Is There A Link Between PCOS And Depression?

Polycystic ovary syndrome, popularly known as PCOS, affects your entire body. It is, therefore, not a surprise that it might affect your brain. Because of this, there may be links between PCOS and mental health conditions, including depression.

What is PCOS?

PCOS is an endocrine condition that causes elevated levels of androgens (male hormones), multiple cysts on the ovaries, and a highly elevated risk of metabolic syndrome and type 2 diabetes.

While the causes of PCOS are uncertain and the condition remains poorly understood, there are ways in which PCOS can be managed. Most women with PCOS can also successfully conceive and carry a child, although it does impact fertility.

Does PCOS cause depression?

There are two aspects of the link between PCOS and depression. The first is understanding whether the endocrine imbalance can affect the brain and cause clinical depression.

The second is whether the stigma associated with certain PCOS symptoms, such as acne and hirsutism, can affect somebody's mental health.

What is clear is that elevated levels of depression are seen in women with PCOS compared to the general population. There is also a strong link between depression and acne, likely due to reduced levels of self-esteem associated with appearance. However, a 2010 study did not show a strong link between acne in teenagers and depression. This is, however, a different population.¹ ²

Another study showed that "depression-like behavior" was common in Chinese women with PCOS. This study also linked depression to poor body image and connected it to acne, hirsutism, and issues relating to fertility. In other words, some symptoms of PCOS cause elevated stress and potential depression.³

Financial and social stressors may also impact things. One study showed that depression is more likely to occur in Black patients, likely because of additional social stress.⁴

However, it's also possible that PCOS could cause depression for clinical reasons. Many women with PCOS also have insulin resistance, which doubles the risk of major depressive disorder. It appears that the high triglyceride-HDL ratio is associated with depression, as is prediabetes. As PCOS causes insulin resistance, it thus indirectly increases the risk of depression.⁵

Other than that, the link is poorly understood, but it may be connected to inflammation and to hyperandrogenism itself. 

In PCOS, certain inhibitory neurotransmitters are decreased and stimulants are increased. This affects the LH and FSH ratio (causing problems with ovary function), but it also reduces serotonin levels and increases cortisol. Inflammation associated with PCOS increases cytokines, resulting in depression, which then causes more inflammation.

Depression in PCOS is thus often a vicious cycle where depression is both caused by and also causes a worsening of PCOS symptoms.

Signs and symptoms of depression

People with PCOS should monitor themselves for the signs and symptoms of depression. These include:

• Feeling persistently sad or "empty"

• Pessimism

• Hopelessness

• Irritability or restlessness

• Frustration

• Feeling guilty, worthless, or helpless

• Decreased energy and fatigue

• Difficulty with concentration, memory, and decision making

• Difficulty sleeping or sleeping too much

• Losing interest in enjoyable activities

• Weight gain or weight loss (weight gain is already common with PCOS)

• Suicidal thoughts

• Unexplained physical symptoms, particularly headaches or digestive problems

Not everyone experiences all of these symptoms, and some may overlap with other PCOS symptoms. However, if you have three or more of these symptoms, consider talking to your doctor about being assessed for depression.

Who is at increased risk of developing depression with PCOS?

You are at higher risk of developing depression if:

• You have acne

• You are overweight or obese

• You are of Black/African descent

• You have a poor body image

• You are trying and failing to get pregnant

Complications of depression and PCOS

PCOS can affect your overall quality of life, especially as there is no cure for PCOS; it can only be managed. It can result in low body image and self-esteem and can cause financial stressors (for example, acne may make it harder for you to find a job).

All of these things cause depression, which can then make your quality of life worse.

One complication that can happen is self-harm, such as cutting or binge behavior, which can cause significant physical damage. Depression can ultimately lead to suicidal ideation. A study identified a seven-fold increased risk of suicide attempts amongst women with PCOS compared to matched controls. Suicide is the ultimate complication of depression.⁶

Depression can also worsen PCOS symptoms or make you feel like it is not worth taking steps to manage your condition. 

A healthy diet, for example, is very important if you have PCOS. Depression can push you into "comfort eating," which often involves consuming high sugar, high salt, or otherwise unhealthy items in a desperate attempt to feel better. This aggravates PCOS and increases your weight. 

Consuming more sugar can also make metabolic syndrome and insulin resistance worse. Some people may also self-medicate with alcohol, which can cause further issues.

Symptoms of depression can also make it harder to find a job, further aggravating financial and relationship stressors. If you are trying to get pregnant, depression can reduce your interest in intercourse and make things even more challenging.

How is depression treated in women with PCOS?

First of all, people with PCOS should consider getting screened regularly for depression. As there are two possible causes — stigma and actual biological cause — both should be addressed.

Most women with PCOS should consider therapy. Psychotherapy can help you deal with the various symptoms of your disease and learn techniques to improve your self-esteem. If you are considering getting pregnant, a counselor can help you deal with the ups and downs of fertility treatment and the potential mood impact if treatment fails.

Managing the symptoms of your PCOS can also reduce depression. Getting proper treatment for acne and staying on your medication can help reduce depression by making the symptoms of PCOS less obvious to yourself and others. 

For some individuals with hirsutism, laser treatment to remove unwanted hair can be a semi-long-term way of dealing with that symptom. Others actually find that they are happier if they let the excess hair grow out. Consider talking to your therapist about handling excessive hair growth, as it is not the same for every person.

Other treatments for depression include the following:

Exercise

Regular exercise improves mood and reduces PCOS symptoms, making it a particularly strong intervention. It can be hard to exercise while depressed. Consider joining a class or getting an exercise buddy who will drag you out to do it. Some people find acquiring a dog who has to be walked a great motivator (but ensure you can properly care for the animal if you choose this route).

Antidepressant medication

For PCOS, a psychiatrist is more likely to recommend a selective serotonin reuptake inhibitor, which can also help with weight loss. Tricyclic and tetracyclic antidepressants, however, tend to cause weight gain and are best avoided if you have that symptom. 

Unfortunately, only one small study has really gone into the impact of antidepressants on people with PCOS. It did show a slight decrease in FSH from the antidepressants tested. 

Antidepressants may be used to improve mood while you get your PCOS symptoms under control. This is particularly the case if you are contemplating pregnancy, as antidepressants can increase the risk of stillbirth and miscarriage. However, if you are suicidal, antidepressants may be needed to help you get back on an even keel.⁷

Herbal medication

Studies have shown that a combination of herbs can reduce depression and stress and improve your chance of conception. The two tablets tested included a combination of Glycyrrhiza glabra, Paeonia lactiflora, Cinnamomum verum, Hypericum perforatum, and a herb called Tribulus terrestris. However, you should not take herbal extracts without consulting your doctor.⁸

Be aware that St. John's wort, a common natural treatment for depression, can interfere with the action of oral contraceptives.

For most people with PCOS, treating and managing its symptoms also reduces depression. Still, some people may need a little bit of extra help. The treatment for depression is otherwise not significantly different from that for people without PCOS. However, some treatments may be particularly recommended as they help all of your symptoms.

The lowdown

People with PCOS often experience depression. This may be directly caused by the hormonal imbalances that characterize the disease or indirectly by the symptoms and associated stigma.

If you have PCOS, consider getting screened for depression regularly and seeking psychotherapy to help you cope with your symptoms and control your mood. Some people with PCOS may need antidepressants or herbal supplements to help treat their depression. Still, the best way to treat it is to improve your PCOS management.