PCOS and depression
PCOS (polycystic ovarian syndrome) is a big topic. On the one hand, cases often go unnoticed. And, in my experience, those who are diagnosed may not get the time and attention to address the complex factors that are at play.
Currently, PCOS is the most common endocrine disorder in reproductive aged women [1]
I want to briefly touch on the characteristics here, but mostly concentrate on the mental health implications.
What is PCOS?
PCOS was originally understood solely as a gynecological condition. However, we now know that it’s a complex hormonal and metabolic condition. Still, in 2021 the exact cause of PCOS is not quite understood. Yet, it manifests with an interplay of symptoms and can include some or all of the following:
Male pattern hair growth
Hair loss
Weight gain
Irregular periods
Acne
Infertility
PCOS can also increase risk for metabolic disease and pregnancy complications. It can, also, carry with it a huge burden on quality of life as well as our mood which is today’s topic.
PCOS and mental health
We know that women with PCOS carry a 3x greater risk of depression and likely even higher risk for anxiety [2]. It is now recommended to screen for anxiety and depression in all women with PCOS. But, what’s going on?
Unfortunately, it’s not quite clear. Originally, researchers were trying to see if increased insulin resistance, testosterone, weight or excess hair growth were correlated. They found that the risk of depression and anxiety was independent of obesity and only slightly correlated with higher insulin resistance, testosterone, hair growth and age [3] and did not find causality.
More recently, a study proposed that it was perhaps the effect on body image that was leading to poor self esteem and a driver of mood concerns. It’s clear that acne, weight gain and hair in unwanted places can all have deep effects on our sense of self confidence. I know for my patients hair growth in areas like the chin, abdomen or breasts, understandably, can be very anxiety provoking. A 2019 study found that women with PCOS had worse body image distress scores and that this mediated, sometimes in part, the effect on mood [4]. However, an earlier study did not find that weight, BMI or hair growth had an effect on depression or quality of life [5].
Ultimately, just as PCOS is complex, the reasons for its effect on mood are complex as well. In my opinion, we’re probably looking at a lot of confounding factors including inflammation, metabolic disturbances, the emotional toll of managing a difficult diagnosis and challenges to self esteem. All to say, that the effects on mood are real and need to be addressed side by side the physical components.
In the end, it’s about addressing mind and body. In that vein, these are the tools that show promise as part of a whole person approach:
Mindfulness Based Stress Reduction
This intervention is near and dear to my heart, in part, because it was part of my own healing back when I was in college and I have no doubt it set a trajectory that was life giving. In a small group of women, MBSR lowered reported feelings of stress and anxiety and also lowered salivary stress hormones. Meditation for the win! [6]
Fish oils (Omega-3s)
2 grams of fish oil daily for 12 weeks led to an improvement in depression and anxiety as well as insulin, testosterone, hair growth and highly sensitive-CRP [7]. Other studies have shown benefit in lowering inflammation which may point to the inflammatory piece at play.
Carnitine
Carnitine is a derivative of an amino acid that is super important in cellular energy. Imagine it as a little shuttle system. Carnitine brings fat into cells so that we can make energy and takes excess waste out to keep our cells from overflowing with trash. A small 60 person study found that supplementing with 250 mg of carnitine daily for 12 weeks led to improvement in depression and anxiety scores. [8]
Vitamin D + probiotic
A small study with 30 participants found that vitamin D together with a probiotic over 3 months improved mental health parameters. The probiotic that was used included these strains: Lactobacillus acidophilus, Bifidobacterium bifidum, Lactobacillus reuteri and Lactobacillus fermentum [9].
Finally, I’d be remiss not to mention the effects of nutrition, exercise and therapy [10]. A 2020 found that this 3 pronged lifestyle approach was beneficial for depression in women with PCOS.
The most important item in this discussion is that you know that there are options. This is a diagnosis that is best managed with support and using a root cause approach. If you’ve been feeling like your mood has taken a hit and and aren’t quite getting adequate answers or attention, I hope this article helps you see the multifaceted approach that can be beneficial.
References:
1. Cooney LG, Dokras A. Depression and Anxiety in Polycystic Ovary Syndrome: Etiology and Treatment. Curr Psychiat Rep. 2017;19:83.
2. The puzzle of polycystic ovary syndrome, depression, and anxiety - Fertility and Sterility [Internet]. n.d. [cited 2021 Oct 11]. Available from: https://www.fertstert.org/article/S0015-0282(19)30614-4/fulltext#relatedArticles
3. Cooney LG, Lee I, Sammel MD, Dokras A. High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2017;32:1075–91.
4. Body-image distress is increased in women with polycystic ovary syndrome and mediates depression and anxiety - Fertility and Sterility [Internet]. n.d. [cited 2021 Oct 11]. Available from: https://www.fertstert.org/article/S0015-0282(19)30551-5/fulltext
5. Greenwood EA, Pasch LA, Cedars MI, Legro RS, Huddleston HG, Network EKSNI of CH and HDRM. Association among depression, symptom experience, and quality of life in polycystic ovary syndrome. Am J Obstet Gynecol. 2018;219:279.e1-279.e7.
6. Stefanaki C, Bacopoulou F, Livadas S, Kandaraki A, Karachalios A, Chrousos GP, et al. Impact of a mindfulness stress management program on stress, anxiety, depression and quality of life in women with polycystic ovary syndrome: a randomized controlled trial. Ann Ny Acad Sci. 2014;18:57–66.
7. Amini M, Bahmani F, Foroozanfard F, Vahedpoor Z, Ghaderi A, Taghizadeh M, et al. The effects of fish oil omega-3 fatty acid supplementation on mental health parameters and metabolic status of patients with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial. J Psychosom Obst Gyn. 2018;1–9.
8. Jamilian H, Jamilian M, Samimi M, Ebrahimi FA, Rahimi M, Bahmani F, et al. Oral carnitine supplementation influences mental health parameters and biomarkers of oxidative stress in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial. Gynecol Endocrinol. 2017;33:1–6.
9. Ostadmohammadi V, Jamilian M, Bahmani F, Asemi Z. Vitamin D and probiotic co-supplementation affects mental health, hormonal, inflammatory and oxidative stress parameters in women with polycystic ovary syndrome. J Ovarian Res. 2019;12:5.
10. Jiskoot G, Loos AD de, Beerthuizen A, Timman R, Busschbach J, Laven J. Long-term effects of a three-component lifestyle intervention on emotional well-being in women with Polycystic Ovary Syndrome (PCOS): A secondary analysis of a randomized controlled trial. Plos One. 2020;15:e0233876.
