illustrating the importance of monitoring postpartum women who are taking HCs for depression symptoms as an at-risk group. However, the definition of depression in the study may ignore milder cases that do not require hospital admission/medication. Leading data and analytics company GlobalData‘s epidemiologists forecast that in the eight major markets (US, France, Germany, Italy, Spain, UK, Japan, and Canada), the 12-month total prevalent cases of major depressive disorder – the severe form of depression – in those 18 and older will increase from 18.0 million cases in 2025 to 18.3 million cases in 2029 for men, and from 36.5 million cases in 2025 to 37.0 million cases in 2029 for women.
