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Current Psychiatry Reports
Published in: Current Psychiatry Reports 11/2017

01-11-2017 | Reproductive Psychiatry and Women’s Health (CN Epperson, Section Editor)

Depression and Anxiety in Polycystic Ovary Syndrome: Etiology and Treatment

Authors: Laura G. Cooney, Anuja Dokras

Published in: Current Psychiatry Reports | Issue 11/2017

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Abstract

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.

Recent Findings

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.

Summary

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.
Literature
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. CrossRefPubMed
2.
Rotterdam Consensus. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19:41–7.CrossRef
3.
Brassard M, AinMelk Y, Baillargeon JP. Basic infertility including polycystic ovary syndrome. Med Clin N Am. 2008;92:1163–92. xi CrossRefPubMed
4.
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 108: Polycystic ovary syndrome. Obstet Gynecol. 2009;114:936–49.
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. CrossRefPubMed
6.
Mansson M, Holte J, Landin-Wilhelmsen K, Dahlgren E, Johansson A, Landen M. Women with polycystic ovary syndrome are often depressed or anxious—a case control study. Psychoneuroendocrinology. 2008;33:1132–8.CrossRefPubMed
7.
Sayyah-Melli M, Alizadeh M, Pourafkary N, et al. Psychosocial factors associated with polycystic ovary syndrome: a case control study. J Caring Sci. 2015;4:225–31.CrossRefPubMedPubMedCentral
8.
Hung JH, Hu LY, Tsai SJ, et al. Risk of psychiatric disorders following polycystic ovary syndrome: a nationwide population-based cohort study. PLoS ONE [Electronic Resource]. 2014;9:e97041.CrossRef
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. CrossRefPubMed
10.
Kerchner A, Lester W, Stuart SP, Dokras A. Risk of depression and other mental health disorders in women with polycystic ovary syndrome: a longitudinal study. Fertil Steril. 2009;91:207–12.CrossRefPubMed
11.
Veltman-Verhulst SM, Boivin J, Eijkemans MJ, Fauser BJ. Emotional distress is a common risk in women with polycystic ovary syndrome: a systematic review and meta-analysis of 28 studies. Hum Reprod Update. 2012;18:638–51.CrossRefPubMed
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. CrossRefPubMed
13.
Barry JA, Hardiman PJ, Saxby BK, Kuczmierczyk A. Testosterone and mood dysfunction in women with polycystic ovarian syndrome compared to subfertile controls. [Erratum appears in J Psychosom Obstet Gynaecol. 2011 Sep;32(3):164]. J Psychosom Obstet Gynecol. 2011;32:104–11.CrossRef
14.
Herguner S, Harmanci H, Toy H. Attention deficit-hyperactivity disorder symptoms in women with polycystic ovary syndrome. Int J Psychiatry Med. 2015;50:317–25.CrossRefPubMed
15.
•• Lee I, Cooney LG, Saini S, et al. Increased risk of disordered eating in polycystic ovary syndrome. Fertil Steril. 2017;107:796–802. Women with PCOS had over a fourfold increased odds of disordered eating than controls in this cross-sectional study. CrossRefPubMed
16.
Hollinrake E, Abreu A, Maifeld M, Van Voorhis BJ, Dokras A. Increased risk of depressive disorders in women with polycystic ovary syndrome. Fertil Steril. 2007;87:1369–76.CrossRefPubMed
17.
Luppino FS, de Wit LM, Bouvy PF, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67:220–9.CrossRefPubMed
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. CrossRefPubMed
19.
Smith KJ, Beland M, Clyde M, et al. Association of diabetes with anxiety: a systematic review and meta-analysis. J Psychosom Res. 2013;74:89–99.CrossRefPubMed
20.
Kan C, Silva N, Golden SH, et al. A systematic review and meta-analysis of the association between depression and insulin resistance. Diabetes Care. 2013;36:480–9.CrossRefPubMedPubMedCentral
21.
22.
Greenwood EA, Pasch LA, Shinkai K, Cedars MI, Huddleston HG. Putative role for insulin resistance in depression risk in polycystic ovary syndrome. Fertil Steril. 2015;104:707–14.e1.CrossRefPubMed
23.
Bromberger JT, Schott LL, Kravitz HM, et al. Longitudinal change in reproductive hormones and depressive symptoms across the menopausal transition: results from the Study of Women’s Health Across the Nation (SWAN). Arch Gen Psychiatry. 2010;67:598–607.CrossRefPubMedPubMedCentral
24.
Milman LW, Sammel MD, Barnhart KT, Freeman EW, Dokras A. Higher serum total testosterone levels correlate with increased risk of depressive symptoms in Caucasian women through the entire menopausal transition. Psychoneuroendocrinology. 2015;62:107–13.CrossRefPubMed
25.
Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab. 1961;21:1440–7.CrossRefPubMed
26.
Ekback MP, Lindberg M, Benzein E, Arestedt K. Health-related quality of life, depression and anxiety correlate with the degree of hirsutism. Dermatology. 2013;227:278–84.CrossRefPubMed
27.
Pasch L, He SY, Huddleston H, et al. Clinician vs self-ratings of hirsutism in patients with polycystic ovarian syndrome: associations with quality of life and depression. JAMA Dermatol. 2016;152:783–8.CrossRefPubMed
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.CrossRefPubMed
29.
Chen TH, Chang SP, Tsai CF, Juang KD. Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic. Hum Reprod. 2004;19:2313–8.CrossRefPubMed
30.
Gameiro S, van den Belt-Dusebout AW, Smeenk JM, Braat DD, van Leeuwen FE, Verhaak CM. Women’s adjustment trajectories during IVF and impact on mental health 11–17 years later. Hum Reprod. 2016;31:1788–98.CrossRefPubMed
31.
Sethi P, Sharma A, Goyal LD, Kaur G. Prevalence of psychiatric morbidity in females amongst infertile couples—a hospital based report. J Clin Diagn Res. 2016;10:Vc04–vc7.PubMedPubMedCentral
32.
Volgsten H, Skoog Svanberg A, Ekselius L, Lundkvist O, Sundstrom PI. Prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment. Hum Reprod. 2008;23:2056–63.CrossRefPubMedPubMedCentral
33.
Adali E, Yildizhan R, Kurdoglu M, et al. The relationship between clinico-biochemical characteristics and psychiatric distress in young women with polycystic ovary syndrome. J Int Med Res. 2008;36:1188–96.CrossRefPubMed
34.
Davari-Tanha F, Hosseini Rashidi B, Ghajarzadeh M, Noorbala AA. Bipolar disorder in women with polycystic ovarian syndrome (PCO). Acta Medica Iranica. 2014;52:46–8.PubMed
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.
36.
Shi X, Zhang L, Fu S, Li N. Co-involvement of psychological and neurological abnormalities in infertility with polycystic ovarian syndrome. Arch Gynecol Obstet. 2011;284:773–8.CrossRefPubMed
37.
38.
Gallinelli A, Matteo ML, Volpe A, Facchinetti F. Autonomic and neuroendocrine responses to stress in patients with functional hypothalamic secondary amenorrhea. Fertil Steril. 2000;73:812–6.CrossRefPubMed
39.
Benson S, Arck PC, Tan S, et al. Disturbed stress responses in women with polycystic ovary syndrome. Psychoneuroendocrinology. 2009;34:727–35.CrossRefPubMed
40.
Kohler O, Krogh J, Mors O, Benros ME. Inflammation in depression and the potential for anti-inflammatory treatment. Curr Neuropharmacol. 2016;14:732–42.CrossRefPubMedPubMedCentral
41.
42.
Anglin RE, Samaan Z, Walter SD, McDonald SD. Vitamin D deficiency and depression in adults: systematic review and meta-analysis. Br J Psychiat. 2013;202:100–7.CrossRef
43.
Ju SY, Lee YJ, Jeong SN. Serum 25-hydroxyvitamin D levels and the risk of depression: a systematic review and meta-analysis. J Nutr Health Aging. 2013;17:447–55.CrossRefPubMed
44.
Krul-Poel YH, Snackey C, Louwers Y, et al. The role of vitamin D in metabolic disturbances in polycystic ovary syndrome: a systematic review. Eur J Endocrinol. 2013;169:853–65.CrossRefPubMed
45.
Moran LJ, Teede HJ, Vincent AJ. Vitamin D is independently associated with depression in overweight women with and without PCOS. Gynecol Endocrinol. 2015;31:179–82.CrossRefPubMed
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. CrossRefPubMed
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.CrossRef
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.
49.
Thomson RL, Buckley JD, Lim SS, et al. Lifestyle management improves quality of life and depression in overweight and obese women with polycystic ovary syndrome. Fertil Steril. 2010;94:1812–6.CrossRefPubMed
50.
Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R. Effect of holistic yoga program on anxiety symptoms in adolescent girls with polycystic ovarian syndrome: a randomized control trial. Int J Yoga. 2012;5:112–7.CrossRefPubMedPubMedCentral
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.
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. CrossRefPubMedPubMedCentral
53.
Clayton WJ, Lipton M, Elford J, Rustin M, Sherr L. A randomized controlled trial of laser treatment among hirsute women with polycystic ovary syndrome. Br J Dermatol. 2005;152:986–92.CrossRefPubMed
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.CrossRefPubMed
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).
56.
Stefanaki C, Bacopoulou F, Livadas S, et al. Impact of a mindfulness stress management program on stress, anxiety, depression and quality of life in women with polycystic ovary syndrome: a randomized controlled trial. Stress. 2015;18:57–66.CrossRefPubMed
57.
Peckmezian T, Hay P. A systematic review and narrative synthesis of interventions for uncomplicated obesity: weight loss, well-being and impact on eating disorders. J Eating Dis. 2017;5:15.CrossRef
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. CrossRefPubMedPubMedCentral
59.
60.
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.CrossRefPubMed
61.
Cinar N, Harmanci A, Demir B, Yildiz BO. Effect of an oral contraceptive on emotional distress, anxiety and depression of women with polycystic ovary syndrome: a prospective study. Hum Reprod. 2012;27:1840–5.CrossRefPubMed
62.
Zethraeus N, Dreber A, Ranehill E, et al. A first-choice combined oral contraceptive influences general well-being in healthy women: a double-blind, randomized, placebo-controlled trial. Fertil Steril. 2017;107:1238–45.CrossRefPubMed
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.CrossRefPubMed
64.
Ladson G, Dodson WC, Sweet SD, et al. Effects of metformin in adolescents with polycystic ovary syndrome undertaking lifestyle therapy: a pilot randomized double-blind study. Fertil Steril. 2011a;95:2595–8 e1-6.CrossRefPubMedPubMedCentral
65.
Ladson G, Dodson WC, Sweet SD, et al. The effects of metformin with lifestyle therapy in polycystic ovary syndrome: a randomized double-blind study. Fertil Steril. 2011b;95:1059–66 e1-7.CrossRefPubMed
66.
Rosenblat JD, Kakar R, Berk M, et al. Anti-inflammatory agents in the treatment of bipolar depression: a systematic review and meta-analysis. Bipolar Disord. 2016;18:89–101.CrossRefPubMed
67.
Colle R, de Larminat D, Rotenberg S, et al. PPAR-gamma agonists for the treatment of major depression: a review. Pharmacopsychiatry. 2017a;50:49–55.PubMed
68.
Colle R, de Larminat D, Rotenberg S, et al. Pioglitazone could induce remission in major depression: a meta-analysis. Neuropsychiatr Dis Treat. 2017b;13:9–16.CrossRefPubMed
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.CrossRefPubMed
70.
71.
Cuijpers P, Cristea IA, Karyotaki E, Reijnders M, Huibers MJ. How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiat. 2016;15:245–58.CrossRef
72.
Rofey DL, Szigethy EM, Noll RB, Dahl RE, Lobst E, Arslanian SA. Cognitive-behavioral therapy for physical and emotional disturbances in adolescents with polycystic ovary syndrome: a pilot study. J Pediatr Psychol. 2009;34:156–63.CrossRefPubMed
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.
Metadata
Title
Depression and Anxiety in Polycystic Ovary Syndrome: Etiology and Treatment
Authors
Laura G. Cooney
Anuja Dokras
Publication date
01-11-2017
Publisher
Springer US
Published in
Current Psychiatry Reports / Issue 11/2017
Print ISSN: 1523-3812
Electronic ISSN: 1535-1645
DOI
https://doi.org/10.1007/s11920-017-0834-2

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