Ongoing or previous mental disorders predispose to adverse mood reporting during combined oral contraceptive use

Abstract

Purpose: Previous studies have emphasised that women with pre-existing mood disorders are more inclined to discontinue hormonal contraceptive use. However, few studies have examined the effects of combined oral contraceptives (COC) on mood in women with previous or ongoing mental disorders.

Materials and methods: This is a supplementary analysis of an investigator-initiated, double-blinded, randomised clinical trial during which 202 women were treated with either a COC (1.5 mg estradiol and 2.5 mg nomegestrolacetate) or placebo during three treatment cycles. The Mini International Neuropsychiatric Interview was used to collect information on previous or ongoing mental disorders. The primary outcome measure was the total change score in five mood symptoms on the Daily Record of Severity of Problems (DRSP) scale in the intermenstrual phase of the treatment cycle.

Results: Women with ongoing or previous mood, anxiety or eating disorders allocated to COC had higher total DRSP Δ-scores during the intermenstrual phase of the treatment cycle in comparison with corresponding women randomised to placebo, mean difference 1.3 (95% CI 0.3–2.3). In contrast, among women without mental health problems, no difference in total DRSP Δ-scores between COC- and placebo users was noted. Women with a risk use of alcohol who were randomised to the COC had higher total DRSP Δ-scores than women randomised to placebo, mean difference 2.1 (CI 95% 1.0–3.2).

Conclusions: Women with ongoing or previous mental disorders or risk use of alcohol have greater risk of COC-induced mood symptoms. This may be worth noting during family planning and contraceptive counselling.

摘要

目的：之前的研究强调, 先前有精神障碍的女性更倾向于中断激素避孕药的使用。然而, 很少有研究调查复方口服避孕药（COC）对持续或既往患有精神障碍女性的情绪影响。

材料和方法：这是研究者发起的一项随机双盲临床试验的辅助分析, 在该实验中202名女性予以三个周期的COC（1.5mg雌二醇和2.5mg醋酸甲地孕酮）治疗或安慰剂治疗。用简明国际神经精神访谈搜集持续或既往患有精神障碍的信息。主要的观察指标为在治疗周期的月经期间的严重性问题每日记录（DRSP）表中5种情绪症状的总变化评分。

结果：在治疗周期的月经期间, 与随机分到安慰剂组的女性相比, 持续或既往患有精神障碍、焦虑或饮食障碍的女性被分配到COC组的总DRSP D分数更高, 平均高1.3（95% CI 0.3-2.3）。相反, 在没有精神健康问题的女性中, 在COC组和安慰剂组的DRSP D总分无差异。随机纳入COC组的有饮酒风险的女性较随机纳入安慰剂组的女性相比DRSP D评分分数较高, 平均高2.1（CI 95% 1.0-3.2）

结论：持续或既往有精神障碍或饮酒风险的女性有更高的风险出现COC诱发情绪症状。在计划生育和避孕咨询期间, 这一点可能值得注意

Keywords:

• Randomised controlled trial
• combined oral contraceptives
• anxiety
• depression
• alcohol

Disclosure statement

I Sundstrom-Poromaa serve occasionally on advisory boards or act as invited speaker at scientific meetings for MSD, Bayer Health Care, and Lundbeck A/S. K Gemzell-Danielsson serves on an ad-hoc basis as invited speaker and on advisory boards for MSD/Merck, Bayer AG, Gedeon Richter, HRA-Pharma, Exeltis, NaturalCycles, Mithra and Actavis. J Brynhildsen has been reimbursed by MSD, for running educational programmes and giving lectures. He has also been paid by Bayer AB, Sweden, for giving lectures. None of the other authors have any conflicts of interest.

Additional information

Funding

This work was supported by the Swedish Research Council project K2013-99X-22269-01-3. No support was obtained from any pharmaceutical company.