de Wit Anouk E, de Vries Ymkje Anna, de Boer Marrit K, Scheper Celeste, Fokkema Ante A, Schoevers Robert A, Giltay Erik J
Department of Psychiatry, University of Groningen, University Medical Center Groningen, The Netherlands.
Department of Developmental Psychology, University of Groningen, The Netherlands.
BJPsych Open. 2021 Jun 8;7(4):e110. doi: 10.1192/bjo.2021.64.
Observational studies suggest that hormonal contraceptive use may increase depressive symptoms in women, but it is unclear whether the effect is causal.
To quantitatively examine the evidence from randomised clinical trials for the link between hormonal contraceptive use and depressive symptoms.
We performed a systematic review and network meta-analysis of randomised clinical trials comparing women randomised to any form of a hormonal contraceptive with women randomised to any other form of a (non-)hormonal contraceptive or placebo. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Web of Science, PsycINFO, EMCare and EMBASE, from inception to 1 May 2020. Certainty of the evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation approach. A random-effect Bayesian network meta-analysis was conducted, with change in depressive symptoms between baseline and three cycles as outcome.
This review identified 3492 records, of which 14 trials were eligible and 12 could be included in the network meta-analysis. These trials included 5833 participants (mean age per study range: 16.8-32.4 years) and compared 10 different interventions. Compared with placebo, hormonal contraceptive use did not cause worsening of depressive symptoms (standardised mean difference: median, -0.04; range, -0.17 [95% credible interval -0.46 to 0.13] to 0.13 [95% credible interval -0.28 to 0.56]).
This study suggests that hormonal contraceptive use does not lead to an increase in depressive symptoms in adult women. Future studies should include first-time users, to confirm the results in young women.
观察性研究表明，使用激素避孕药可能会增加女性的抑郁症状，但尚不清楚这种影响是否具有因果关系。
定量研究随机临床试验中关于使用激素避孕药与抑郁症状之间联系的证据。
我们对随机临床试验进行了系统评价和网状Meta分析，比较随机分配至任何形式激素避孕药组的女性与随机分配至任何其他形式（非）激素避孕药或安慰剂组的女性。我们检索了Cochrane对照试验中心注册库（CENTRAL）、PubMed、科学引文索引、心理学文摘数据库、循证医学数据库和荷兰医学文摘数据库，检索时间从建库至2020年5月1日。采用推荐分级的评估、制定与评价方法评估证据的确定性。进行随机效应贝叶斯网状Meta分析，以基线至三个周期抑郁症状的变化作为结局指标。
本综述共识别出3492条记录，其中14项试验符合纳入标准，12项可纳入网状Meta分析。这些试验共纳入5833名参与者（每项研究的平均年龄范围：16.8 - 32.4岁），并比较了10种不同的干预措施。与安慰剂相比，使用激素避孕药不会导致抑郁症状恶化（标准化均差：中位数，-0.04；范围，-0.17 [95%可信区间 -0.46至0.13]至0.13 [95%可信区间 -0.28至0.56]）。
本研究表明，使用激素避孕药不会导致成年女性抑郁症状增加。未来研究应纳入首次使用者，以证实年轻女性中的结果。
