In Reply: Dr Freeman raises a very important
issue for clinicians who care for women: that depression is a serious health
problem and is often overlooked. The relationship between hormonal patterns
and depression, however, is not simple. Mood disorders and depression are
reported in studies as reasons for contraceptive discontinuation by some women,
and admonishing women to report symptoms of depression has been a commonly
accepted clinical practice in providing progestin-only contraceptive methods.
Depression and postpartum depression are common irrespective of contraceptive
status, however, and a review of 400 peer-reviewed, published clinical studies
involving 55 000 users of implantable levonorgestrel (Norplant, Wyeth-Ayerst)
concluded that reports of mood disturbances, anxiety, and depression were
similar to those reported by women using hormonal methods containing estrogen.1
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