Depression Risk Higher for Women with ADHD on Birth Control: Study
Women with ADHD taking a combined oral contraceptive are six times more likely to develop depression than are their neurotypical peers, according to a new study wherein 42% of ADHD subjects taking oral hormonal contraceptives developed depression or were prescribed antidepressants.
December 16, 2022
The risk of developing depression is three to six times higher in girls and young women with ADHD who take oral hormonal contraceptives (HCs) than it is among their neurotypical peers on similar birth control, according to a population-based cohort study published in the Journal of the American Academy of Child & Adolescent Psychiatry. 1
Women with ADHD were three times more likely to develop depression than women without ADHD, regardless of HC use, according to the research. However, the risk for depression increased substantially for women on a combined oral contraceptive (COC) or progestogen-only pill (POP). Women with ADHD who used oral combined HC were five times more likely to develop depression than were neurotypical women not using hormonal birth control. The risk increased sixfold for women with ADHD on a COC compared with neurotypical women using a COC.
Overall, 42% of women with ADHD developed depression or were prescribed antidepressants during the study period; the same was true for only 11% of subjects without ADHD.
The Swedish study was based on data from national population-based registers and included 29,767 girls and young women with ADHD aged 15 to 24 years, plus 763,146 controls without ADHD. Seven hormonal birth control groups were analyzed. These included women using any HC, COC, combined non-oral contraceptives (i.e., patch or vaginal ring), POP, progestogen implants, progestogen injection, and the hormonal IUD.
The study found that medical reasons for taking hormonal contraceptives, such as menstrual bleeding, irregular menses, dysmenorrhea, and acne, were more common in women with ADHD, further placing them at risk for depression. 1 Women with ADHD who used non-oral HCs, such as progestogen implants or hormonal IUD, had a moderate risk of developing depression no different than that for women without ADHD.
Women with ADHD at Risk for Unplanned, Unwanted Pregnancies
Researchers noted that women with ADHD face an elevated risk of becoming teenage mothers. In Sweden, women with ADHD are six times more likely to give birth as teenagers than women without the disorder.2
“Adverse effects of hormonal contraception, including depression, may affect adherence to user-dependent contraception and increase the risk for unplanned pregnancies and teenage births in women with ADHD,” researchers said. “To prevent subsequent unplanned pregnancies and to overcome health disparities among women, health care providers need to identify women at risk and provide them with the most-effective contraceptive methods that are easily available and that do not confer unnecessary risk of depression.”
Additional research has confirmed the risk for unplanned pregnancies among women with ADHD. Stephen P. Hinshaw, Ph.D., professor of psychology at the University of California, Berkeley and principal investigator of the ongoing Berkeley Girls with ADHD Longitudinal Study, told ADDitude: “By the time they reached their mid to late 20s, about 43% of the BGALS participants in the ADHD group had one or more unplanned pregnancies compared to about 10% of individuals in the comparison group.”
Ellen Littman, Ph.D., discussed why women with ADHD are more likely to engage in risky sexual behaviors than women without ADHD during the ADDitude webinar titled, “Why ADHD Is Different for Women: Gender-Specific Symptoms & Treatments.”
“One theory for this is the early recognition of sexuality as a shortcut to social acceptance,” she explained. “It’s common to find a history of early initiation of sexual activity, early intercourse, more sexual partners, more casual sex, less protected sex, sexually transmitted infections, and more unplanned pregnancies in women with ADHD than women without ADHD.”
While researchers hope the study’s findings provide clinicians with guidance in contraception counseling, they also recognize several limitations, including “selection bias and residual confounding due to a lack of intact information on exposures, outcome variables, and missing covariates.”
“Given the increased risk of depression in women with ADHD, which may be further increased by oral HC use, future clinical trials on contraception need to include women with mental health problems, including ADHD, to guide prescribers on the best available choices for these women,” they said.
1Lundin, C., Wikman, A., Wikman, P., Kallner, H.K., Sundström-Poromaa, I., Skoglund, C. (2022). Hormonal Contraceptive Use and Risk of Depression Among Young Women with Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry. S0890-8567(22)01894-9. https://doi.org/10.1016/j.jaac.2022.07.847
2Skoglund C., Kopp Kallner H., Skalkidou A., et al. (2019). Association of Attention-Deficit/Hyperactivity Disorder with Teenage Birth Among Women and Girls in Sweden. JAMA Network Open. https://doi.org/10.1001/jamanetworkopen.2019.12463