Considerations in the Treatment of Depression and Anxiety in Women with PCOS

Abstract

Women with polycystic ovary syndrome (PCOS) are known to be at a greater risk of depression and anxiety. What is less clear is whether existing treatments for PCOS are effective in managing this increased risk and what the optimal approach to treatment is. In this review, currently available interventions are explored including lifestyle modifications, oral contraceptives, insulin sensitizing agents, psychosocial interventions and psychiatric medications. While data are often conflicting, lifestyle interventions, and cognitive behavioral therapy (CBT) appear most promising in reducing depression and anxiety symptoms in this population. There is an urgent need for large prospective studies to fill gaps in the literature.

Keywords

PCOS - depression - anxiety - treatment

Publikationsverlauf

Artikel online veröffentlicht:
19. Dezember 2023

• References

• 1 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 2017; 32 (05) 1075-1091
• 2 Wang Y, Ni Z, Li K. The prevalence of anxiety and depression of different severity in women with polycystic ovary syndrome: a meta-analysis. Gynecol Endocrinol 2021; 37 (12) 1072-1078
• 3 Yin X, Ji Y, Chan CLW, Chan CHY. The mental health of women with polycystic ovary syndrome: a systematic review and meta-analysis. Arch Women Ment Health 2021; 24 (01) 11-27
• 4 Brutocao C, Zaiem F, Alsawas M, Morrow AS, Murad MH, Javed A. Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis. Endocrine 2018; 62 (02) 318-325
• 5 Çoban ÖG, Tulacı ÖD, Adanır AS, Önder A. Psychiatric disorders, self-esteem, and quality of life in adolescents with polycystic ovary syndrome. J Pediatr Adolesc Gynecol 2019; 32 (06) 600-604
• 6 Rowlands IJ, Teede H, Lucke J, Dobson AJ, Mishra GD. Young women's psychological distress after a diagnosis of polycystic ovary syndrome or endometriosis. Hum Reprod 2016; 31 (09) 2072-2081
• 7 Greenwood EA, Yaffe K, Wellons MF, Cedars MI, Huddleston HG. Depression over the lifespan in a population-based cohort of women with polycystic ovary syndrome: longitudinal analysis. J Clin Endocrinol Metab 2019; 104 (07) 2809-2819
• 8 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 (06) 1861-1869
• 9 Nasiri-Amiri F, Faramarzi M, Omidvar S, Alizadeh-Navaei R. Depression and anxiety in adolescents and young women with polycystic ovary syndrome: a systematic review and meta-analysis. Int J Adolesc Med Health 2023; 35 (03) 233-242
• 10 Lee IT, Sansone S, Irfan M, Copp T, Beidas R, Dokras A. Implementation of international guidelines for polycystic ovary syndrome: barriers and facilitators among gynecologists and primary care providers. F S Rep 2022; 3 (02) 94-101
• 11 Ismayilova M, Yaya S. “I felt like she didn't take me seriously”: a multi-methods study examining patient satisfaction and experiences with polycystic ovary syndrome (PCOS) in Canada. BMC Womens Health 2022; 22 (01) 47
• 12 Teede HJ, Tay CT, Laven J. et al; International PCOS Network. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Fertil Steril 2023; 120 (04) 767-793
• 13 DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 2000; 160 (14) 2101-2107
• 14 Castro A, Roca M, Ricci-Cabello I. et al. Adherence to lifestyle interventions for treatment of adults with depression: a systematic review and meta-analysis. Int J Environ Res Public Health 2021; 18 (24) 13268
• 15 Greenwood EA, Pasch LA, Cedars MI, Legro RS, Eisenberg E, Huddleston HG. Eunice Kennedy Shriver National Institute of Child Health and Human Development Reproductive Medicine Network. Insulin resistance is associated with depression risk in polycystic ovary syndrome. Fertil Steril 2018; 110 (01) 27-34
• 16 Xing L, Xu J, Wei Y. et al. Depression in polycystic ovary syndrome: Focusing on pathogenesis and treatment. Front Psychiatry 2022; 13: 1001484
• 17 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: 107-113
• 18 Yoshida T, Saito K, Kawamura T. et al. Circulating steroids and mood disorders in patients with polycystic ovary syndrome. Steroids 2021; 165: 108748
• 19 Dokras A, Clifton S, Futterweit W, Wild R. Increased risk for abnormal depression scores in women with polycystic ovary syndrome: a systematic review and meta-analysis. Obstet Gynecol 2011; 117 (01) 145-152
• 20 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 (05) 986-992
• 21 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 (05) 930-938.e1
• 22 Risal S, Manti M, Lu H. et al. Prenatal androgen exposure causes a sexually dimorphic transgenerational increase in offspring susceptibility to anxiety disorders. Transl Psychiatry 2021; 11 (01) 45
• 23 Robinson SL, Ghassabian A, Sundaram R. et al. The associations of maternal polycystic ovary syndrome and hirsutism with behavioral problems in offspring. Fertil Steril 2020; 113 (02) 435-443
• 24 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 (05) 1812-1816
• 25 Kogure GS, Lopes IP, Ribeiro VB. et al. The effects of aerobic physical exercises on body image among women with polycystic ovary syndrome. J Affect Disord 2020; 262: 350-358
• 26 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 (08) 2966-2974
• 27 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
• 28 Patten RK, Pascoe MC, Moreno-Asso A, Boyle RA, Stepto NK, Parker AG. Effectiveness of exercise interventions on mental health and health-related quality of life in women with polycystic ovary syndrome: a systematic review. BMC Public Health 2021; 21 (01) 2310
• 29 Mikkelsen K, Stojanovska L, Polenakovic M, Bosevski M, Apostolopoulos V. Exercise and mental health. Maturitas 2017; 106: 48-56 DOI: 10.1016/j.maturitas.2017.09.003.
• 30 Smith PJ, Merwin RM. The role of exercise in management of mental health disorders: an integrative review. Annu Rev Med 2021; 72: 45-62
• 31 Kang JH, Le QA. Effectiveness of bariatric surgical procedures: a systematic review and network meta-analysis of randomized controlled trials. Medicine (Baltimore) 2017; 96 (46) e8632
• 32 Dawes AJ, Maggard-Gibbons M, Maher AR. et al. Mental health conditions among patients seeking and undergoing bariatric surgery: a meta-analysis. JAMA 2016; 315 (02) 150-163
• 33 Gill H, Kang S, Lee Y. et al. The long-term effect of bariatric surgery on depression and anxiety. J Affect Disord 2019; 246: 886-894
• 34 Skubleny D, Switzer NJ, Gill RS. et al. The impact of bariatric surgery on polycystic ovary syndrome: a systematic review and meta-analysis. Obes Surg 2016; 26 (01) 169-176
• 35 Oinonen KA, Mazmanian D. To what extent do oral contraceptives influence mood and affect?. J Affect Disord 2002; 70 (03) 229-240
• 36 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 (06) 1840-1845
• 37 Hamal C, Velugoti LSDR, Tabowei G. et al. Metformin for the improvement of comorbid depression symptoms in diabetic patients: a systematic review. Cureus 2022; 14 (08) e28609
• 38 Moulton CD, Hopkins CWP, Ismail K, Stahl D. Repositioning of diabetes treatments for depressive symptoms: a systematic review and meta-analysis of clinical trials. Psychoneuroendocrinology 2018; 94: 91-103
• 39 Erensoy H, Niafar M, Ghafarzadeh S, Aghamohammadzadeh N, Nader ND. A pilot trial of metformin for insulin resistance and mood disturbances in adolescent and adult women with polycystic ovary syndrome. Gynecol Endocrinol 2019; 35 (01) 72-75
• 40 Naderpoor N, Shorakae S, de Courten B, Misso ML, Moran LJ, Teede HJ. Metformin and lifestyle modification in polycystic ovary syndrome: systematic review and meta-analysis. Hum Reprod Update 2015; 21 (05) 560-574
• 41 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 (06) 767-776
• 42 Guo QJ, Shan J, Xu YF. et al. Pioglitazone metformin complex improves polycystic ovary syndrome comorbid psychological distress via inhibiting NLRP3 inflammasome activation: a prospective clinical study. Mediators Inflamm 2020; 2020: 3050487
• 43 Kahal H, Kilpatrick E, Rigby A, Coady A, Atkin S. The effects of treatment with liraglutide on quality of life and depression in young obese women with PCOS and controls. Gynecol Endocrinol 2019; 35 (02) 142-145
• 44 American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder (revision). Am J Psychiatry 2000; 157 (4, Suppl): 1-45
• 45 Gautam M, Tripathi A, Deshmukh D, Gaur M. Cognitive behavioral therapy for depression. Indian J Psychiatry 2020; 62 (Suppl. 02) S223-S229
• 46 Majidzadeh S, Mirghafourvand M, Farvareshi M, Yavarikia P. The effect of cognitive behavioral therapy on depression and anxiety of women with polycystic ovary syndrome: a randomized controlled trial. BMC Psychiatry 2023; 23 (01) 332
• 47 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 pilot randomized clinical trial. Fertil Steril 2018; 110 (01) 161-171.e1
• 48 Jiskoot G, van der Kooi AL, Busschbach J, Laven J, Beerthuizen A. Cognitive behavioural therapy for depression in women with PCOS: systematic review and meta-analysis. Reprod Biomed Online 2022; 45 (03) 599-607
• 49 Bandealy SS, Sheth NC, Matuella SK. et al. Mind-body interventions for anxiety disorders: a review of the evidence base for mental health practitioners. Focus Am Psychiatr Publ 2021; 19 (02) 173-183
• 50 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 (01) 57-66
• 51 Moeller LV, Lindhardt CL, Andersen MS, Glintborg D, Ravn P. Motivational interviewing in obese women with polycystic ovary syndrome - a pilot study. Gynecol Endocrinol 2019; 35 (01) 76-80
• 52 Phimphasone-Brady P, Palmer B, Vela A. et al. Psychosocial interventions for women with polycystic ovary syndrome: a systematic review of randomized controlled trials. F&S Reviews 2022; 3 (01) 42-56
• 53 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 (06) e0233876
• 54 Masoudi M, Ansari S, Kashani L. et al. Effect of sertraline on depression severity and prolactin levels in women with polycystic ovary syndrome: a placebo-controlled randomized trial. Int Clin Psychopharmacol 2021; 36 (05) 238-243
• 55 Guideline Development Panel for the Treatment of Depressive Disorders. Summary of the clinical practice guideline for the treatment of depression across three age cohorts. Am Psychol 2022; 77 (06) 770-780
• 56 Permanente K. Adult and Adolescent Depression Screening, Diagnosis, and Treatment Guideline 2021. Accessed September 7, 2023 at: https://wa.kaiserpermanente.org/static/pdf/public/guidelines/depression.pdf
• 57 Fava M. Weight gain and antidepressants. J Clin Psychiatry 2000; 61 (Suppl. 11) 37-41
• 58 de Silva VA, Suraweera C, Ratnatunga SS, Dayabandara M, Wanniarachchi N, Hanwella R. Metformin in prevention and treatment of antipsychotic induced weight gain: a systematic review and meta-analysis. BMC Psychiatry 2016; 16 (01) 341
• 59 Zhichao H, Ching LW, Huijuan L. et al. A network meta-analysis on the effectiveness and safety of acupuncture in treating patients with major depressive disorder. Sci Rep 2021; 11 (01) 10384
• 60 Smith CA, Armour M, Lee MS, Wang LQ, Hay PJ. Acupuncture for depression. Cochrane Database Syst Rev 2018; 3 (03) CD004046
• 61 Wang Z, Dong H, Wang Q. et al. Effects of electroacupuncture on anxiety and depression in unmarried patients with polycystic ovarian syndrome: secondary analysis of a pilot randomised controlled trial. Acupunct Med 2019; 37 (01) 40-46
• 62 Tarkesh F, Namavar Jahromi B, Hejazi N, Hoseini G. Effect of vitamin K2 administration on depression status in patients with polycystic ovary syndrome: a randomized clinical trial. BMC Womens Health 2022; 22 (01) 315
• 63 Shahdadian F, Mohammadi H, Rouhani MH. Effect of vitamin K supplementation on glycemic control: a systematic review and meta-analysis of clinical trials. Horm Metab Res 2018; 50 (03) 227-235
• 64 Karamali M, Gholizadeh M. The effects of coenzyme Q10 supplementation on metabolic profiles and parameters of mental health in women with polycystic ovary syndrome. Gynecol Endocrinol 2022; 38 (01) 45-49
• 65 Oral carnitine supplementation reduces body weight and insulin resistance in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial. Clin Endocrinol (Oxf) 2023; 98 (05) 745
• 66 Expression of concern: “Calcium plus vitamin D supplementation influences biomarkers of inflammation and oxidative stress in overweight and vitamin D-deficient women with polycystic ovary syndrome: a randomized double-blind placebo-controlled clinical trial”. Clin Endocrinol (Oxf) 2023; 98 (05) 746
• 67 Expression of concern: “Comparison of myo-inositol and metformin on clinical, metabolic and genetic parameters in polycystic ovary syndrome: a randomized controlled clinical trial”. Clin Endocrinol (Oxf) 2023; 98 (05) 748
• 68 Bengtsdotter H, Lundin C, Gemzell Danielsson K. et al. Ongoing or previous mental disorders predispose to adverse mood reporting during combined oral contraceptive use. Eur J Contracept Reprod Health Care 2018; 23 (01) 45-51
• 69 Raeder F, Merz CJ, Tegenthoff M. et al. Do oral contraceptives modulate the effects of stress induction on one-session exposure efficacy and generalization in women?. Psychopharmacology (Berl) 2023; 240 (05) 1075-1089
• 70 Raeder F, Heidemann F, Schedlowski M, Margraf J, Zlomuzica A. No pills, more skills: the adverse effect of hormonal contraceptive use on exposure therapy benefit. J Psychiatr Res 2019; 119: 95-101
• 71 Zemdegs J, Martin H, Pintana H. et al. Metformin promotes anxiolytic and antidepressant-like responses in insulin-resistant mice by decreasing circulating branched-chain amino acids. J Neurosci 2019; 39 (30) 5935-5948
• 72 Tsai WH, Sung FC, Chiu LT, Shih YH, Tsai MC, Wu SI. Decreased risk of anxiety in diabetic patients receiving glucagon-like peptide-1 receptor agonist: a nationwide, population-based cohort study. Front Pharmacol 2022; 13: 765446
• 73 Pozzi M, Mazhar F, Peeters GGAM. et al. A systematic review of the antidepressant effects of glucagon-like peptide 1 (GLP-1) functional agonists: Further link between metabolism and psychopathology: Special Section on “Translational and Neuroscience Studies in Affective Disorders”. Section Editor, Maria Nobile MD, PhD. This Section of JAD focuses on the relevance of translational and neuroscience studies in providing a better understanding of the neural basis of affective disorders. The main aim is to briefly summaries relevant research findings in clinical neuroscience with particular regards to specific innovative topics in mood and anxiety disorders. J Affect Disord 2019; 257: S0165-0327 (19)30593-2
• 74 Kaczkurkin AN, Foa EB. Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues Clin Neurosci 2015; 17 (03) 337-346
• 75 Oberg E, Lundell C, Blomberg L, Gidlöf SB, Egnell PT, Hirschberg 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 (01) 1-11
• 76 Dema H, Videtič Paska A, Kouter K. et al. Effects of mindfulness-based therapy on clinical symptoms and DNA methylation in patients with polycystic ovary syndrome and high metabolic risk. Curr Issues Mol Biol 2023; 45 (04) 2717-2737
• 77 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 (02) 112-117
• 78 Steenen SA, van Wijk AJ, van der Heijden GJ, van Westrhenen R, de Lange J, de Jongh A. Propranolol for the treatment of anxiety disorders: systematic review and meta-analysis. J Psychopharmacol 2016; 30 (02) 128-139
• 79 Szeleszczuk Ł, Frączkowski D. Propranolol versus other selected drugs in the treatment of various types of anxiety or stress, with particular reference to stage fright and post-traumatic stress disorder. Int J Mol Sci 2022; 23 (17) 10099
• 80 Rao VS, Armour M, Patwardhan K. et al. A scoping review of Ayurveda studies in women with polycystic ovary syndrome. J Integr Complement Med 2023; 29 (09) 550-561
• 81 Rao V, Metri K, Rao S, Nagaratna R. Improvement in biochemical and psychopathologies in women having PCOS through yoga combined with herbal detoxification. J Stem Cells 2018; 13 (04) 213-222