title: Rapid relapse in depression following initialization of oral contraception with ethinyl estradiol and chlormadinone acetate.
abstract: OBJECTIVE
  Female sexual hormones (estrogens and gestagens) may affect neurocognitive functioning and mood. Thus, the use of oral hormonal contraceptives (OHC) bears the risk of psychiatric adverse drug reactions such as depression and psychosis. However, the available empiric evidence regarding this connection is conflicting, and, moreover, female sex hormones seem to feature also mood-stabilizing and antidepressive effects. Hence, individual susceptibility factors and preparation-specific pharmacologic properties might play a pivotal role in the development of mood disturbances related to OHC. Single case reports provide empiric data for further systematic approaches.
  
  
  METHODS
  A clinical case is presented and discussed.
  
  
  RESULTS
  A 36-year-old female patient with recurrent major depressive disorder developed rapid relapse in depression after initialization of OHC with ethinyl estradiol 30 μg/chlormadinone acetate 2 mg. This OHC combination was described to particularly feature positive effects on depressive mood.
  
  
  CONCLUSIONS
  OHC may induce serious mood disturbances and should be administered with care, particularly in patients with affective disorders.
authors.affiliation: Department of Psychiatry and Psychotherapy III, University Hospital of Ulm, Ulm University, Ulm, Germany. Electronic address: maximilian.gahr@uni-ulm.de.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Gahr
authors.affiliation: Department of Psychiatry and Psychotherapy III, University Hospital of Ulm, Ulm University, Ulm, Germany.
authors.forename: Roland W
authors.initials: RW
authors.lastname: Freudenmann
authors.affiliation: Department of Psychiatry and Psychotherapy III, University Hospital of Ulm, Ulm University, Ulm, Germany.
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Connemann
authors.affiliation: Department of Psychiatry and Psychotherapy III, University Hospital of Ulm, Ulm University, Ulm, Germany.
authors.forename: Markus A
authors.initials: MA
authors.lastname: Kölle
authors.affiliation: Department of Psychiatry and Psychotherapy III, University Hospital of Ulm, Ulm University, Ulm, Germany.
authors.forename: Carlos
authors.initials: C
authors.lastname: Schönfeldt-Lecuona
mesh_terms: D000328:Adult; D002715:Chlormadinone Acetate / Q000009:adverse effects / Q000031:analogs & derivatives*; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects*; D003865:Major Depressive Disorder / Q000139:chemically induced*; D004997:Ethinyl Estradiol / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D006801:Humans; D012008:Recurrence
chemical_list: D003277:Contraceptives, Oral, Combined; C488302:ethinylestradiol-chlormadinone acetate; D002715:Chlormadinone Acetate; D004997:Ethinyl Estradiol
keywords: Contraceptive pill; Gestagens; Mood disorder; Oestrogens