Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a retrospective study the case histories of 70 users of Depo-Provera (containing depo medroxyprogesterone acetate) were reviewed during April-June 1987 at the Family Planning Association of Victoria's Richmond Clinic in Australia to ascertain their socioeconomic status, obstetric and contraceptive history, and side effects of Depo-Provera use. 47 (67%) were employed; 20 (29%) were health care card holders (8 were unemployed and 6 were supporting mothers); 2 were wards of state referred from adolescent institutions; and 3 women (4%) had intellectual disability. 37 (53%) had been pregnant with the total number of pregnancies of 65; 16 women had a total of 25 terminations of pregnancy; and 1 woman had a history of 4 therapeutic abortions. 53 women (76%) had started using contraception before the age of 20; 47% had used more than 1 type of contraception, 46% had used oral contraceptives only, 23% had used the condom, and 5% had used nothing. Age range at start of Depo Provera use was 14-40 years. The reasons given for commencing Depo-Provera included a combination of problems with other methods, forgetting OCs, and side effects of OCs. 47 (67%) had requested the use of Depo-Provera, of whom 13 (18%) had used it previously. 43 (61%) used Depo-Provera for 1 year or less, and only 1 patient had used it for 6 years. Among 52 women (74%) who had more than 1 dose of the injectable, the major side effects related to menstrual disturbances; 31 (41%) had amenorrhea. 2 of these women had breakthrough bleeding during the 1st dose. 17 women (24%) had either irregular bleeding or breakthrough bleeding, while 1 patient continued to have regular periods. 7 women (10%) had other side effects including depression; 4 women (6%) complained of weight gain; and 2 (3%) had breast soreness. 41 women (59%) were smokers, and 40% of them smoked 15 or more cigarettes per day. 35% of the women continued with the method beyond the study period, while the proportion of women within the clinic who continued using Depo-Provera was about 0.5%.
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PMID:Depo Provera: a profile of current users. 214 Jun 75

Medroxyprogesterone acetate injections (Depo-Provera) were given to 625 women at 3 monthly intervals involving 693 episodes. Ages at entry to the study ranged from 15-51 years with the majority in their 20s and a mean age of 30. Length of exposure ranged from 3-168 cycles. 4 women have received more than 160 continuous cycles of DMPA. Of the medication-induced reasons for discontinuing DMPA, bleeding was the most common with an incidence of 10.5% followed by depression (1.4%), weight gain (1.4%), and loss of libido (1.6%). No patient ceased treatment because of headaches, recurrent vaginal infections, mastalgia, nausea, chloasma, hypertension, or other vascular illnesses. The 59 women who move away or were lost to follow-up accounted for 405 cycles of treatment. The solitary unplanned pregnancy occurred in a 28-year-old obese woman who had previously had other method failures, once with an IUD and once with oral contraceptives (OCs). No association was found with carcinoma of the cervix. Of 80 women ceasing treatment to become pregnant, only 1 women has required the assistance of chlomiphene and conceived 2 years after ceasing DMPA. Amenorrhea was the side effect most appreciated by the women using DMPA. Due to the problem of irregular bleeding, it is wise to warn prospective patients about the lack of bleeding control that they have 1 chance in 10 of having relative menorrhagia. Women using OC subject to frequent vaginal moniliasis had a marked reduction in episodes after switching to DMPA. Chloasma, 1 of the minor stigmas of OC, was not induced in any of the patients. DMPA is a safe and efficient reversible method of contraception for women who have various gynecological conditions or problems associated with using OCs.
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PMID:Medroxyprogesterone acetate as an injectable contraceptive. 296 70

The contractability of the Fallopian tubes is instrumental in the transport of the ovum to the uterus. Various studies have been done to determine the effect of different hormones on this property of the tubes, but they have been inconclusive. 34 patients who were scheduled for salpingectomies for reasons of birth control and who had been using steroid contraceptives for at least 3 months prior to the operation were selected for study. Half the sample had used pure progestagens (Depo-Provera or chlormadinone) and half had used a combined preparation (quinestrol + quingestanol or deladroxate). All were between 29-41 years of age with numbers of pregnancies ranging from 5 to 21. The intensity and frequency of the contractions and the general activity of the isthmus portion of the tubes were studied for 10-minute periods in 2 cm segments. Also, histological studies were done using hematoxylin eosin tincture and Van Giessen tincture, and histochemical tests were performed. The 17 cases on combined orals exhibited a significantly higher rate of activity than those on pure progestins, but were also subject to contractions of greater intensity. The histochemical studies showed a decrease in the energetic material and in the enzymatic activity related to carbohydrate metabolism in the tubes of the progestin group. The depression of motor activity and energetic metabolism was, however, neutralized by administering estrogens.
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PMID:[Effects of various steroids on the morphology and function of human fallopian tubes]. 419 46

The capability of an early second injection or prior use of oral contraceptives (OCs) to improve satisfaction and long-term continuation of Depo-Provera in adolescents was investigated in a clinical trial involving 78 females 12-20 years of age (average, 15.9 years) recruited from a hospital-based adolescent health clinic. 36 subjects received injection of 150 mg of Depo-Provera every three months (Group 1), 27 received the second injection after only six weeks (Group 2), and 15 switched directly from OCs to the standard Depo-Provera regimen (Group 3). There was no difference between Groups 1 and 2 in terms of duration or frequency of menstrual bleeding; however, prior OC users experienced a significant reduction in the duration and intensity of bleeding in the first six months of Depo-Provera use (when estrogen was still present in the women's systems). Overall, 64% of study subjects reported less dysmenorrhea while on Depo-Provera. A slightly greater change in body mass index was observed among girls in Group 2 than in Groups 1 and 3; moreover, 70% of those in the early injection group reported increased appetite and weight gain compared to 39% of those on the standard schedule. The most commonly reported side effects included initial pain and soreness at the injection site (27%), decreased libido (56%), mood changes (31%), depression (26%), frequent headache (25%), fatigue (24%), and increase in acne (15%); there were no significant differences by group. 17 adolescents (22%) discontinued Depo-Provera, generally after two injections and due to bleeding irregularities or weight gain. 87% of adolescents who were prior OC users, 52% of those on the regular schedule, and 39% of those who received an early injection stated they were very satisfied with Depo-Provera. These findings indicate that early second Depo-Provera injection offers no advantages; use of OCs immediately prior to Depo-Provera should be further investigated, however, given its potential to minimize bleeding problems.
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PMID:Depo-Provera in adolescents: effects of early second injection or prior oral contraception. 766 88

Clinicians examined the family planning decisions of 3938 women who underwent prenatal diagnosis (ultrasonography, amniocentesis, or chorionic villus sampling) at the Division of Reproductive Genetics at the University of Tennessee in Memphis between January 1988 and May 1993. 104 women were carrying fetuses with chromosome abnormalities, of whom 92 opted to terminate their pregnancies. 57 women were carrying fetuses with neural tube defects, of whom 49 chose to end their pregnancies. Among the 91 fetal chromosome abnormality cases with complete information on family planning decisions, 84 had autosomal abnormalities and 7 had sex chromosome abnormalities. Among the 41 fetal neural tube defect cases with complete information on family planning decisions, 22 had spina bifida and 19 had anencephaly. The mean age of women with a chromosome abnormality fetus was higher than that of those with a neural tube defect fetus (36.8 vs. 27.3 years; p 0.03). Just 20 women (15.2%) chose permanent sterilization after continuing or terminating the affected pregnancy. Women carrying fetuses with chromosome abnormalities were more likely to choose permanent sterilization than those carrying fetuses with neural tube defects (18.7% vs. 7.3%; p 0.03). Advanced maternal age was associated with the decision to undergo permanent sterilization (p 0.04). Physicians should counsel women who have opted to terminate a pregnancy of an abnormal fetus to delay any decision to undergo permanent sterilization to allow for resolution of grief and depression. They should advise the women to use safe, reliable, and long term reversible contraceptive agents (e.g., Norplant subdermal implant system, the injectable Depo-Provera, IUDs, and oral contraceptives).
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PMID:Family planning decisions after prenatal detection of fetal abnormalities. 797 49

A study was made of all women who had been inpatients of the mental health or disability units of Porirua Hospital in New Zealand for at least 6 months who were prescribed oral or injectable hormonal contraceptives during January 1992. The aim was to describe the use of hormonal contraceptives in this population and assess the appropriateness and safety of this method as well as the patient consent process and patient satisfaction. Data were collected from medical records and from interviews with the patients (when possible) and their nurses. 42 women were prescribed contraceptives (60% of those under 50). 3 were married, 3 separated or divorced, and 36 never married. 32 were nulliparous, none had more than 2 children. 11 were Maoir, 1 Pacific Islander, and 29 New Zealand pakeha. 23 women were intellectually disabled, 28 had mental disorders, 9 had both. 29 of the women received Depo Provera, 7 progesterone-only oral contraceptives (OCs), and 6 combined OCs. 25 had been using their current contraceptive for more than 3 years. Treatment was prescribed by psychiatric staff in 16 cases, other staff in 25, and outside practitioners in 1. The reason for treatment was contraception in 32 women and menstruation prevention in 9. 27 women were smokers (21 heavy). 7, including 6 of the heavy smokers, had other contraindications to the use of estrogens. Of the 26 women interviewed, 12 complained of side effects, 8 of weight gain, 2 of depression, and 5 of other effects (the nurses identified only 2 of 42 women as suffering side effects). Of the 22 interviewees who were treated for contraception, 15 stated they were sexually active. The nurses thought that 29 of the 42 were or might be sexually active. Therefore, 13 women considered definitely not sexually active were prescribed contraceptives. Very few of the women used condoms, although 38% knew how to practice safe sex. 14 of the women interviewed stated they chose contraception. The nurses said 8 had given consent, the families of 2 gave consent, consent information was unknown for 10, and a unilateral staff decision was made for 22. 17 of the 28 women definitely treated without consent were mentally retarded. The women were given very little information about their contraceptive method and knew of very few other methods. These results indicate that contraceptives have been used to manage menstrual hygiene and address staff concerns. In some cases, their administration without consent was illegal. The patients received inadequate medical care and some of the prescriptions were inappropriate. Ethically correct ways in which to address the problem of contraception in this population exist through educationally-focused family planning services for both in- and out-patients.
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PMID:Use of hormonal contraceptives in an institutional setting: reasons for use, consent and safety in women with psychiatric and intellectual disabilities. 834 76

The US Food and Drug Administration finally approved the injectable contraceptive Depo-Provera (DMPA) in October 1992, 25 years after its introduction. Women return to a health facility every 90 days for an intramuscular injection of 150 mg DMPA, which provides them 99% effective contraception. Menstrual changes and spotting are the leading reasons for DMPA discontinuation. Eventually, more than 50% of DMPA users develop amenorrhea. During the first year, women gain about 2 kg and weight increases as time passes. Weight gain is the second leading reason for DMPA discontinuation. DMPA may adversely affect glucose tolerance in women at risk for diabetes, but it does not affect cardiovascular or metabolic functions. It may increase the risk of osteoporosis. A rare side effect is convulsions. 1-10% of DMPA users have other central nervous system effects, such as headaches, dizziness, and depression. Itching and rashes may develop. Fertility returns within 1 year after discontinuation. DMPA is linked to low birth weight. It apparently does not harm breast-fed infants or hinder lactation. A World Health Organization study shows that DMPA users less than 35 years old experience a slight increase in breast cancer but a reduced incidence of endometrial cancer. Nurses are instrumental in guiding women as they choose DMPA and in informing them about its potential side effects, including breast cancer risk. They must screen women for pregnancy and evaluate their risk of breast cancer. They must determine whether women are able to return every 3 months for DMPA injections. Women who select DMPA must use other contraception, e.g., barrier protection, within the first 24 hours after initial injection. Nurses should counsel them about the likely menstrual changes to reduce the likelihood of dissatisfaction. They should recommend a daily dose of 1200 mg of elemental calcium and daily exercise of long bones to minimize the risk of developing osteoporosis.
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PMID:Depo-Provera. 849 47

The product labeling for Depo-Provera cites depression as an infrequent side effect. Previous research on this topic has documented self-reported depression or mood changes in 1-5% of Depo-Provera users. These studies were limited, however, by a lack of measurement of baseline depression. In the present study, 495 new acceptors of Depo-Provera enrolled in a broader prospective cohort study conducted at three US hospitals (Texas, Pennsylvania, New York) were interviewed at enrollment and again after 12 months of use. Included in both the initial and follow-up questionnaires were six questions on depressive symptoms in the past month taken from the Mental Health Inventory. At 12 months, 172 women were still using Depo-Provera, 221 had discontinued the method, and 102 were lost to follow-up. Women who were still using Depo-Provera at 12 months had lower depressive symptom scores at baseline than women who discontinued use or were lost to follow-up. Between baseline and the 12-month follow-up, the mean depression score dropped from 7.4 to 6.7 among continuing users and remained steady at 8.0 among discontinuers. The mean depression score in the quintile of women with the highest depression scores at baseline also decreased after 12 months of use, from 15.4 to 9.5. These results suggest that Depo-Provera use is not likely to exacerbate symptoms in women with pre-existing depression.
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PMID:Depressive symptoms and Depo-Provera. 964 14

At a symposium on "Controversies in Contraception" at Wayne State University (Detroit), Dr. C. Alvin Paulsen outlined 3 separate trends in using drugs in men to prevent conception: 1) Danazol--a male "pill"; 2) Provera (medroxyprogesterone acetate) as a pill or injection plus monthly testosterone injections; and 3) a combination of the 1st and 2nd methods. The mechanism of action of the pill methods is blocking the ability of the testes to make hormones and the depression of signals coming from the pituitary gland. Advantages of a successful male contraceptive pill include its use as an alternative to sterilizaiton as well as an effective contraceptive with no adverse effects for the female.
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PMID:Interest increasing for male contraceptive pill. 1226 43

Finding the most appropriate contraceptive method for retarded or developmentally delayed young people poses a tremendous challenge to family planning nurse practitioners. Retarded young people have the same sex drive and are influenced by the same pressures affecting sexual decision making as every adolescent. The crucial difference is the retarded person's lack of appropriate information about physical and emotional changes of adolescence, sexuality, and birth control. Since retarded teenagers struggle to be accepted, they tend to be compliant and thus vulnerable to sexual exploitation. Parents are generally more concerned about sexuality in retarded daughters than sons, and many request to have their child sterilized. Mentally retarded teens usually lack the motor skills and motivation to use barrier methods consistently. Long-acting injectable contraceptives such as Depo-Provera offer the greatest protection against pregnancy and have the highest satisfaction rate among parents and caretakers of retarded young people; however, side effects can include depression and weight gain. If hormonal contraception is selected, its effects on seizure activity must be carefully evaluated. In addition, may epileptic teens may be on anticonvulsants or other medications that interfere with the effectiveness of hormonal methods. Sterilization must be approved by the courts and is difficult to obtain if a young woman demonstrates enough comprehension and competence to one day marry and have a family.
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PMID:Physically, mentally disabled teens require special contraceptive care. 1226 27


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