Risk factors involving depression:
(1) history of depression and/or an anxiety disorder
(2) history of depression associated with hormonal therapy
(3) history of depression associated with other medications
(4) family history of depression associated with oral contraceptives
(5) history of dysmenorrhea
(6) history of premenstrual depression
(7) history of depression associated with pregnancy
Risk factors associated with patient:
(1) age < 20 years
(2) vitamin B6 (pyridoxine) deficiency
(3) recent psychological stress or distress
Risk factors associated with formulation:
(1) high estrogen content
(2) progresterone content
(2a) high progesterone without premenstrual mood symptoms
(2b) low progesterone content or low ratio of progesterone to estrogen, with premenstrual mood symptoms
(3) triphasic product (vs monophasic)
Establishing a causal link with oral contraceptives:
(1) onset or worsening of symptoms after starting oral contraceptives (temporal relation)
(2) disappearance or reduction of symptoms upon stopping medication
(3) recurrence on re-exposure
(4) exclusion of other causes
