PCOS and Depression: Things to Know

Most of us feel sad, down, or miserable from time to time, and it may not necessarily indicate depression. Similarly, not everyone experiencing PCOS will have depression. However, women with PCOS are about three times more likely to experience depression than those without PCOS. Therefore, your PCOS problem might be affecting your mental health, but it often goes unnoticed. Because early diagnosis and treatment are crucial, you need to routinely screen for signs of depression.

What is PCOS?

Polycystic ovary syndrome (PCOS) is an endocrinal disorder that arises from the imbalance of reproductive hormones. As a result, your ovaries do not regularly release eggs (ovulation), leading to polycystic ovaries. Women with polycystic ovaries have enlarged ovaries with fluid-filled sacs (follicles). In PCOS, these underdeveloped sacs or follicles often fail to release an egg, which means ovulation does not occur. Another feature of PCOS is the presence of high levels of male hormones or androgens in your body. It is responsible for physical signs of PCOS, such as excess facial or body hair. 

PCOS and Depression: The Connection

Women experience unique hormonal and psychosocial factors during PCOS. As a result, it often impacts their emotions and mood. Before adolescence, people of all gender experience depression at about the same frequency. However, the biological and hormonal changes that occur during and after adolescence sharply increase the depression rate among women. 

A study shows that acne formed during PCOS was associated with depressive thoughts in women. In addition, PCOS-induced infertility was associated with an increased likelihood of depression among married females. 

The results also claim that the prevalence of depressive disorders was 25.7% among PCOS people. In addition, the psychological morbidity due to PCOS impacts social factors (e.g., relationships with others), psychological factors (e.g., motivation and feelings of worthlessness), and physical factors (e.g., eating and sleeping patterns).

Warning Signs and Symptoms of Depression

PCOS shows multiple symptoms. These symptoms increase the risk for emotional and psychological disturbances, triggering depressive thoughts. The warning signs of depression vary from person to person. Its intensity also differs depending on the severity of PCOS. 

A PCOS woman who experiences at least five of the listed symptoms for two consecutive weeks is diagnosed with depression.

• Difficulty thinking, concentrating or making decisions.
• Inappropriate guilt
• Anxious feeling
• Restlessness or irritability
• Loss of energy or increased fatigue
• Changes in sleeping patterns
• Appetite changes that result in weight losses or gains 
• Lack of interest or pleasure in activities most of the day
• Depressed mood nearly every day
• Thoughts of death or attempts at suicide

Why Does PCOS Cause Depression?

PCOS-related depression is often a by-product of impaired metabolic and reproductive features. For instance, a study shows that obesity is another major factor causing depression among adolescents with PCOS. It also claims that extreme depression is due to the appearance of embarrassing symptoms such as acne, weight gain, and hirsutism during PCOS. 

You might feel anxious and frustrated about how PCOS affects your weight, fertility, and physical appearance. And it is perfectly natural to feel so. But when you feel like you have lost control over your health and body, things can get distressing. 

The following are some of the common causes of depression in PCOS. 

Insulin Resistance

Insulin helps in absorbing blood glucose by the cells. However, in insulin resistance, the cells fail to respond to insulin, resulting in abnormal glucose in the blood. Insulin resistance is associated with PCOS, and about 70% of women with PCOS have it. Multiple clinical trials explain a bidirectional correlation between insulin resistance and depression. For example, according to a study, depression scores were significantly higher among PCOS women with insulin resistance. It is due to elevated cortisol that occurs during insulin resistance. The excess cortisol hormones change behavioural patterns, leading to the onset of depressive episodes. 

Stress

Stress is a common symptom of PCOS that induces the exaggerated synthesis of cortisol. Cortisol is known to release in constant stress situations. The excess cortisol suppresses the synthesis of serotonin, resulting in depression. Neurotransmitters like serotonin are associated with positive feelings. When stress lowers your serotonin, you feel sadder and more lonely. As a result, your body starts to report more symptoms of depression and anxiety.  

Inflammation

PCOS shows a link with inflammation, and persistent inflammation is due to high cortisol levels. As mentioned earlier, abnormal cortisol levels do more harm than good to your mental health. 

Obesity

Obesity and weight gain are common symptoms of PCOS. Due to the hormonal and immunological imbalances, obesity is likely related to depression. In addition, women get disturbed and underconfident due to their abnormal weight, which affects their mental health. Moreover, obesity interferes with your routine activities. As a result, you tend to face uneasiness in enjoying life and other pleasurable activities. 

Hormonal Imbalances

Researchers find that low secretion of oestrogen and progesterone in PCOS increases the risk for anxiety and depression. Abnormal changes in hormonal levels can cause symptoms like excess facial and body hair, which reduce self-confidence and create depressive symptoms. In addition, hormonal imbalances lead to anxiety directly, and depression occurs as a secondary reflection of these changes. 

The elevated levels of androgens or male hormones in the blood of PCOS women can cause embarrassment, social withdrawal, and self-consciousness. In addition, it results in a negative self-image, which plays a role in the possible mechanism of depression in PCOS women. 

Infertility

Infertility is a contributory factor causing depression in women with PCOS. However, depression in PCOS is not solely due to infertility. Around 75% of PCOS women might be at risk of infertility or ovulatory dysfunction. And the prevalence of depression in infertile PCOS women ranges between 7% and 26%. Moreover, trying to get pregnant can cause extra pressure and mental stress. As a result, depression might arise as a common side effect of infertility. 

Other Complications of PCOS Induced Depression

PCOS can trigger a cycle of depressive symptoms. A study shows that depression in PCOS pairs with obsessive-compulsive disorder, bipolar disorder, anxiety, and sometimes, suicidal thoughts.

Obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder (OCD) refers to unnecessary thoughts and fears or obsessions. It causes repetitive behaviours that drive you to do something repetitively, such as repeated cleaning, constantly seeking approval or reassurance, arranging things in a particular way, and excessively checking locks, switches, or appliances. As a result, these obsessions and compulsions disrupt your routine activities resulting in overall distress.

Bipolar Disorder

A bipolar disorder is associated with a series of frequent mood changes. It spans from depressive moods to violent maniac behaviour. People with bipolar disorder experience both depression and hyperactivity. It includes extreme stages of excitement and enormous energy. However, the symptoms are uniquely personal. No two individuals show similar experiences. 

Suicide 

A study finds that people with depression are at a higher risk of suicide. It is one of the common disorders which induces suicidal tendencies and death. Unable to cope with PCOS symptoms causes isolation and depression, and negative thoughts, including suicide. Suicide rates are more common in women with PCOS.

Nonetheless, Polycystic Ovarian Disease is not life-threatening. And some timely medical interventions can prevent further complications. A proper dietary approach and regular workouts may help you reverse most of the symptoms. With treatment, most women with PCOS can free themselves from such thoughts. 

What Treatments Are Available?

There are some treatment options and preventative measures that can help with PCOS related depression and anxiety. Treatment for depression is a combination therapy. It includes psychological counselling, medication and diet. Moreover, it is a long term therapy. Ideally, it helps relieve depression and prepares the patient to maintain a positive approach to PCOS treatment. You can talk to your doctor about the suitable treatment options that meet your needs and conditions. 

Some of the standard treatment approaches are:

Cognitive Behavioural Therapy

It is the most common type of therapy. It identifies and eliminates the negative thoughts that cloud you. Moreover, it assists you with coping strategies.

Interpersonal Therapy

It emphasises improving and regulating your behaviour in your personal life. Interpersonal therapy helps you prevent and resolve issues that surface due to depression, anxiety and stress.

Psychodynamic Therapy 

Psychodynamic therapy recognises the negative thoughts that influence your behaviour from past experiences. It prepares you to resolve and happily live in the present without slipping into the past. Additionally, it also moulds you to live without the depressive baggage of the past. 

Medications

Antidepressants are the drug of choice in treating depression. However, a specific category of antidepressants impacts blood glucose and may cause weight gain. Therefore, you must start them under medical supervision. Most antidepressants work to raise the serotonin level to regulate mood swings. 

Diet

Medical treatment and counselling help relieve the symptoms of depression. However, lifestyle modification boosts your overall well being. It includes a well-balanced diet and well-planned workout or exercise. Moreover, relaxation techniques also help to destress and overcome depression.

There is no particular diet to cure depression. Nonetheless, eating a balanced diet with specific nutrients helps. In addition, a study finds that people could help manage or improve their symptoms of depression by modifying their diet.

The PCOS diet emphasises fresh fruits, vegetables, whole grains, and healthy fats. As a result, it improves your well-being and reduces the symptoms of PCOS. It also restricts junk and processed refined foods and artificial sweets. 

Some depression-fighting dietary components are:

Antioxidants

Fresh fruits and vegetables are dense in antioxidants. They are compounds that suppress oxidative stress in cells. Oxidative stress induces radical cell injury resulting in depression. A study finds that antioxidants combat the symptoms and help prevent anxiety and depression. Berries, such as blackberries, citrus fruits, and green leafy vegetables, are good sources of antioxidants.

Omega-3 fatty acids

Studies find that omega-3 fatty acids are effective in reducing depressive disorders. It enhances brain function by improving the synthesis of serotonin. It is a hormone associated with relaxation, sleep and regulation of mood swings. Better serotonin levels reduce the risk of unhappy and depressive feelings. Sources of omega-three fatty acids include

• Seafood like sardines, tuna, and mackerel
• flaxseed chia seeds
• Nuts 

Selenium

Selenium is present in whole grains, brazil nuts, seafood and eggs. It helps regulate your mood swings and reduce anxiety, controlling the symptoms of depression.

Conclusion

PCOS or Polycystic Ovarian Syndrome is a complex condition that impacts many health aspects, including mental health. Depression is one of the reported side effects; some call it an unwanted companion of PCOS. The reasons are still unclear, but depression could be due to hormonal differences and symptoms associated with PCOS or a combination of factors that are still unknown. Nonetheless, therapy, medications and lifestyle modifications can help. Leading an active lifestyle can improve mental health. With proper medical help, you can see a difference in the symptoms of anxiety and depression in PCOS. 

Frequently Asked Questions (FAQs)

Q. Are people with PCOS prone to depression?

A. Yes, women with polycystic ovary syndrome (PCOS) are prone to anxiety and depression. The symptoms of PCOS are the primary reasons resulting in mental health issues. In addition, the hormonal imbalances in PCOS impact the emotional well-being of people, triggering depression.

Q. How can PCOS affect your mental health?

A. PCOS results in psychological and emotional disturbances causing depression and anxiety. In extreme cases, it may escalate to bipolar disorders and obsessive-compulsive disorder. In addition, the presence of facial or body hair, weight gain, hair loss, and acne tend to affect women’s mental well-being and confidence. 

Q. Can PCOS cause suicidal thoughts?

A. PCOS may cause suicidal thoughts because it happens due to the high release of cortisol hormone suppressing the release of serotonin that is happy hormone. As a result, PCOS induced depression, anxiety and negative thoughts. Further, the suicidal tendency in women with PCOS is comparatively higher than in non-PCOS individuals. In case of harmful or unpleasant thoughts, please reach out to friends and family for support. 

Q. Can PCOS cause bipolar disorder?

A. Yes, PCOS causes bipolar disorder. It is a risk factor for extreme stages of depression. People with bipolar disorder experience both depression and hyperactivity. It includes intense emotional outbursts.

Q. Can PCOS cause anger issues?

A. PCOS causes anger issues as you tend to get frustrated over the cycle of mood swings. The hormonal imbalances affect your psychological health in multiple ways. It makes you angry, depressed, irritated, and restless.

Q. Is there a link between PCOS and bipolar?

A. PCOS is associated with bipolar disorder. It results in a series of frequent mood swings. It triggers depressive moods to violent hyperactive behaviour, which is common in people with bipolar disorder.

Q. Can antidepressants worsen PCOS?

A. Some antidepressants may worsen PCOS symptoms, impacting blood glucose levels and weight gain. Moreover, too many antidepressants raise the serotonin level abnormally to regulate mood swings. However, excess serotonin further imbalances the hormones in PCOS. 

Q. Is Polycystic Ovary Syndrome life-threatening?

A. Polycystic Ovarian Syndrome is not life-threatening. However, PCOS combined with diabetes, cardiac diseases, and liver disorders may cause severe health complications. But having PCOS does not mean your lifespan gets reduced.  

Q. What helps with PCOS mood swings?

A. Psychological counseling, medications, and lifestyle modification help regulate mood swings. However, the psychological changes differ from person to person. Therefore the treatment plan is individualised.