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Chapter 17 - Mood Disorders in Polycystic Ovary Syndrome

Published online by Cambridge University Press:  13 May 2022

By
Anuja Dokras
Edited by
Gabor T. Kovacs ,
Bart Fauser  and
Richard S. Legro
Gabor T. Kovacs
Affiliation:
Monash University, Melbourne, Australia
Bart Fauser
Affiliation:
University Medical Center, Utrecht, Netherlands
Richard S. Legro
Affiliation:
Penn State Medical Center, Hershey, PA, USA
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Summary

Polycystic ovary syndrome (PCOS) is associated with a high prevalence of mental health disorders, including depression, anxiety and eating disorders. There are numerous clinic-based and population studies from around the world showing a high prevalence of both depressive symptoms and depression in reproductive-age women with PCOS compared to controls. These studies indicate that the risk of depression may be independent of obesity and associated with clinical and biochemical hyperandrogenism, with genetic data supporting closely linked biological pathways. Similarly, the risk of anxiety is significantly higher in women with PCOS as compared to a control population. Longitudinal studies depicted a persistence of both depression and anxiety symptoms in women with PCOS over time. First-line treatments for PCOS, including weight-loss interventions and use of hormonal contraceptives, may improve depression and anxiety scores. Recent publications indicate an increased risk of disordered eating and eating disorders in women with PCOS. Given that lifestyle modifications are a first-line treatment for PCOS, early screening and treatment of depression, anxiety and disordered eating are essential for comprehensive management of this population.

Keywords

anxietydepressionbody imageeating disorderdisordered eatingobesityhyperandrogenism

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Polycystic Ovary Syndrome , pp. 162 - 169
Publisher: Cambridge University Press
Print publication year: 2022

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References

Cooney, L. G. and Dokras, A. Beyond fertility: Polycystic ovary syndrome and long-term health. Fertil Steril 2018; 110: 794–809.Google Scholar
Dokras, A., Stener-Victorin, E., Yildiz, B. O. et al. Androgen excess– Polycystic Ovary Syndrome Society: Position statement on depression, anxiety, quality of life, and eating disorders in polycystic ovary syndrome. Fertil Steril 2018; 109: 888–899.Google Scholar
Kan, C., Silva, N., Golden, S. H. et al. A systematic review and meta-analysis of the association between depression and insulin resistance. Diabetes Care 2013; 36: 480–489.CrossRefGoogle ScholarPubMed
Luppino, F. S., de Wit, L. M., Bouvy, P. F. et al. Overweight, obesity, and depression: A systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry 2010; 67: 220–229.CrossRefGoogle ScholarPubMed
Van der Kooy, K., van Hout, H., Marwijk, H. et al. Depression and the risk for cardiovascular diseases: Systematic review and meta analysis. Int J Geriatr Psychiatry 2007; 22: 613–626.Google Scholar
Teede, H. J., Misso, M. L., Costello, M. F. et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril 2018; 110: 364–379.CrossRefGoogle ScholarPubMed
Hollinrake, E., Abreu, A., Maifeld, M., Van Voorhis, B. J. and Dokras, A. Increased risk of depressive disorders in women with polycystic ovary syndrome. Fertil Steril 2007; 87: 1369–1376.CrossRefGoogle ScholarPubMed
Guo, N., Robakis, T., Miller, C. and Butwick, A. Prevalence of depression among women of reproductive age in the United States. Obstet Gynecol 2018; 131: 671–679.Google Scholar
Kerchner, A., Lester, W., Stuart, S. P. and Dokras, A. Risk of depression and other mental health disorders in women with polycystic ovary syndrome: A longitudinal study. Fertil Steril 2009; 91: 207–212.Google Scholar
Cesta, C. E., Månsson, M., Palm, C. et al. Polycystic ovary syndrome and psychiatric disorders: Co-morbidity and heritability in a nationwide Swedish cohort. Psychoneuroendocrinology 2016: 73: 196–203.CrossRefGoogle Scholar
Cooney, L. G., Lee, I., Sammel, M .D. and 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: 1075–1091.Google Scholar
Hart, R. and Doherty, D. A. The potential implications of a PCOS diagnosis on a woman’s long-term health using data linkage. J Clin Endocrinol Metab 2015; 100: 911–919.Google Scholar
Hung, J. H., Hu, L. Y., Tsai, S. J. et al. Risk of psychiatric disorders following polycystic ovary syndrome: A nationwide population-based cohort study. PLoS ONE 2014; 9: e97041.CrossRefGoogle ScholarPubMed
Karjula, S., Morin-Papunen, L., Auvinen, J. et al. Psychological distress is more prevalent in fertile age and premenopausal women with PCOS symptoms: 15-year follow-up. J Clin Endocrinol Metab 2017: 102: 1861–1869.Google Scholar
Greenwood, E. A., Yaffe, K., Wellons, M. F., Cedars, M. I. and Huddleston, H. G. Depression over the lifespan in a population-based cohort of women with polycystic ovary syndrome: Longitudinal analysis. J Clin Endocrinol Metab 2019; 104: 2809–2819.CrossRefGoogle Scholar
Tay, C. T., Teede, H. J., Boyle, J. A., Kulkarni, J., Loxton, D. and Joham, A. E. Perinatal mental health in women with polycystic ovary syndrome: A cross-sectional analysis of an Australian population-based cohort. J Clin Med 2019; 8: 2070.Google Scholar
Alur-Gupta, S., Boland, M. R., Barnhart, K. T., Sammel, M. D. and Dokras, A. Postpartum complications increased in women with polycystic ovary syndrome. Am J Obstet Gynecol 2020; 224(3): 280.e1–280.e13.Google Scholar
Greenwood, E. A., Pasch, L. A., Shinkai, K., Cedars, M. I. and Huddleston, H. G. Clinical course of depression symptoms and predictors of enduring depression risk in women with polycystic ovary syndrome: Results of a longitudinal study. Fertil Steril 2019; 111: 147–156.Google Scholar
Jedel, E., Gustafson, D., Waern, M. et al. Sex steroids, insulin sensitivity and sympathetic nerve activity in relation to affective symptoms in women with polycystic ovary syndrome. Psychoneuroendocrinology 2011; 36: 1470–1479.Google Scholar
Weiner, C. L., Primeau, M. and Ehrmann, D. A. Androgens and mood dysfunction in women: Comparison of women with polycystic ovarian syndrome to healthy controls. Psychosom Med 2004; 66: 356–362.Google Scholar
Ekbäck, M. P., Lindberg, M., Benzein, E. and Årestedt, K. Health-related quality of life, depression and anxiety correlate with the degree of hirsutism. Dermatology 2013; 227: 278–284.Google Scholar
Barry, J. A., Qu, F. and Hardiman, P. J. An exploration of the hypothesis that testosterone is implicated in the psychological functioning of women with polycystic ovary syndrome (PCOS). Med Hypotheses 2018; 110: 42–45.Google Scholar
Deeks, A. A., Gibson-Helm, M. E., Paul, E. and Teede, H. J. Is having polycystic ovary syndrome a predictor of poor psychological function including anxiety and depression? Hum Reprod 2011; 26: 1399–1407.Google Scholar
Himelein, M. J. and Thatcher, S. S. Depression and body image among women with polycystic ovary syndrome. J Health Psychol 2006; 11: 613–625.Google Scholar
Alur-Gupta, S., Chemerinski, A., Liu, C. et al. Body-image distress is increased in women with polycystic ovary syndrome and mediates depression and anxiety. Fertil Steril 2019; 112: 930–938.e1.Google Scholar
Tay, C. T., Teede, H. J., Loxton, D., Kulkarni, J. and Joham, A. E. Psychiatric comorbidities and adverse childhood experiences in women with self-reported polycystic ovary syndrome: An Australian population-based study. Psychoneuroendocrinology 2020; 116: 104678.Google Scholar
Day, F., Karaderi, T., Jones, M. R. et al. Large-scale genome-wide meta-analysis of polycystic ovary syndrome suggests shared genetic architecture for different diagnosis criteria. PLoS Genet 2018; 19(14): e1007813.Google Scholar
Thomson, R. L., Buckley, J. D., Lim, S. S. et al. Lifestyle management improves quality of life and depression in overweight and obese women with polycystic ovary syndrome. Fertil Steril 2010: 94: 1812–1816.CrossRefGoogle ScholarPubMed
Oberg, E., Lundell, C., Blomberg, L. et al. Psychological well-being and personality in relation to weight loss following behavioral modification intervention in obese women with polycystic ovary syndrome: A randomized controlled trial. Eur J Endocrinol 2020; 183: 1–11.Google Scholar
Moran, L. J., Ko, H., Misso, M. et al. Dietary composition in the treatment of polycystic ovary syndrome: A systematic review to inform evidence-based guidelines. J Acad Nutr Diet 2013; 113: 520–545.Google Scholar
Qaseem, A., Barry, M. J., Kansagara, D. and Clinical Guidelines Committee of the American College of Physicians. 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: 350–359.Google Scholar
Abilés, V., Rodríguez-Ruiz, S., Abilés, J. et al. Effectiveness of cognitive-behavioral therapy in morbidity obese candidates for bariatric surgery with and without binge eating disorder. Nutr Hosp 2013; 28: 1523–1529.Google Scholar
Cooney, L.G., Milman, L. W., Hantsoo, L. et al. 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: 161–171.e1.Google Scholar
Dokras, A., Sarwer, D. B., Allison, K. C. 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: 2966–2974.Google Scholar
Cinar, N., Harmanci, A., Demir, B. and Yildiz, B. O. Effect of an oral contraceptive on emotional distress, anxiety and depression of women with polycystic ovary syndrome: A prospective study. Hum Reprod 2012; 27: 1840–1845.Google Scholar
AlHussain, F., AlRuthia, Y., Al-Mandeel, H. et al. Metformin improves the depression symptoms of women with polycystic ovary syndrome in a lifestyle modification program. Patient Prefer Adherence 2020; 14: 737–746.Google Scholar
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: 767–776.Google Scholar
Ekbäck, M. P., Lindberg, M., Benzein, E. and Årestedt, K. Health-related quality of life, depression and anxiety correlate with the degree of hirsutism. Dermatology 2013; 227: 278–284.Google Scholar
Stener-Victorin, E., Manti, M., Fornes, R., Risal, S., Lu, H. and Benrick, A. Origins and impact of psychological traits in polycystic ovary syndrome. Med Sci (Basel) 2019; 7: 86.Google ScholarPubMed
Chaudhari, A. P., Mazumdar, K. and Mehta, P. D. Anxiety, depression, and quality of life in women with polycystic ovarian syndrome. Indian J Psychol Med 2018; 40: 239–246.CrossRefGoogle ScholarPubMed
Kogure, G. S., Ribeiro, V. B., Lopes, I. P. et al. Body image and its relationships with sexual functioning, anxiety, and depression in women with polycystic ovary syndrome. J Affect Disord 2019; 253: 385–393.Google Scholar
Stener-Victorin, E., Holm, G., Janson, P. O., Gustafson, D. and 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.CrossRefGoogle ScholarPubMed
Lee, I., Cooney, L. G., Saini, S. et al. Increased odds of disordered eating in polycystic ovary syndrome: A systematic review and meta-analysis. Eat Weight Disord 2019; 24: 787–797.CrossRefGoogle ScholarPubMed
Lee, I., Cooney, L. G., Saini, S. et al. Increased risk of disordered eating in polycystic ovary syndrome. Fertil Steril 2017; 107: 796–802.Google Scholar
Pirotta, S., Barillaro, M., Brennan, L. et al. Disordered eating behaviours and eating disorders in women in Australia with and without polycystic ovary syndrome: A cross-sectional study. J Clin Med 2019; 8: 1682.Google Scholar
Thannickal, A., Brutocao, C., Alsawas, M. et al. Eating, sleeping and sexual function disorders in women with polycystic ovary syndrome (PCOS): A systematic review and meta-analysis. Clin Endocrinol (Oxf) 2020; 92: 338–349.Google Scholar
Paganini, C., Peterson, G., Stavropoulos, V. and Krug, I. The overlap between binge eating behaviors and polycystic ovarian syndrome: An etiological integrative model. Curr Pharm Des 2018; 24: 999–1006.CrossRefGoogle ScholarPubMed
Kessler, R. C., Berglund, P. A., Chiu, W. T. et al. The prevalence and correlates of binge eating disorder in the World Health Organization World Mental Health Surveys. Bio Psychiatry 2013; 73: 904–914.Google Scholar
Striegel-Moore, R. H. and Bulik, C. M. Risk factors for eating disorders. Am Psychol 2007; 62: 181–198.Google Scholar
Moran, L. J., Brown, W. J., McNaughton, S. A., Joham, A. E. and Teede, H. J. Weight management practices associated with PCOS and their relationships with diet and physical activity. Hum Reprod 2017; 32: 669–678.Google ScholarPubMed
Hudson, J. I., Hiripi, E., Pope, H. G., Jr., Kessler, R. C. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 2007; 61: 348–358.Google Scholar
Greenwood, E. A., Pasch, L. A., Cedars, M. I. and Huddleston, H. G. Obesity and depression are risk factors for future eating disorder-related attitudes and behaviors in women with polycystic ovary syndrome. Fertil Steril 2020; 113: 1039–1049.Google Scholar
Lim, S. S., Hutchison, S. K., Van Ryswyk, E., Norman, R. J., Teede, H. J. and Moran, L. J. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2019; 3: CD007506.Google ScholarPubMed
Sherwood, N. E., Jeffery, R. W. and Wing, R. R. Binge status as a predictor of weight loss treatment outcome. Int J Obes Relat Metab Disord 1999; 23: 485–493.CrossRefGoogle ScholarPubMed
Yanovski, S. Z., Gormally, J. F., Leser, M. S., Gwirtsman, H. E. and Yanovski, J. A. Binge eating disorder affects outcome of comprehensive very-low-calorie diet treatment. Obes Res 1994; 2: 205–212.CrossRefGoogle ScholarPubMed
Killen, J. D., Taylor, C. B., Hayward, C. et al. Weight concerns influence the development of eating disorders: A 4-year prospective study. J Consult Clin Psychol 1996; 64: 936–940.Google Scholar
Grilo, C. M., Masheb, R. M., Wilson, G. T., Gueorguieva, R. and White, M. A. Cognitive-behavioral therapy, behavioral weight loss, and sequential treatment for obese patients with binge-eating disorder: A randomized controlled trial. J Consult Clin Psychol 2011; 79: 675–685.CrossRefGoogle ScholarPubMed
Linardon, J., Wade, T. D., de la Piedad Garcia, X. and Brennan, L. The efficacy of cognitive-behavioral therapy for eating disorders: A systematic review and meta-analysis. J Consult Clin Psychol 2017; 85: 1080–1094.Google Scholar

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