Chapter 2 46 with current OC-induced mood complaints were more likely to have comorbid mood disorders than women without OC-induced mood complaints in a cross-sectional comparison (Segebladh et al., 2009). Joffe et al. (2003) retrospectively found that presence of a previous depressive episode was a significant predictor of OC-associated mood deterioration and Hall et al. (2012) found that in young women (aged 13–24) depressed moods at start of OC use increased the likelihood of reporting OC-related moodiness. However, there are only a few prospective studies on OC that specifically assessed women with diagnoses of depression. This means that clinicians and OC users currently have very limited guidance on whether OC use could affect women with a history of depression diagnoses differently than they affect non-depressed women. Insomnia is an important component of depression, both as a symptom as well as a risk factor (Baglioni et al., 2011; Fava, 2004; Paunio et al., 2015). Previous studies showed that OC use was associated with less deep sleep as revealed with EEG measurements, and a longer time to fall asleep (Burdick et al., 2002), more frequent insomnia complaints and more daytime sleepiness compared to no use of OC (Bezerra et al., 2020). On the other hand, OC use has also been associated with longer sleep durations compared to no use in sleep EEG assessments (Guida et al., 2020). The association between OC use and insomnia has not been examined at large. Previous studies have also not assessed the association of OC use with specific subtypes of depression. Atypical depression, which is characterized by mood reactivity and can include increased appetite and/or weight gain, hypersomnia, leaden paralysis and interpersonal sensitivity, is more prevalent in women than in men (Lamers et al., 2010), suggesting a role for sex hormones. In addition, Halbreich & Kahn (2007) noted that symptoms of postpartum depression and premenstrual dysphoric disorder strongly overlap with symptoms of atypical depression. Following their conclusion, OC use might also be associated with symptoms of atypical depression, but this has not yet been studied. Our study firstly aimed to investigate the association between self-reported OC use and depressive symptom severity (including atypical depressive symptoms) and insomnia symptom severity in adult women, as well as the association between OC use and concurrent diagnoses of major depressive
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