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The relationship between progestin hormonal contraception and depression: a systematic review

  • Brett L. Worly
    Correspondence
    Corresponding author. Tel.: +1 614 293 9899; fax: +1 614 366 0894.
    Affiliations
    Department of Obstetrics & Gynecology, The Ohio State University, Columbus, OH

    Dept of Psychiatry & Behavioral Health, The Ohio State University, Columbus, OH
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  • Tamar L. Gur
    Affiliations
    Department of Obstetrics & Gynecology, The Ohio State University, Columbus, OH

    Dept of Psychiatry & Behavioral Health, The Ohio State University, Columbus, OH

    Dept of Neuroscience, The Ohio State University, Columbus, OH

    Institute for Behavioral Medicine Research, Wexner Medical Center at The Ohio State University, Columbus, OH
    Search for articles by this author
  • Jonathan Schaffir
    Affiliations
    Department of Obstetrics & Gynecology, The Ohio State University, Columbus, OH
    Search for articles by this author

      Abstract

      Objective

      We performed a systematic review to look for an association between progestin-only contraception and depression.

      Methods

      We searched PubMed, Ovid and Web of Science for English-language articles including progestin-only contraception and depression from database inception to September 2016. We evaluated study quality with the procedures guiding reviews for the United States Preventive Services Task Force and the Cochrane Risk of Bias Tools. We included studies that evaluated progestin-only contraception and depression, focusing on externally validated depression measures. We excluded case studies, review articles and other psychiatric disorders.

      Results

      We identified 26 studies that met the inclusion criteria, including 5 randomized controlled trials, 11 cohort studies and 10 cross-sectional studies. We found minimal association between progestin-only methods and depression. No correlation with depression was found in five low-quality, high-risk-of-bias progestin subdermal implant studies and four out of five varying-quality and medium-risk-of-bias levonorgestrel intrauterine device studies. Three medroxyprogesterone acetate intramuscular injection trials with varying levels of quality and bias show no difference in depression. Two progestin-only contraceptive pill studies with varying levels of quality and bias indicate no increase in depression scores, while one good-quality, medium-bias study shows an association between progestin-only pills, the intrauterine device and depression.

      Conclusion

      Despite perceptions in the community of increased depression following the initiation of progestin contraceptives, the preponderance of evidence does not support an association based on validated measures (mostly level II-1 evidence, moderate quality, low risk of bias).

      Keywords

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