Depression and Anxiety in Polycystic Ovary Syndrome: Etiology and Treatment
- 813 Downloads
Purpose of Review
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive age women and is associated with an increased prevalence of depression and anxiety symptoms. This review presents potential mechanisms for this increased risk and outlines treatment options.
Women with PCOS have increased odds of depressive symptoms (OR 3.78; 95% CI 3.03–4.72) and anxiety symptoms (OR 5.62; 95% CI 3.22–9.80). Obesity, insulin resistance, and elevated androgens may partly contribute to this association. Therefore, in addition to established treatment options, treatment of PCOS-related symptoms with lifestyle modification and/or oral contraceptive pills may be of benefit.
Screening for anxiety and depression is recommended in women with PCOS at the time of diagnosis. The exact etiology for the increased risk in PCOS is still unclear. Moreover, there is a paucity of published data on the most effective behavioral, pharmacological, or physiological treatment options specifically in women with PCOS.
KeywordsPCOS Depression Anxiety Treatment
Compliance with Ethical Standards
Conflict of Interest
Laura G. Cooney and Anuja Dokras declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.•• Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2016;31:2841–55. This meta-analysis evaluated the prevalence of PCOS according to the NIH, Rotterdam, and Androgen Excess & PCOS Society (AE& PCOS) criteria. They also compared the prevalence of PCOS by continent. CrossRefPubMedGoogle Scholar
- 4.American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 108: Polycystic ovary syndrome. Obstet Gynecol. 2009;114:936–49.Google Scholar
- 5.•• 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. 2017a;32:1075–91. This is the largest meta-analysis demonstrating an increased odds of depressive and anxiety symptoms in women with PCOS and the only meta-analysis to evaluate moderate and severe symptoms. They also performed extensive sensitivity analyses and a meta-regression to assess potential etiologies for this association. CrossRefPubMedGoogle Scholar
- 9.• Hart R, Doherty DA. The potential implications of a PCOS diagnosis on a woman’s long-term health using data linkage. J Clin Endocrinol Metab. 2015;100:911–9. This large population based retrospective cohort study showed an increased prevalence of depression and anxiety in hospitalized Australian women with PCOS compared to controls. CrossRefPubMedGoogle Scholar
- 12.•• Cesta CE, Mansson M, Palm C, Lichtenstein P, Iliadou AN, Landen M. Polycystic ovary syndrome and psychiatric disorders: co-morbidity and heritability in a nationwide Swedish cohort. Psychoneuroendocrinology. 2016;73:196–203. This is the largest registry study (over 24,000 women with PCOS included) demonstrating an increased odds of psychiatric disorders in women with PCOS compared to controls. CrossRefPubMedGoogle Scholar
- 18.•• Behboudi-Gandevani S, Ramezani Tehrani F, Rostami Dovom M, et al. Insulin resistance in obesity and polycystic ovary syndrome: systematic review and meta-analysis of observational studies. Gynecol Endocrinol. 2016;32:343–53. Insulin resistance is common in both obese and lean women with PCOS. CrossRefPubMedGoogle Scholar
- 28.Biringer E, Howard LM, Kessler U, Stewart R, Mykletun A. Is infertility really associated with higher levels of mental distress in the female population? Results from the North-Trøndelag Health Study and the Medical Birth Registry of Norway. J Psychosom Obstet Gynaecol. 2015;36:38–45.CrossRefPubMedGoogle Scholar
- 35.Ozenli Y, Haydardedeoglu B, Micozkadioglu I, Simsek E, Bulgan Kilicdag E, Bagis T. Anxiety, depression and ways of coping skills by women with polycystic ovary syndrome: a controlled study. J Turkish-German Gynecol Assoc. 2008;9:190–4.Google Scholar
- 46.•• Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E. American association of clinical endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society disease State clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome—part 2. Endocr Pract. 2015a;21:1415–26. This extensive and up-to-date review provides evidenced-based guidelines on PCOS evaluation and treatment. CrossRefPubMedGoogle Scholar
- 47.Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E. American association of clinical endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society disease State clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome—part 1. Endocrine Pract. 2015b;21:1291–300.CrossRefGoogle Scholar
- 48.Galletly C, Moran L, Noakes M, Clifton P, Tomlinson L, Norman R. Psychological benefits of a high-protein, low-carbohydrate diet in obese women with polycystic ovary syndrome--a pilot study. Appetite. 2007;49:590–3.Google Scholar
- 51.Stener-Victorin E, Holm G, Janson PO, Gustafson D, Waern M. Acupuncture and physical exercise for affective symptoms and health-related quality of life in polycystic ovary syndrome: secondary analysis from a randomized controlled trial. BMC Complement Altern Med. 2013;13:131.Google Scholar
- 52.•• Dokras A, Sarwer DB, Allison KC, et al. Weight loss and lowering androgens predict improvements in health-related quality of life in women with PCOS. J Clin Endocrinol Metab. 2016;101:2966–74. This is a secondary analysis of a three-arm randomized controlled trial comparing changes in quality of life and the prevalence of depressive and anxiety symptoms after women with PCOS received one of three interventions: oral contraceptive pills (OCPs), a lifestyle (LS) modification program, or a combined OCP and LS. CrossRefPubMedPubMedCentralGoogle Scholar
- 54.Kashani L, Omidvar T, Farazmand B, et al. Does pioglitazone improve depression through insulin-sensitization? Results of a randomized double-blind metformin-controlled trial in patients with polycystic ovarian syndrome and comorbid depression. Psychoneuroendocrinology. 2013;38:767–76.CrossRefPubMedGoogle Scholar
- 55.•• Cooney LG, Milman LW, Hantsoo L, et al. Cognitive behavioral therapy improves weight loss and quality of life in women with polycystic ovary syndrome: a randomized clinical trial. 2017b. Unpublished data. This unpublished study is the first RCT to demonstrate significant weight loss in women with PCOS, depression and overweight/obesity who receive cognitive behavioral therapy (CBT). Google Scholar
- 58.• Haqq L, McFarlane J, Dieberg G, Smart N. Effect of lifestyle intervention on the reproductive endocrine profile in women with polycystic ovarian syndrome: a systematic review and meta-analysis. Endocr Connect. 2014;3:36–46. This meta-analysis of seven studies demonstrates significant improvements in the laboratory profile of women with PCOS who received lifestyle interventions. CrossRefPubMedPubMedCentralGoogle Scholar
- 59.Moran LJ, Hutchison SK, Norman RJ, Teede HJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2011(1):1-63. https://doi.org/10.1002/14651858.CD007506.pub3.
- 63.Harris-Glocker M, Davidson K, Kochman L, Guzick D, Hoeger K. Improvement in quality-of-life questionnaire measures in obese adolescent females with polycystic ovary syndrome treated with lifestyle changes and oral contraceptives, with or without metformin. Fertil Steril. 2010;93:1016–9.CrossRefPubMedGoogle Scholar
- 69.Qaseem A, Barry MJ, Kansagara D, Clinical Guidelines Committee of the American College of P. Nonpharmacologic versus pharmacologic treatment of adult patients with major depressive disorder: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;164:350–9.CrossRefPubMedGoogle Scholar
- 70.Work Group on Major Depressive Disorder. Practice guideline for the treatment of patients with major depressive disorder. 2010. http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf.
- 73.Teede HJ, Misso ML, Deeks AA, Moran LJ, Stuckey BG, Wong JL, et al. Guideline Development G: Assessment and management of polycystic ovary syndrome: summary of an evidence-based guideline. Med J Aust. 2011;195:S65-112.Google Scholar