The relationship between progestin-only contraceptive methods and depression was evaluated in a new systematic review published in the journal Contraception.

Researchers performed a literature search to identify studies evaluating progestin-only contraception and depression “focusing on externally validated depression measures.” Case studies, review articles, and other psychiatric disorders were not included in the analysis. Study quality was graded according to the United States Preventive Services Task Force and the Cochrane Risk of Bias Tools.

A total of 26 studies (11 cohort studies, 10 cross-sectional studies, and 5 randomized controlled trials) were included. The results showed little association between progestin-only contraceptive use and depression. Specifically, no correlation was found with progestin subdermal implants (5 low-quality, high-risk-of-bias studies) and in 4 out of 5 studies involving levonorgestrel intrauterine devices (IUDs) (varying quality, medium-risk-of-bias). 

Moreover, no difference in depression was seen in the 3 trials evaluating medroxyprogesterone acetate intramuscular (IM) injection. With regard to progestin-only oral contraceptive pills, 2 studies showed no difference in depression (varying levels of quality and bias). Only one study with good-quality evidence and medium-bias demonstrated an association between progestin-only pills, IUD, and depression. 

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Lead author, Brett L. Worly, concluded, “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.”

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