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347.445 617.353 m 401.712 617.353 l S BT /TT1 1 Tf 8.5649 0 0 8.5649 347.4447 618.5863 Tm (Endocrinology)Tj 0 0 0 rg ( )Tj ET 0.486 w 23.359 604.235 m 352.966 604.235 l S 0 0 0.4 rg BT /TT0 1 Tf 10.1221 0 0 10.1221 23.3588 605.6928 Tm (Ask the Experts about Gynecology and Reproductive Endocrinology)Tj 0 0 0 rg /TT1 1 Tf 0 -1.381 TD (from Medscape Ob/Gyn & Women's Health)Tj 0 -1.1 TD ( )Tj 0 0.024 0.4 rg /TT2 1 Tf 17.9084 0 0 17.9084 23.3588 558.7004 Tm (Oral Contraceptives and Depression)Tj 0 0 0.4 rg /TT0 1 Tf 10.9008 0 0 10.9008 23.3588 535.9055 Tm (Question)Tj 0 0 0 rg /TT1 1 Tf 10.1221 0 0 10.1221 70.6027 535.9055 Tm ( )Tj -4.667 -1.256 Td (What is the percentage of depression in women taking )Tj /TT3 1 Tf (Ortho Tri-Cyclen)Tj /TT1 1 Tf (, and of oral )Tj 0 -1.201 TD (contraceptives in general? )Tj 0 -1.1 TD ( )Tj ET q 74.7480927 0 0 85.6488495 25.6946564 396.2066803 cm /Im4 Do Q 0 0 0.4 rg BT /TT0 1 Tf 10.9008 0 0 10.9008 23.3588 387.173 Tm (Response from Andrew M. Kaunitz, MD )Tj 0 0 0 rg /TT1 1 Tf 10.1221 0 0 10.1221 229.2851 387.173 Tm ( )Tj -20.344 -1.256 Td (Professor and Assistant Chairman, University of Florida Health Science C\ enter, Department of )Tj 0 -1.2 TD (Obstetrics and Gynecology, Jacksonville, Florida )Tj 0 -1.1 TD ( )Tj 0 -1 TD ( )Tj 0 -2.946 TD (Mood disorders, including depression, are common in general, and particu\ larly among women. )Tj 0 -1.2 TD (Use of oral contraceptives \(OCs\) is also common among women. Although \ many trials of OC use )Tj T* (report on mood complaints/depression as adverse events, few trials of OC\ use have included )Tj T* (mood disorder/depression as a primary outcome, using a validated definit\ ion and assessing this )Tj T* (outcome at baseline and during OC use.)Tj 0 -2.662 TD (In most women, use of progestin, with or without estrogen, is not accomp\ anied by mood-related )Tj 0 -1.2 TD (complaints. However, in some women, particularly those with a history of\ depression, )Tj T* (premenstrual syndrome \(PMS\), or postpartum depression, use of progesti\ ns alone, or combined )Tj T* (with estrogen, results in dysphoria substantial enough to result in medi\ cation discontinuation.)Tj 0 -2.662 TD (In a small, placebo-controlled, double-blind clinical trial performed in\ Manila and Edinburgh )Tj 0 -1.2 TD (focusing on mood as a primary outcome, use of combined oral contraceptiv\ es was associated with )Tj 0 -1.359 TD ("modest" negative effects on mood.)Tj 8.6038 0 0 8.6038 182.4585 149.1862 Tm ([1])Tj 10.1221 0 0 10.1221 23.3588 119.4925 Tm (In a small, 6-cycle study of an OC containing 20 mcg estrogen and 100 mc\ g levonorgestrel )Tj T* (\()Tj /TT3 1 Tf (Alesse)Tj /TT1 1 Tf (, )Tj /TT3 1 Tf (Levlite)Tj /TT1 1 Tf (\), 1 of 32 women discontinued due to "intolerable mood changes.")Tj 8.6038 0 0 8.6038 386.6828 108.4935 Tm ([2])Tj 10.1221 0 0 10.1221 23.3588 78.7849 Tm (In a large \(N = 2894\), 13-cycle study, 0.5% of participants randomized\ to an OC containing 25 )Tj 0 -1.2 TD (mcg estrogen and triphasic norgestimate \()Tj /TT3 1 Tf (Ortho Tri-Cyclen Lo)Tj /TT1 1 Tf (\) discontinued OC use due to )Tj 0 -1.201 TD (emotional lability; the corresponding percentage with those randomized t\ o 20 mcg estrogen )Tj 0 -1.359 TD (combined with 1 mg norethindrone acetate \()Tj /TT3 1 Tf (Loestrin Fe 1/20)Tj /TT1 1 Tf (\) was 0.3%.)Tj 8.6038 0 0 8.6038 346.8522 43.4778 Tm ([3])Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.0076 0 0 7.0076 18 8.682 Tm (http://www.medscape.com/viewarticle/458927 \(1 of 2\)16.8.2006 20:07:50)Tj ET EMC endstream endobj 163 0 obj<>stream /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.0076 0 0 7.0076 18 781.682 Tm (Oral Contraceptives and Depression)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 612 756 re W* n /Artifact <>BDC Q /CS0 cs /P0 scn 7.786 302.224 15.573 465.547 re f EMC q 0 18 612 756 re W* n /Artifact <>BDC Q /P1 scn 487.42 302.224 116.794 465.547 re f EMC q 0 18 612 756 re W* n /Artifact <>BDC Q 0.933 0.933 0.933 rg 8.565 276.53 590.198 24.916 re f 0.702 0.702 0.702 rg 7.786 302.224 m 599.542 302.224 l 598.763 301.446 l 8.565 301.446 l h f 7.786 302.224 m 7.786 275.751 l 8.565 276.53 l 8.565 301.446 l h f 599.542 302.224 m 599.542 275.751 l 598.763 276.53 l 598.763 301.446 l h f 7.786 275.751 m 599.542 275.751 l 598.763 276.53 l 8.565 276.53 l h f EMC q 0 18 612 756 re W* n /Artifact <>BDC Q 1 1 0.965 rg 8.565 267.965 590.198 7.786 re f 0.702 0.702 0.702 rg 7.786 275.751 m 7.786 267.186 l 8.565 267.965 l 8.565 275.751 l h f 599.542 275.751 m 599.542 267.186 l 598.763 267.965 l 598.763 275.751 l h f 7.786 267.186 m 599.542 267.186 l 598.763 267.965 l 8.565 267.965 l h f EMC q 0 18 612 756 re W* n /Artifact <>BDC Q 0 0 0.2 rg 7.786 249.901 591.756 17.285 re f EMC EMC EMC /Article <>BDC q 0 18 612 756 re W* n 0 0 0 rg BT /TT0 1 Tf 10.1221 0 0 10.1221 23.3588 749.7993 Tm (Clinical Recommendations)Tj /TT1 1 Tf 0 -2.689 TD (Few women using OCs report depression or other negative mood symptoms. A\ history of )Tj 0 -1.2 TD (depression, PMS, or postpartum depression does not represent a contraind\ ication to use of OCs. )Tj T* (Nonetheless, clinicians should be aware that in some women \(many of who\ m have the high-risk )Tj T* (history mentioned above\) use of any progestin-based medication \(includ\ ing OCs\) may cause )Tj T* (unpleasant or even intolerable dysphoria. In this latter circumstance, i\ t may be appropriate to )Tj T* (discontinue or avoid OC use.)Tj /TT0 1 Tf 0 -2.634 TD (Posted 08/07/2003)Tj ET 0.5 0.5 0.5 rg 78.836 609.626 m 78.836 611.183 l 411.698 611.183 l 410.92 610.404 l 79.615 610.404 l 79.615 610.404 l h f 0.875 0.875 0.875 rg 411.698 611.183 m 411.698 609.626 l 78.836 609.626 l 79.615 610.404 l 410.92 610.404 l 410.92 610.404 l h f 0 0 0 rg BT /TT0 1 Tf 11.6794 0 0 11.6794 23.3588 579.7027 Tm (References)Tj /TT1 1 Tf 10.1221 0 0 10.1221 40.4341 551.9097 Tm (1. )Tj (Graham CA, Ramos R, Bancroft J, Maglaya C, Farley TMM. The effects of st\ eroidal )Tj 1.39 -1.2 Td (contraceptives on the well-being and sexuality of women: a double-blind,\ placebo-)Tj 0 -1.2 TD (controlled, two- center study of combined and progestogen-only methods. \ Contraception. )Tj T* (1995;52:363-369. )Tj ET 0 0 0.4 RG 0.486 w 10 M 0 j 0 J []0 d 136.665 514.012 m 173.793 514.012 l S 0 0 0.4 rg BT /TT1 1 Tf 10.1221 0 0 10.1221 136.6652 515.47 Tm (Abstract)Tj 0 0 0 rg ( )Tj -9.507 -1.354 Td (2. )Tj (Kwiecien M, Edelman A, Nichols MD, Jensen J. Bleeding patterns and patie\ nt acceptability )Tj 1.39 -1.2 Td (of standard or continuous dosing regimens of a low-dose oral contracepti\ ve: a randomized )Tj T* (clinical trial. Contraception. 2003;67:9-13. )Tj ET 243.535 476.015 m 280.663 476.015 l S 0 0 0.4 rg BT /TT1 1 Tf 10.1221 0 0 10.1221 243.5347 477.473 Tm (Abstract)Tj 0 0 0 rg ( )Tj -20.065 -1.354 Td (3. )Tj (Hampton RM, Short M, Bieber E, et al. 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