PCOS and Depression By Angela Grassi, MS, RDN, LDN - Reviewed by a board-certified physician. Updated October 31, 2016 Though you may not automatically connect depression to polycystic ovarian syndrome (PCOS), the relationship between the two is well documented. As much as 40 percent of women with PCOS experience depressive symptoms. One study published in the journal Psychoneuroendocrinology sadly even showed that suicide rates were seven times more common among women with PCOS than those without the syndrome. There are numerous reasons why women with PCOS experience such high rates of depression. First, it's possible that 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 as well.Higher levels of androgens, or male hormones classically associated with the condition, may also contribute to higher rates of mood disorders in women with PCOS. Article How PCOS Affects Your Relationships Article Talking to Your Partner About PCOS Beyond the physical influences of PCOS that can contribute to depression, the difficulties and frustrations of managing the many uncontrollable 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 DepressionDepression is so much more than just being sad. Anyone struggling with depression knows that it’s 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. It’s definitely one you can’t just "snap out of."Depression can appear in many forms. Here are some types of depression that can impact the emotional health of women with PCOS.Major Depressive DisorderMajor depressive disorder is a distinct psychological disorder that is different than the “blues” or feeling down or frustrated with having PCOS. It is also different from a grief response that may result from the death of a loved one or the end of a relationship. Major depressive disorder can last weeks or even months and can affect your ability to function in daily activities. The condition depletes energy and interest in activities that once were pleasurable, and it can recur throughout an individual’s life. Major depression disorder 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 of pleasure. Article Is PCOS Affecting Your Self-Esteem? Article Endometrial Biopsy: What You Need to Know Before The Procedure Happens Major depressive disorder can make it difficult to have the motivation to properly care for yourself. Since exercising regularly and preparing or eating healthy foods are such an important part of self-care for everyone, especially women with PCOS, major depressive disorder can have a real impact on how well you feel when managing your syndrome.Bipolar DepressionWomen with PCOS have been shown to have higher rates of bipolar depression, requiring treatment under the care of a trained mental health care professional.Bipolar I disorder, once called manic depression, is diagnosed when someone has a history of both depressive and manic episodes. Seeking pleasure, enjoying fast-paced activities, and exhibiting an increased rate of speech typically characterize the disorder. An individual can be diagnosed with bipolar I when she has experienced at least one manic episode. A manic episode is characterized by an abnormally and persistently elevated expansive or irritated mood in a weeks time.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, as well as duration of the episode. In hypomania, the symptoms last for at least four consecutive days. Irritability is also more likely to be the key mood during hypomania rather than elevated mood, and the disturbance is not severe enough to cause marked impairment.Seasonal Affective DisorderSeasonal affective disorder, commonly referred to as 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 the lack of energy, moodiness, and fatigue. Symptoms of SAD improve during other months. The Most Common Signs and Symptoms of DepressionMany people experience depression differently. Below is a list of some common symptoms of depression, but do not include all possible symptoms. Category The Connection Between PCOS and Depression Article The Surprising Benefits of Yoga for PCOS 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 back acheDigestive issuesHow 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 in dealing with difficult or painful feelings, including the day-to-day struggles with PCOS. It is also helpful in 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 GroupsA support group for women diagnosed with PCOS may be helpful to some. Being surrounded by women who share similar struggles can be comforting and supportive. If led by a trained mental health professional, a support group may offer life-changing skills and strategies to cope with PCOS and depression. MedicationsMedications (antidepressants) are available to help treat depression. There are many types available. Discuss your options with your doctor and therapist. Also, be sure to discuss other medications or supplements that you are taking with your doctor that may interact. If at all possible, avoid medications that can lead to weight gain and have the potential to make certain aspects of PCOS worse. Alternative and Integrative MedicineAlternative and integrative medicine therapies are also available to treat depression. Mindfulness-based practice has been shown to be an effective treatment to reduce depressive symptoms in women with PCOS as well as anxiety. 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 also help improve depressive symptoms, but it can also carry with it some side effects that are of particular importance for those with PCOS, including hormone level changes.Health Concerns That Can Look Like DepressionIn addition to depression, women with PCOS are at an increased rate 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, posttraumatic stress disorder, acute stress disorder, social anxiety, and generalized anxiety. According to the DSM-5, the diagnostic criteria for generalized anxiety disorder include at least three of the following six symptoms: Restlessness or feeling of being on edgeEasily fatiguedDifficulty concentrating or mind going blank IrritabilityMuscle tensionSleep disturbancesAppetite changesWeight changesBecause of the higher incidences for mental health disorders, the Androgen Excess and PCOS Society recommends that all women with PCOS be routinely screened for anxiety and depression by their physician and referred to appropriate treatment providers. When to Seek Help If you Experience Depressive SymptomsIf you or someone you know may be depressed, it is important that you seek help from a trained mental health professional. Don’t be afraid to discuss what you are feeling to your friends and family. 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 and worth attention. Discuss your symptoms with your doctor and make an appointment with a psychologist or counselor who can help you.Sources:Association AP. DSM. 5th ed. Washington D.C.: American Psychological Association 2013.Depression. National Institute of Mental Health website. https://www.nimh.nih.gov/health/topics/depression/index.shtml. Accessed September 10, 2016.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(1):207-212.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(8):1132-1138.Mattei S. Psychological Aspects of PCOS. In, PCOS: The Dietitian's Guide. 2013 Luca Publishing. Bryn Mawr, PA.Moran LJ, Teede HJ, Vincent AJ. Vitamin D is Independently Associated with Depression in Overweight Women with and Without PCOS. Gynecol Endocrinol. 2014;4:1-4.