Depression, anxiety, and PCOS
Top things to know:
People with PCOS are about 3 times more likely to experience depression and anxiety than people without PCOS; the reasons for this are still unclear
Medications and other therapies may be helpful for improving symptoms of depression and anxiety
How is PCOS related to mental health?
Polycystic ovary syndrome (PCOS) is a complex condition which impacts many aspects of a person’s health, including mental health. People who have been diagnosed with PCOS are about 3 times more likely to be diagnosed with anxiety and depression than people without PCOS (1-3). People with PCOS are also much more likely to report symptoms of anxiety and depression and those symptoms are more likely to be severe (3-5).
Most of the research on PCOS and mental health has focused on depression and anxiety, but it may also be associated with an increased risk of obsessive compulsive disorder (OCD), bipolar disorder, and eating disorders (3,6).
Why is there a link between PCOS and mental health?
It’s unclear what causes the increased risk for anxiety and depression among people with PCOS. It could be due to PCOS symptoms or hormonal differences associated with the disorder, or to a combination of factors that is still unknown.
PCOS can cause symptoms like infertility and hirsutism (excess facial and body hair). Some people with PCOS report feeling frustrated and anxious about their ability to become pregnant, their weight, excess body and facial hair, or lack of control over their health and bodies (7,8).
A person’s values and the culture they live in will impact which characteristics they may find distressing. These same characteristics can also impact the emotional well-being of people without PCOS. People with PCOS still have an increased risk for depression and anxiety regardless of their weight, age, socioeconomic factors, facial and body hair, and fertility (4,5,9,10).
Researchers have looked into whether differences in hormone levels in PCOS explain the increased risk for anxiety and depression. Some people with PCOS have insulin resistance, resulting in higher levels of insulin in the bloodstream. One study found that greater insulin resistance increased the risk for depression (11), but other studies found no difference (12,13). One study showed that people with greater insulin resistance reported more anxiety symptoms, but more research is needed (12).
Androgens (a group of hormones including testosterone) are elevated in many people with PCOS. Only one study has looked at levels of testosterone and found no effect on depression and anxiety symptoms (10). Higher levels of DHEAS (a type of androgen hormone) may be associated with increased risk for depression and anxiety in people with PCOS, but this was only found in one study and more research is needed (14).
Chemicals in the brain
People with PCOS who have anxiety or depression may have lower levels of certain neurotransmitters (chemicals that send signals throughout the brain and nervous system). Neurotransmitters like serotonin (a chemical messenger within the nervous system that is associated with positive feelings) play an important role in depression and anxiety. One study showed that people with PCOS who have low levels of serotonin and other neurotransmitters report more symptoms of depression and anxiety (15).
What treatments are available?
People who have PCOS and feel depressed or anxious, or notice changes in their mood, can talk to their healthcare provider about possible treatment options. There are many treatments that may help with depression and anxiety.
The effect of diet and exercise on symptoms of depression and anxiety in people with PCOS has been researched. Low-calorie diets in combination with exercise do not appear to improve symptoms of anxiety, and may only improve depression short-term (16,17).
Leading an active lifestyle in general may help improve mental health. People with PCOS who reported exercising regularly had fewer symptoms of anxiety and depression (18), and those who said they did at least 150 minutes of moderate exercise each week were less likely to be depressed (19).
Medications and supplements
No studies have been done on anti-depressants or anti-anxiety medication for treating people with PCOS specifically, but they may be prescribed in the same way they would be to people without PCOS. Medications that help the body use insulin such as metformin may improve symptoms of depression in people with PCOS (13,20). Metformin may also help with anxiety symptoms (20).
Taking omega-3 fatty acid from fish oil alone, or in combination with Vitamin D, may decrease symptoms of depression and anxiety in people with PCOS (21,22).
Complementary and alternative therapies
There may be improvement in depression and anxiety among people with PCOS who receive acupuncture (23) and in people who practice mindfulness 30 minutes a day (24). Yoga practice that includes poses, guided relaxation, breathing exercises, and meditation may also improve symptoms of anxiety in people with PCOS (25).
Some people with PCOS may experience an increase in facial hair. Depending on the culture they live in, they may feel self-conscious about it. For people with PCOS who feel distressed about facial hair, receiving laser hair removal may improve symptoms of depression and anxiety (26).
More research is needed find the best treatments for depression and anxiety in people with PCOS.