History of depression as a risk factor for depression with oral contraceptives and discontinuance.

Abstract

The objective was to evaluate history of severe depression during or after pregnancy as a predisposition to depressive reactions with oral contraceptives. To this end, four measures of current depression were used. They consisted of the Minnesota Multiphasic Personality Inventory (MMPI) Depression scale and three questions mainly on premenstrual moods. The patients were members of the Kaiser Foundation Health Plan in Northern California. The data were collected during routine annual multiphasic health examinations in 1969. All four measures of present depression were significantly related to depressive history among current users of contraceptive pills. However, this was also true for past users and never users. Further, 441 patients with a history of depression generated no evidence for an association between use of “the pill” and abnormal depression. Only past users reported more cases of severe premenstrual irritability than current users. The four measures of present depression were independent of dose of progestin used by 130 current users with a depressive history. One thousand one hundred and ninety-four patients who discontinued the drug showed a significantly greater prevalence (11.7 per cent) of history of severe depression during or after pregnancy than current users (9.3 per cent of 1638 patients) or never users (8.9 per cent of 1458 patients). On the other hand, 1420 past users revealed no association between number of months of pill use and depressive history. This research found no evidence of oral contraceptives aggravating a depressive history. But a history of depression in relation to pregnancy is related to discontinuance of the drug. The sequence of these events is unknown.