I Can’t Stand the Pill!

About ADHD, hormonal contra­ceptives, and depression

Blog by Lotta Borg Skoglund

ADHD and hormones

Our research group GODDESS ADHD (Gender-informed research to Overcome Diagnostic Delay and Emotional dysregulation through Self-awareness and Self-efficacy in female ADHD) are dedicated to increase the knowledge around how hormones affect mental health in females across an entire lifetime. This bog is a summary of our most recent study called Hormonal Contraceptive Use and Risk of Depression Among Young Women With Attention-Deficit/Hyperactivity Disorder.

It’s no secret that mental illness is more common in women compared to men. And girls and women with ADHD is an especially vulnerable and underserved group where we know far too little about how the brain and the hormones interplay. This is a huge problem since women with ADHD have such high risk for comorbidity like anxiety, depression, and emotional instability. Being un- or misdiagnosed and treated for other conditions than ADHD is costly, not only for the women themselves but also for society. A serious consequence of ADHD in girls and women is that they, more often than women without the diagnosis, engage in risky sexual behavior, and consequently are at higher risk for exploitation, victimization, and unplanned teenage pregnancies. Delaying childbirth is an important to make sure that girls and young women get the same opportunities to establish a solid psychosocial platform for themselves in life. Encouragingly enough, this long-term mission has resulted in Swedish teenage pregnancies decreasing from around 15% during the 70-ies to about 2% today. In a previous study when we interviewed midwifes at Swedish youth centres showed that young women with ADHD find it difficult to access and act on contraceptive counselling. Perhaps consequently, another of our studies found that they are six times more likely than non-ADHD females to become teenage mothers. That is why we in this study wanted to explore if women with ADHD, compared to non-ADHD women, got depressed from their contraceptives.

We compared over 29 thousand girls and young women with ADHD between the age 15 and 24 years with over 760 thousand girls and women without ADHD for our “non-ADHD control group” and found a much higher risk of developing depression when on the pill among ADHD women. In fact, those with ADHD that used combined oral contraceptives (pills that contain both estrogen and progesterone) had a five times higher risk to develop depression compared with non-ADHD women who were not using these pills. We found no difference in risk between combined pills (estrogen and progesterone) or progestogen-only pills, so we don’t think that the hormones in the pill per se is the reason why women with ADHD are at risk for depression. Not the least since many of the different contraceptives contain the same hormones. (Next week we will post a blog-special about how different estrogens affect the female body across a lifetime, so stay tuned).  A more feasible explanation is that women due to ADHD-symptoms more often forget to take their pills and that their hormones fluctuate more due to that. Also, forgetting to take a pill may cause stress from irregular bleedings and unplanned pregnancies that increase the risk for anxiety and depression in susceptible women. This is why, many experienced midwifes and gynaecologists recommend that women with ADHD use long-acting non-oral products (LARCs), like IUDs (intra uterine devices). Beyond being safe and effective as contraceptives that you don’t have to actively remember every day, they ensure stable serum levels of hormones.

So, in conclusion our study becomes part of a much-needed pool of research on ADHD, hormones, and sexual and physical health in females. We hope that this new knowledge will become an integrated part of the shared decision making, contraception counselling and standard of care for young woman with ADHD.

Reference: Lundin C, Wikman A, Wikman P, Kallner HK, Sundström-Poromaa I, Skoglund C. Hormonal Contraceptive Use and Risk of Depression Among Young Women With Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry. 2022 Oct 28:S0890-8567(22)01894-9. doi: 10.1016/j.jaac.2022.07.847. Epub ahead of print. PMID: 36332846.

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