DEPRESSION IN USERS OF DEPO-MEDROXYPROGESTERONE ACETATE

Prevalence of depression is high among poor, young, Hispanic inner cit y women. Depot-medroxyprogesterone acetate (DMPA) is a popular contrac eptive choice in this group. DMPA labelling suggests that depression m ay worsen with use. In order to identify any association of DMPA use w ith worsening depression, we surveyed an English-speaking subset of DM PA users in a Title-X funded family planning clinic. Eighty women comp leted the CES-D scale on two occasions: once about four weeks after a DMPA injection when the subject would have been exposed to the highest blood levels, and once immediately prior to an injection when recent blood levels of the drug would be somewhat lower (or absent preceding the first injection). The median CES-D score was 14. The scores were n ot related to timing of the test (pre- or postinjection). The depressi on scores were somewhat higher among those women receiving their first DMPA injection during the study period (i.e., unexposed women) and am ong those women who had received four or more injections. Scores were unrelated to age or parity, but were somewhat higher in women who repo rted fewer years of education or a recent adverse pregnancy outcome. T hese data provide little evidence of increasing depression with long-t erm use of DMPA and no evidence of a short-term effect of dose (within the contraceptive range) on mood. Women at risk of depression should not be denied DMPA as a contraceptive choice.