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 disorder 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.

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