Insulin Resistance, Hyperandrogenism, and Its Associated Symptoms Are the Precipitating Factors for Depression in Women With Polycystic Ovarian Syndrome

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2021 Oct 20

PMID 34667688

Citations 8

Authors

Aarthi Ethirajulu

Almothana Alkasabera

Chike B Onyali

Comfort Anim-Koranteng

Hira E Shah

Nitin Bhawnani

Jihan A Mostafa

Affiliations

Soon will be listed here.

Abstract

Polycystic ovarian syndrome (PCOS) is a combination of many symptoms resulting from hormonal imbalance, metabolic syndromes, hyperandrogenism, and anovulation. This paper explores the various etiopathology and mechanisms causing depression in women with PCOS and how to prevent and treat PCOS-induced depression. Women with PCOS present with multiple symptoms such as acne, hirsutism, androgenic alopecia, obesity, menstrual irregularities, infertility, and mood disturbances like depression and anxiety. Depression is the most common psychological problem faced by women with PCOS. The various pathophysiological mechanisms that lead to depression are Insulin resistance, disturbance in the hypothalamic pituitary adrenal (HPA) axis, hyperandrogenism and its clinical presentation, obesity, and infertility. Lifestyle modifications such as dietary changes and weight loss play a significant role in preventing and managing PCOS-induced depression. Cognitive behavioral therapy (CBT) and lifestyle modification have shown to be effective measures for weight loss in obese women with PCOS. Antidepressants also play a part in treating PCOS-induced depression. Over the last decade, the number of cases of depression in women with PCOS has increased. This paper provides detailed data on the fundamental causes of depression in women with PCOS to facilitate a more straightforward treatment approach.

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References

Cinar N, Kizilarslanoglu M, Harmanci A, Yazgan Aksoy D, Bozdag G, Demir B . Depression, anxiety and cardiometabolic risk in polycystic ovary syndrome. Hum Reprod. 2011; 26(12):3339-45. DOI: 10.1093/humrep/der338. View

Moran L, Pasquali R, Teede H, Hoeger K, Norman R . Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Fertil Steril. 2008; 92(6):1966-82. DOI: 10.1016/j.fertnstert.2008.09.018. View

Lo J, Feigenbaum S, Yang J, Pressman A, Selby J, Go A . Epidemiology and adverse cardiovascular risk profile of diagnosed polycystic ovary syndrome. J Clin Endocrinol Metab. 2006; 91(4):1357-63. DOI: 10.1210/jc.2005-2430. View

Chaudhari A, Mazumdar K, Mehta P . Anxiety, Depression, and Quality of Life in Women with Polycystic Ovarian Syndrome. Indian J Psychol Med. 2018; 40(3):239-246. PMC: 5968645. DOI: 10.4103/IJPSYM.IJPSYM_561_17. View

Greenwood E, Pasch L, Cedars M, Legro R, Eisenberg E, Huddleston H . Insulin resistance is associated with depression risk in polycystic ovary syndrome. Fertil Steril. 2018; 110(1):27-34. PMC: 6392023. DOI: 10.1016/j.fertnstert.2018.03.009. View

Shah K, Kulkarni R, Singh R, Pannu H, Kamrai D . Role of Bupropion and Naltrexone in Managing Depression With Polycystic Ovary Syndrome: A Case Report and Literature Review. Cureus. 2020; 12(11):e11343. PMC: 7719465. DOI: 10.7759/cureus.11343. View

Elsenbruch S, Hahn S, Kowalsky D, Offner A, Schedlowski M, Mann K . Quality of life, psychosocial well-being, and sexual satisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2003; 88(12):5801-7. DOI: 10.1210/jc.2003-030562. View

Legro R, Arslanian S, Ehrmann D, Hoeger K, Murad M, Pasquali R . Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013; 98(12):4565-92. PMC: 5399492. DOI: 10.1210/jc.2013-2350. View

Kitzinger C, Willmott J . 'The thief of womanhood': women's experience of polycystic ovarian syndrome. Soc Sci Med. 2002; 54(3):349-61. DOI: 10.1016/s0277-9536(01)00034-x. View

10.

Sulaiman M, Al-Farsi Y, Al-Khaduri M, Waly M, Saleh J, Al-Adawi S . Psychological burden among women with polycystic ovarian syndrome in Oman: a case-control study. Int J Womens Health. 2017; 9:897-904. PMC: 5731436. DOI: 10.2147/IJWH.S145383. View

11.

Jiskoot G, Dietz de Loos A, Beerthuizen A, Timman R, Busschbach J, Laven J . Long-term effects of a three-component lifestyle intervention on emotional well-being in women with Polycystic Ovary Syndrome (PCOS): A secondary analysis of a randomized controlled trial. PLoS One. 2020; 15(6):e0233876. PMC: 7263605. DOI: 10.1371/journal.pone.0233876. View

12.

Barlampa D, Bompoula M, Bargiota A, Kalantaridou S, Mastorakos G, Valsamakis G . Hypothalamic Inflammation as a Potential Pathophysiologic Basis for the Heterogeneity of Clinical, Hormonal, and Metabolic Presentation in PCOS. Nutrients. 2021; 13(2). PMC: 7915850. DOI: 10.3390/nu13020520. View

13.

Bremer A . Polycystic ovary syndrome in the pediatric population. Metab Syndr Relat Disord. 2010; 8(5):375-94. PMC: 3125559. DOI: 10.1089/met.2010.0039. View

14.

McCartney C, Marshall J . CLINICAL PRACTICE. Polycystic Ovary Syndrome. N Engl J Med. 2016; 375(1):54-64. PMC: 5301909. DOI: 10.1056/NEJMcp1514916. View

15.

Veltman-Verhulst S, Boivin J, Eijkemans M, Fauser B . 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(6):638-51. DOI: 10.1093/humupd/dms029. View

16.

Cooney L, Lee I, Sammel M, Dokras A . High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2017; 32(5):1075-1091. DOI: 10.1093/humrep/dex044. View

17.

Blank S, McCartney C, Marshall J . The origins and sequelae of abnormal neuroendocrine function in polycystic ovary syndrome. Hum Reprod Update. 2006; 12(4):351-61. DOI: 10.1093/humupd/dml017. View

18.

Moran L, Hutchison S, Norman R, Teede H . Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2011; (2):CD007506. DOI: 10.1002/14651858.CD007506.pub2. View

19.

Cooney L, Milman L, Hantsoo L, Kornfield S, Sammel M, Allison K . Cognitive-behavioral therapy improves weight loss and quality of life in women with polycystic ovary syndrome: a pilot randomized clinical trial. Fertil Steril. 2018; 110(1):161-171.e1. PMC: 6443091. DOI: 10.1016/j.fertnstert.2018.03.028. View

20.

Basirat Z, Faramarzi M, Esmaelzadeh S, Abedi Firoozjai S, Mahouti T, Geraili Z . Stress, Depression, Sexual Function, and Alexithymia in Infertile Females with and without Polycystic Ovary Syndrome: A Case-Control Study. Int J Fertil Steril. 2019; 13(3):203-208. PMC: 6642420. DOI: 10.22074/ijfs.2019.5703. View