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Hormonal Methods Appropriate for Women with Depression
Considering depressive disorders for the first time, the October 2003 MEC meeting concluded that there is no need for restriction on use of hormonal contraceptives for women with depression (see Table 4). A variety of studies have found no increase in symptoms among depressed women using combined or progestin-only oral contraceptives (5, 6, 10, 17), DMPA injectable (5, 8, 48), or Norplant® implants (5, 48). A single study reported that taking fluoxetine (Prozac®) for depression did not reduce the effectiveness of combined or progestin-only oral contraceptives (17). Conclusions cannot be reached concerning postpartum depression or bipolar disorder because current evidence is inadequate (33).
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Table 4. Other New or Redefined Conditions Considered
by the 2003 WHO Expert Working Group |
| Condition |
Method |
COC/
Patch/
Ring |
CIC |
POP |
DMPA
NET-EN
Injectables |
LNG/ETG Implants |
Cu-IUD |
LNG-IUD |
| Initiation |
Continuation |
Initiation |
Continuation |
| Depressive disorders |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
| Known thrombogenic mutations |
4 a |
4 a |
2 a |
2 a |
2 a |
1 a |
1 a |
2 a |
1 a |
| |
| Drug Interactions |
| Antiretroviral therapy |
2 b |
2 b |
2 b |
2 b |
2 b |
2/3 c |
2 c |
2/3 c |
2 c |
| Drugs that affect liver enzymes |
a) Rifampicin* |
3 |
3 --> 2 |
3 |
2 |
3 |
1 |
1 |
1 |
1 |
|
b) Certain an-ticonvulsants** |
3 |
3 --> 2 |
3 |
2 |
3 |
1 |
1 |
1 |
1 |
| Antibiotics (excluding rifampicin) |
|
Griseofulvin |
3 --> 2 |
3 --> 1 |
3 --> 2 |
2 --> 1 |
3 --> 2 |
1 |
1 |
1 |
1 |
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Source: World Health Orbanization, 2003 (55)
Refer to Table 1 for category definitions.
*Formerly, “Certain antibiotics (rifampicin and griseofulvin)” (51)
**“(phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine)” (55). (Italicized anticonvulsants
were added October 2003.)
Clarifications:
aRoutine screening is not appropriate because of the rarity of the condition and the high cost of screening" (54). As for all the MEC, the classifications refer to known conditions and do not necessarily imply that screening is necessary or advisable.
b“Limited data...suggest drug interactions between many antiretrovirals (ARVs) and hormonal contraceptives, but there are currently no clinical outcome studies. Current concerns relate to efficacy and toxicity for both the hormonal contraceptive and the ARVs” (55).
cThere is no known drug interaction between ARV therapy and IUD use. However, AIDS as a condition is classified as category 3 for insertion and category 2 for continuation unless the woman is clinically well on ARV therapy, in which case both insertion and continuation are classified as category 2."
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