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Harvard Medical School

Does Depo-Provera Cause Mood Changes?

Depo-Provera (DMPA), also known as the birth control shot, is a highly effective form of contraception that lasts for 3 months, and thus requires only 4 injections per year. DMPA contains a long-lasting form of depot medroxyprogesterone acetate that works as a contraceptive agent by preventing the ovaries from releasing an egg each month. Potential side effects of DMPA include bone density loss, weight gain, and mood worsening. Although depression is listed in the packet insert as a side effect of the injection, available research addressing this side effect are limited and contradictory.

In two older studies, between 1% and 5% of DMPA users reported experiencing depression or mood changes on the treatment, but these studies used brief non-standardized interviews. Three more recent studies have used more structured assessments of mood to evaluate whether there are mood effects of DMPA use.

The 2006 Bulletin of the American College of Obstetricians and Gynecologists states that DMPA does not appear to be associated with mood worsening. This is based primarily on a one large study of 495 women who chose to use DMPA. After 12 months, 34% of participants were still using DMPA, 44% had discontinued use, and 20% were lost to follow-up. Over the 12 month period, depression levels improved slightly in the women who continued using DMPA, and depression levels were unchanged in those who discontinued it.

It is important to note, however, that in this study women who discontinued DMPA had slightly higher baseline depression scores than continuers. Furthermore, one of the limitations of this study is that it did not provide any information as to why such a large proportion of women discontinued DMPA use. If a significant proportion of those who discontinued did so because of mood worsening, we cannot conclude that DMPA use has no impact on mood.

Of two other studies that have examined the relationship between DMPA use and depression, one found a negative effect on mood and the other reported no relationship. The first was a 3- year study of 183 women which found that women using DMPA had an increase in depressive symptoms when compared with women not using DMPA. The women who stopped using DMPA during the study had higher levels of depression immediately before or immediately after they discontinued DMPA than they had before starting DMPA. Levels of depression in this group dropped to those observed in non-DMPA users within several months of the discontinuation of DMPA.

The second study of 39 adolescents found that over 1 year of continued use, DMPA was not associated with any mood changes.

Although some women report mood worsening on DMPA, more research is needed to determine how common this side effect is and if women with a history of mood disroder are more susceptible to such a side effect. Women with a history of mood disorder should talk to their doctor about these risks and benefits before using DMPA.

One option for women considering DMPA who are concerned about side effects is to have a short trial of oral medroxyprogesterone acetate (Provera) – the same medication that is in the DMPA injection. The advantage of administering a short trial of oral medroxyprogesterone acetate is that, if there is an adverse reaction, the oral medication can be stopped immediately, whereas the side effects of the long acting DMPA injection may linger.

Adriann Kanarek-Farrell, BA
Hadine Joffe, MD, MSc

ACOG Practice Bulletin. No. 73: Use of hormonal contraception in women with coexisting medical conditions. Obstet Gynecol. 2006 Jun;107(6):1453-72.

Westhoff C, Truman C, Kalmuss D, Cushman L, Davidson A, Rulin M, Heartwell S. Depressive symptoms and Depo-Provera. Contraception 1998;57:237-40.

Civic D, Scholes D, Ichikawa L, LaCroix AZ, Yoshida CK, Ott SM, Barlow WE. Depressive symptoms in users and non-users of depot medroxyprogesterone acetate. Contraception 2000;61:385-90.

Gupta N, O’Brien R, Jacobsen LJ, Davis A, Zuckerman A, Supran S, Kulig J. Mood changes in adolescents using depot-medroxyprogesterone acetate for contraception: a prospective study. J Pediatr Adolesc Gynecol 2001;14:71-6.

Schwallie PC, Assenzo JR. Contraceptive use–efficacy study utilizing medroxyprogesterone acetate administered as an intramuscular injection once every 90 days. Fertil Steril 1973;24:331-9.

Fraser IS, Dennerstein GJ. Depo-Provera use in an Australian metropolitan practice. Med J Aust 1994;160:553-6.

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8 Responses to Does Depo-Provera Cause Mood Changes?

  1. Denise Ross September 21, 2008 at 3:29 pm #

    I took depo for about 4 years from the age of 17 until 21. I am a very negative person, and seem to get annoyed really easily. I didn’t notice it as much when I was younger, but that time in a young girls life is rather stressfull anyway. So I am not sure that they are related or not. I am 25 now and am really tired of being so irritable and can’t seem to do anything about it. I take some over the counter mood pills that help for the most part, but I am still a bit over the top when it comes to annoyances.

  2. sonya September 12, 2012 at 7:31 am #

    I am 40 and currently using depo. I had serious depression as a teenager, but have been stable for the last 25 years. Not anymore..I found myself visualling my own suicide..how I would do it etc. the other day. I am rational enough to know that even though the feelings seemed real, that it was the drug causing the emotion. (please do not flood me with hotline advice. I added this experience to inform). I also have random weird cramps throughout my body. Not just old age pains! So, I chose depo b/c I have children and was afraid of doing anything “drastic” to my body until menopause..LOL that is truly a laugh considering where this drug has taken me. But no worries, as well as causing weird random bouts of depression, odd cramping..I have absolutely no interest at all in sex..so i guess the drug is working…oh and the 30 day period..that was awesome.

  3. Marie williams November 18, 2012 at 12:54 pm #

    Thank you Sonya and Denise , this irritability,(on top of my regular irritable self) has gotten in the way of my relationship, it is not worth it for me. All this time I thought is was just me being mean, I’m not usually mean, I have been on it for over 2 years, enough of the Depo, I’m taking something else!!

  4. MrsHmmz December 15, 2012 at 7:42 am #

    My own personal experience & anecdotal reports from people I have spoken to suggests that mood changes & reduced sex drive are incredibly common symptoms with Depo-Provera, so I find it very surprising there has not been more published evidence of this! I realise my sample could in no way be considered “scientific” but I can’t help but wonder how many women don’t report the adverse effects (nobody I’ve spoken to actually reported them) and just stop taking it. It seems the symptoms are often quite subtle and the women experiencing them only realise how bad they were feeling when they start to get better, or the effects are noticed more by the people who live with them than by the women themselves.

    My own experience was that I completely lost my sex drive & became almost devoid of emotion, apart from being irritable with my partner & children & having bouts of extreme sadness. I became so detached that I almost didn’t notice how bad it was, but my husband says I became cold & emotionless, almost like a robot. I knew that the Depo was making me feel bad, but it was only when the effects of the injection started to wear off that I really noticed how awful I had been feeling! I never reported these symptoms to my doctor & wasn’t asked about it, I just never went back for a second injection.

    The injection seems to be the only plausible explanation for this; nothing else was going on in my life at the time, I have never had a similar set of symptoms at any other point in my life, and they definitely started shortly after I had the shot then gradually faded away after 3 months.

    I do know that I seem to be quite sensitive to hormonal fluctuations (I get quite bad PMT, and I lost my sex drive whilst pregnant), which perhaps made me more prone to react badly to something like Depo Provera, but judging by the things I’ve heard from other people who’ve tried it I am far from being unusual in experiencing these side effects.

  5. Chloe December 27, 2012 at 11:36 pm #

    I am 23, and I have actually been on Depo since I am about 14 or 15. It’s been a long time. That makes it very difficult to compare the progression of my mood up to my current mood, to my previous mood. If I look back on that period of my life, I could say that I am prone to over-thinking and anxiety. I can drive myself mad with all these worst case scenarios that haunt my mind. sometimes I feel like I am living on a never ending rollercoaster, of indifference, sudden anger, frustration, sadness, hopelessness and an occasional break from it all thanks to a very very supportive boyfriend. My happiest moments are quite literally during and after sex, and sometimes after a work out, during moments of euphoria. Otherwise I am generally sad. I avoid large gatherings like the plague and I am incapable of maintaining friendships. I like to think that I am too old for an identity crisis but I often find myself infuriated against society and feel misunderstood.

    I wish I could find out what makes me that way. I cry very often, and even if I wait to be alone to cry, my boyfriend tells me he can actually smell it when he comes in the room if I’ve recently cried…It’s becoming difficult to hide.

    I wish there was away to find out whether this is a hormonal problem, a personality disorder or perhaps Depo, without consulting any professional. I’ve lost count of how many times I’ve tried using my benefits from work to contact a counselor, but was unable to speak when they contacted me back. I often completely avoid answering the phone when I know it’s the counseling agency calling back. I can’t do it.

  6. Iesha May 26, 2014 at 4:44 am #

    I started the depo shot on April 18th, ever since then I have noticed that I have been VERY EMOTIONAL crying late at night for no reason what so ever. I have never been more depressed before in my life. I wish I would have known the side affects before I got the shot. I feel like I’m a completely different person and no one understands why sometimes I’m happy then the next I feel like crying. I have also noticed I’m starting to become a lot more irritated than I used to be before, I absolutely hateeee the shot!!

  7. Bria H. June 12, 2014 at 1:28 pm #

    I would not recommend the shot to anyone! I received my first shot on may 28th. And ever since i have had nothing but trouble. I have endometriosis which is a chronic disease that can eventually cause issues with your whole reproductive system if a severe case. i have tried all methods of birth control (pills, implants, Iud’s) since getting my shot i have been experiencing depression, crying fits, im so irritable that i have pushed away everyone of the opposite sex. My sex drive is ZERO. My boyfriend doesnt even know what sex is anymore. In the short of time ive been on this shot my appetite has spiked. i didnt eat big meals before the shot & now i want to eat like im feeding twins. No matter how portioned or healthy i make my meal it seems like the food is never enough. ive gained weight already. I will not being getting a second shot. they dont warn you of the side effects before you get this. They kjust say its a good option for you. Well i call BS. STAY AWAY FROM THIS SHOT!

  8. Karey June 17, 2014 at 12:02 am #

    I have had 6 shots now about to get my 7th and I am hesitant because there is a week in between getting the shot and my next due time to get it, that I experience super PMS. I am tired and anxious and previously experienced basic lost of control on irritability. I started taking magnesium and Vitamin D to see if it helps with the mood swings and fatigue, but I would recommend fully researching this before taking this shot, I don’t think they have enough evidence to say what it’s long term effects are.

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