PCOS and depression: The link

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Scientists are unsure precisely how PCOS increases the risk of depression.

But according to some studies, a little over 27–49% of people with PCOS experience depression, compared with around 19% of people without PCOS.

Also, around 50% of people with PCOS experience anxiety, compared with approximately 39% of people who do not have PCOS.

Learn more about PCOS.

The link between PCOS and depression remains unclear. Yet several research-supported theories may help explain how PCOS can increase the risk of experiencing depression.

Some of the most established theories regarding the link between PCOS and depression include the following:

Insulin resistance

According to the Centers for Disease Control and Prevention (CDC), many people with PCOS are insulin-resistant. This means their bodies continue to make insulin but cannot use it properly. Insulin is a hormone that helps regulate blood sugar, or glucose, levels.

Being insulin-resistant increases the risk of developing type 2 diabetes. By some estimates, 44–70% of people with PCOS are insulin-resistant.

Experts have not fully established the association between insulin resistance, type 2 diabetes, and depression. However, having insulin resistance and type 2 diabetes likely increases the risk of developing depression.

Some research supports the idea that insulin resistance can impair physiological mechanisms that have an association with learning and reward, which could contribute to depressive symptoms.

Inflammation

PCOS is an inflammatory condition. Research also notes that depression may lead to an increase in inflammation in the body.

Inflammation has an association with many other conditions, such as stress and obesity.

Stress

Many people with PCOS experience stress. According to the National Institute of Mental Health, stress is a major risk factor for depression.

Stress may also play a significant role in the relationship between PCOS, anxiety, and depression. Increased stress levels can raise levels of the hormone cortisol. Some research indicates that elevated cortisol levels have a positive association with severe and acute major depressive disorder.

Cortisol helps regulate metabolism, immune function, and the inflammatory response. Increased inflammation activity of the immune system seems to contribute to depression.

Also, stress can trigger the release of cytokines, which are substances that cause the body to produce more inflammation.

Obesity

People with PCOS have a higher risk of obesity. Based on some estimates, people with obesity have a 55% risk of experiencing depression.

Other factors linked to obesity in PCOS, such as the overproduction of cortisol or self-perception, may contribute to developing depression.

Another factor to consider is the stigma around obesity, which may result in social isolation and trigger depression.

Increased levels of inflammation in people with PCOS and obesity can link to depression too. More research to determine the link between obesity and depression would be beneficial.

Sleep apnea

Sleep apnea can cause a low-grade inflammatory condition in the body and may worsen other health issues such as PCOS.

Anxiety and depression are common in people with obstructive sleep apnea (OSA). Some studies indicate that having OSA and insomnia can contribute to the likelihood of experiencing depression.

A 2017 study found that poor sleep can negatively impact a person’s ability to regulate their emotions, which may lead to depressive symptoms.

Infertility

People with infertility or who are having trouble conceiving often report elevated levels of depression and anxiety.

Infertility can lead to the atypical secretion of hormones, neuropeptides, or cytokines, which may contribute to depression in PCOS.

Depression may also develop because infertility can affect a person’s identity. This may lead to the following:

• feelings of isolation
• feelings of failure
• questions of self-worth

Changes in physical appearance

Symptoms that medical professionals typically associate with PCOS may contribute to the development of depression. These can include:

• excessive body hair
• acne
• dark skin patches

These changes to physical appearance can result in feelings of low self-esteem and poor self-image.

The best treatment option for people with PCOS and depression depends on the underlying cause.

If depression relates to insulin resistance, obesity, or type 2 diabetes, certain lifestyle changes can help a person better manage these conditions. Some measures include:

• eating a low-carbohydrate diet
• losing weight or maintaining a healthy weight
• exercising to help treat some symptoms
• taking certain medications — such as insulin-sensitizing medications — to treat insulin resistance and type 2 diabetes

If hormonal imbalance is causing depression, taking birth control pills may be beneficial. These medications can help manage or reduce symptoms of PCOS and regulate menstruation cycles.

People with PCOS who experience severe or chronic stress may find it helpful to learn ways to manage their stress. For example, using relaxation techniques or yoga. This can help alleviate some depressive symptoms.

If depression stems from emotions surrounding infertility, treatments such as certain medications or surgery may improve a person’s chances of conceiving.

Using a continuous positive airway pressure machine may reduce OSA and depressive symptoms.

Learn more about talking therapies for treating mental health conditions.

What about antidepressants?

Doctors may prescribe antidepressant medications that help manage depression.

However, taking antidepressants can lead to weight gain and obesity, which has the potential to worsen PCOS-related depression.

If symptoms of depression occur frequently or for at least two weeks, a person should talk with a doctor as soon as possible.

Signs of depression include:

• aches, pain, or digestive problems with no clear underlying cause
• cognitive problems, such as trouble focusing, remembering things, or making decisions
• feeling continuously sad, anxious, guilty, helpless, or hopeless
• irritability or restlessness
• loss of interest in things once enjoyed
• reduced energy and unexplained fatigue
• trouble sleeping or oversleeping
• thoughts of death or suicide

Learn more about how doctors diagnose depression.

A family doctor or healthcare professional can help people with depression access the care they need.

In the U.S., someone can also find local treatment services by contacting the Substance Abuse and Mental Health Services Administration National Helpline at 1-800-662-HELP (4357).

If someone is experiencing a mental health crisis or considering suicide, call 911, contact the Suicide & Crisis Lifeline by calling or texting 988, or text “HELLO” to 741741.

People with PCOS are more likely to develop depression. Although the precise relationship between depression and PCOS remains unclear, several factors may be involved, including:

• insulin resistance and type 2 diabetes
• obesity
• stress
• sleep apnea
• infertility
• changes to physical appearance

People with PCOS who experience symptoms of depression can get support and treatment by talking with a healthcare professional or reaching out to national mental health services.