Polycystic ovarian syndrome includes a group of symptoms that may impact the female during the reproductive period of her life. Around 6-12 % of females in the United States are known to have PCOS in their reproductive life.(1)
Depression is a mental disorder that is characterized by a persistent feeling of sadness, hopelessness, and loss of interest in activities that a person once enjoyed.
There is a link between these conditions. 27-49% of females with PCOS experience depressive symptoms. In a study, it was observed that suicidal rates were 7 times higher in females with PCOS than those without the syndrome.(2, 3)
Around 50% of people with PCOS experience anxiety than those who do not have PCOS.
What is PCOS?
PCOS or polycystic ovarian syndrome is a hormonal disorder that shows up symptoms around puberty. The symptoms of PCOS include:
- Irregular periods
- Collection of fluid called follicular cysts on the ovaries
- Secretion of excess androgen, a male sex hormone, which can cause an increase in body and facial hair, severe acne, and male pattern baldness
PCOS may be caused due to excess insulin, low-grade inflammation, genetics, and the production of high levels of androgen from the ovaries.
PCOS can be diagnosed with a complete medical history, physical examination, and laboratory tests. Along with these a doctor may also take into account other factors including obesity, insulin resistance, and a family history of PCOS.
What is Depression
Depression is a mood disorder that is characterized by sadness and loss of interest, interfering with everyday activities.
There are several causes of depression which include hormone imbalance, family history, childhood history of trauma, brain structure, and brain chemistry. Certain medical conditions including insomnia, chronic pain, stroke and heart attack can also put a person at a high risk of depression.(4)
The symptoms of depression may vary in people. A few of the symptoms include:
- Feeling of sadness
- Decreased energy and fatigue
- Moving and talking slowly
- Changes in appetite and weight
- Difficulty in having proper concentration or making a decision
- Thoughts of death, suicide, or self-harm
- Decrease in sexual desire
- Insomnia, restless sleep, and excessive sleepiness
A mental health professional can help diagnose depression. He takes the medical history and examines the mental status of the person. Questionnaires and standardized rating scales are used to assess the severity of depression. Laboratory tests are also performed to rule out any medical condition that may be causing it.
The Connection Between PCOS and Depression
The link between PCOS and depression is quite unclear. There are theories explaining how PCOS can increase the risk of experiencing depression and vice versa.
Many people with PCOS are insulin resistant, which means their bodies continue to make insulin but cannot use it properly.(1)
Insulin is a hormone that regulates blood sugar or glucose levels. Being insulin resistant increases the risk of type 2 diabetes.
44-70% of people with PCOS are insulin resistant.(5)
Insulin resistance and type 2 diabetes can increase the risk of developing depression. Research shows that insulin resistance impairs physiological mechanisms that have an association with learning and reward. This may contribute to depressive symptoms.(6)
Research shows that depression may increase inflammation in the body.(7) PCOS is an inflammatory condition.
Inflammation is also associated with other conditions in the body such as stress and obesity.
It is commonly observed that people with PCOS experience stress and stress is known to be a major risk factor for depression.(8, 9)
Increased stress levels may increase the risk of PCOS, anxiety, and depression. Stress increases the level of the hormone cortisol which has a positive association with depressive disorder.
People with PCOS have a higher risk of obesity and people with obesity have a 55% risk of experiencing depression.(10)
Other factors that are linked to obesity in PCOS are the overproduction of cortisol.
Another factor is the stigma around obesity which leads to social isolation and may trigger depression.
Infertility also triggers depression and anxiety.(11) It can lead to the atypical secretion of hormones that may contribute to depression in PCOS.
Changes in Physical Appearance
Physical symptoms that may be associated with depression in those with PCOS include:(12)
- Excessive body hair
- Dark skin patches
Treatment of Depression In PCOS
The treatment for people with PCOS and depression depends on the underlying cause.
If depression is related to insulin resistance, obesity, or type 2 diabetes, management of these conditions may help in controlling depression. The measures include:
- Eating a low-carb diet
- Maintaining a healthy weight
- Taking medication to improve insulin resistance
If hormonal imbalance is causing depression, taking birth control pills may be helpful. These may reduce the symptoms of PCOS and regulate the hormones.
Stress in people with PCOS can be managed by relaxation techniques and yoga. This may help with depressive symptoms as well.
Antidepressants may be prescribed by the doctor to help manage depression. However, taking them may increase the weight that might worsen PCOS.
PCOS and depression are linked conditions. Females with PCOS are at a higher risk of developing depression and those with depression have a higher risk of suffering from PCOS. Several factors including hormonal imbalance, insulin resistance, and physical and emotional symptoms are associated with PCOS. Females with PCOS often experience irregular periods, weight gain, infertility, hirsutism, feeling of insecurity, low self-esteem, and depression.
Depression on other hand can lead to changes in appetite, sleep patterns, and energy levels that may exacerbate the symptoms of PCOS.
It is therefore important to get treated for any of these at the earliest to stop one condition from making way for the other.
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