Can Depo-Provera Cause Anxiety?
Depo-Provera (DMPA) is not associated with causing anxiety based on available evidence, though it has been studied for its effects on depression with reassuring findings. The major documented adverse effects include menstrual irregularities, weight gain, headache, mastalgia, hair loss, and changes in libido—but anxiety is not listed among recognized side effects in clinical guidelines 1.
Evidence on Mood Effects
The relationship between DMPA and mood disorders has been specifically investigated, with findings that are generally reassuring:
Depression Studies (Most Relevant to Mood)
A prospective study of adolescents using DMPA found that depressive symptoms actually improved over 12 months of use, with mean Beck Depression Inventory scores decreasing by 4.8 points (p=0.02), and no significant changes in negative or positive affect were observed 2.
Among adult DMPA users followed for one year, women who continued the method had lower baseline depressive symptom scores, and those scores improved slightly at follow-up (7.4 vs 6.7), with subjects having the highest depression scores at enrollment showing improvement over time 3.
A cross-sectional study of DMPA users found no evidence of increasing depression with long-term use and no short-term dose-related effects on mood, leading researchers to conclude that women at risk of depression should not be denied DMPA as a contraceptive choice 4.
Important Exception - Immediate Postnatal Use
- One randomized controlled trial found that DMPA administered within 48 hours of childbirth was associated with higher depression scores at 1 and 3 months postpartum compared to IUD users (p=0.04 at 1 month, p=0.002 at 3 months), though this specific context (immediate postnatal period) represents a unique hormonal environment 5.
Clinical Guideline Perspective
Major clinical guidelines from the American College of Pediatrics and CDC list the recognized adverse effects of DMPA as menstrual irregularities, headache, mastalgia, hair loss, change in libido, and weight gain—but do not include anxiety or mood disorders as documented side effects 1.
Clinical Recommendations
If a patient reports anxiety while using DMPA, evaluate for other causes of anxiety rather than automatically attributing it to the contraceptive, as the evidence does not support a causal relationship 1, 3, 4, 2.
Counsel patients that mood-related concerns should not preclude DMPA use, as prospective studies show either no effect or improvement in depressive symptoms over time 3, 4, 2.
Consider alternative contraceptive methods if anxiety symptoms are severe and temporally related to DMPA initiation, using shared decision-making to optimize both contraceptive efficacy and quality of life 1.
Common Pitfalls to Avoid
Do not dismiss patient-reported anxiety symptoms, even though they are not documented side effects—evaluate comprehensively for other medical and psychosocial causes 1.
Avoid withholding DMPA from patients with pre-existing anxiety disorders based solely on theoretical concerns, as the evidence does not support worsening of mood symptoms with use 4.
Do not confuse the immediate postnatal context (where some depression risk may exist) with routine DMPA use in non-postpartum patients, as these represent different clinical scenarios 5.