There are numerous reasons why women with PCOS are at a high risk of depression.
A related imbalance in sex hormones or insulin could be to blame. Being faced with more or worsening metabolic complications of PCOS such as pre-diabetes, type 2 diabetes, metabolic syndrome, and cardiovascular disease can be difficult to cope with. Higher levels of androgens (male hormones) may contribute to higher rates of mood disorders in women with PCOS.
Beyond the hormonal influences of PCOS that can contribute to depression, the difficulties and frustrations of managing the symptoms of PCOS can’t be overlooked. Struggles with infertility, weight gain, and dermatological symptoms (acne, hair loss, excess hair growth) can all take a significant toll on the emotional health of women with PCOS.
So many aspects of PCOS may seem out of control and can worsen over time, even with the best of efforts to live a healthy lifestyle.
Different Types of Depression
Depression is so much more than just being sad. The condition is often described as a feeling of being in a dark hole that you can’t get out of, even though you desperately want to. Depression is a serious mental health condition that requires treatment.
Depression in PCOS can appear in many forms. Here are some types of depression that can impact the emotional health of women with PCOS.
Major Depressive Disorder
Major depressive disorder (MDD) is a distinct psychological disorder that is different than the “blues” or feeling down or frustrated with having PCOS. MDD can last for weeks, or even months, and can affect your ability to function in daily activities.
MDD is diagnosed when an individual experiences one or more major depressive episodes without a history of manic, mixed, or hypomanic episodes. The individual must have experienced a significant change in functioning, where one of the major clinical manifestations is either depressed mood or loss of interest or pleasure.
The condition depletes energy and causes diminished interest in activities that once were pleasurable, and it can recur throughout an individual’s life. MDD can make it difficult to have the motivation to properly care for yourself.
Bipolar Depression
Women with PCOS have higher rates of bipolar depression.
Bipolar I disorder, once called manic depression, is diagnosed when someone has a history of both depressive and manic episodes.
A hallmark symptom of bipolar disorder is decreased need for sleep. A manic episode is an episode characterized by a period of abnormally and persistently elevated, expansive, or irritable mood and abnormally persistent increased goal-directed activity or energy lasting at least one week and present most of the day nearly every day. There are several conditions that must be met within these parameters to be considered bipolar disorder.
Bipolar II differs from bipolar I in that the person has a history of at least one hypomanic episode. The symptoms of hypomanic episodes are similar to those of mania—with differences in severity, degree of impairment, and duration. Hypomania symptoms last for at least four consecutive days. Irritability is more prevalent than elevated mood, and the disturbance is not severe enough to cause marked impairment.
Seasonal Affective Disorder
Seasonal affective disorder (SAD) can also affect women with PCOS. SAD is a seasonal form of depression that occurs during the same time frame each year. Most people experience SAD from the fall through the winter months, when days are shorter and darker. Typical symptoms of SAD are a lack of energy, moodiness, and fatigue. Symptoms of SAD improve during other months.
The Most Common Signs and Symptoms of Depression
Many people experience depression differently. Below is a list of some common symptoms of depression, but it does not include all possible symptoms.
FatigueSadnessLonelinessHelplessnessTearfulness Sleep disturbancesLack of motivationAppetite changesChanges in weight (this is also a sign of PCOS itself) Feelings of guiltDifficulty concentrating Loss of interest in sexLoss of interest in hobbies or activities previously enjoyedPoor decision-makingHeadachesPhysical pains such as neck or backacheDigestive issues
How Is Depression Treated?
Depression can be managed in many ways, ranging from therapy and medications to complementary and alternative medicine.
Individual Therapy
Finding someone to talk to can be helpful for dealing with difficult or painful feelings, including the day-to-day struggles with PCOS. It is also helpful for changing the negative thinking patterns that are common in depression.
While there are many types of talk therapy, both cognitive-behavioral treatment (CBT) and interpersonal psychotherapy have been found to be effective for treating depression.
Support Group
A support group may be helpful. Being surrounded by women who share similar struggles can be comforting and beneficial for you. If it’s led by a trained mental health professional, a support group may offer life-changing skills and strategies to cope with PCOS and depression.
Medication
Antidepressants are available to help treat depression. There are many types available. Discuss your options with your healthcare provider and therapist.
Also, to avoid harmful interactions, be sure to tell your healthcare provider about other medications or supplements that you are taking.
Alternative and Integrative medicine
Alternative and integrative medicine therapies are also available to treat depression. Mindfulness-based practices have been shown to be effective for reducing depressive symptoms in women with PCOS. Other treatment strategies, such as acupuncture and Reiki may also be helpful.
Nutritional supplements such as fish oil and vitamin D have also demonstrated effectiveness in improving depressive symptoms. One study published in the Journal of Gynecology and Endocrinology found that vitamin D deficiency was a significant independent predictor of depression in both women with and without PCOS.
St. John’s Wort may help improve depressive symptoms, but it can also carry with it some side effects that are of particular concern in PCOS, including hormone level changes.
Health Concerns That Can Look Like Depression
In addition to depression, women with PCOS are at an increased risk of having another mood disorder—anxiety. Some symptoms of anxiety are similar to those of depression.
Anxiety occurs in many forms, such as panic attacks, agoraphobia, post-traumatic stress disorder, acute stress disorder, social anxiety, and generalized anxiety.
According to the DSM-5, the diagnostic criteria for generalized anxiety disorder includes at least three of the following six symptoms:
Restlessness or a feeling of being on edgeGetting easily fatiguedDifficulty concentrating or “mind going blank” IrritabilityMuscle tensionSleep disturbancesAppetite changesWeight changes
When to Seek Help If You Experience Depressive Symptoms
If you or someone you know may be depressed, it is important that you discuss your symptoms with your healthcare provider, who may refer you to a mental health professional. Know that you are not alone. PCOS is a complicated condition that is associated with mood disorders, including depression. What you are feeling is real, worth attention, and treatable.
