Illustration by Marta Pucci
Everything you need to know about depression, anxiety, and PCOS
PCOS may impact your mood, but there are treatments that can help
Top things to know about depression, anxiety, and PCOS:
PCOS is thought to affect roughly 1 in 10 people with cycles worldwide, but a majority go undiagnosed (1)
People with PCOS are three to eight times more likely to experience depression and anxiety than people without PCOS; the reasons for this are still unclear
Medications and other therapies may be helpful for improving symptoms of depression and anxiety
How is PCOS related to mental health?
Polycystic ovary syndrome (PCOS) is a complex condition that impacts many aspects of a person’s health, including mental health. People with PCOS are about three to eight times more likely to be diagnosed with anxiety and depression than those without PCOS (2-4). Symptoms of anxiety and depression are often more severe in people with PCOS (2).
Most of the research on PCOS and mental health has focused on depression and anxiety. But PCOS may also increase the risk of obsessive-compulsive disorder (OCD), bipolar disorder, autism spectrum disorder, eating disorders, and sleep disorders, (2,5). Adolescents with PCOS are more likely to have psychiatric disorders than peers without PCOS (6,7).
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Why is there a link between PCOS and mental health?
It’s unclear what causes the increased risk for anxiety and depression among people with PCOS. It could be due to PCOS symptoms, hormonal differences, or a mix of unknown factors.
PCOS symptoms
Some of the most common symptoms of PCOS include (8,9):
Infertility
Obesity
Irregular or infrequent menstrual periods
Metabolic changes that can affect cholesterol and blood sugar levels
PCOS can look and feel different for everyone. Some people with PCOS sometimes report feeling frustrated and anxious about their ability to become pregnant, their weight, excess body and facial hair, or lack of control over their health and bodies (10). A person’s values and culture will impact which PCOS characteristics they may find distressing (10).
Track your PCOS symptoms in Clue
For people who are experiencing changes to their body due to PCOS, tracking with Clue can give them peace of mind. You can track your PCOS symptoms to help you see if any interventions improve your symptoms. Tracking categories available on Clue include periods, skin, ovulation signs, and mood. You can also add your diagnosis for PCOS in the ‘My Health Record’ feature in the Clue app.
Hormonal differences of PCOS
Insulin
Researchers have looked into whether differences in hormone levels in people with PCOS explain the increased risk for anxiety and depression. One hormone that may be involved is insulin. Insulin is a hormone that allows the cells in your body to take up and use blood sugar. Some people with PCOS have insulin resistance, resulting in higher levels of insulin in the bloodstream (9). Insulin resistance is linked to higher blood sugar, high blood pressure, high cholesterol, and increased inflammation in the body (11).
One study found that greater insulin resistance increased the risk for depression (12), but other studies found no difference (13,14). Researchers aren’t clear about how depression and insulin resistance may be related – whether insulin resistance negatively affects mood, or whether depression itself causes insulin resistance (15). It’s thought to be a complex relationship involving different hormones and inflammation in the body.
Insulin resistance is more likely in people with PCOS and obesity (16). It isn’t fully clear why, but may be related to genetic predisposition and/or the impact of obesity on fat and muscle tissue in the body (17).
Androgens
Another type of hormone that may contribute to mood changes is androgens. Androgens (a group of hormones including testosterone) are elevated in many people with PCOS (8). When androgens stay elevated over a long time period (chronic hyperandrogenism), they can block ovulation and lead to many of the symptoms of PCOS, including acne and hirsutism (excess hair growth) (8). Only one study has looked at levels of testosterone and found no effect on depression and anxiety symptoms (18). Higher levels of DHEAS (a type of androgen hormone) may be associated with an increased risk for depression and anxiety in people with PCOS, but this was only found in one study, and more research is needed (19).
Chemicals in the brain of people with PCOS
People with PCOS and anxiety or depression may have lower levels of certain neurotransmitters (20). These are chemicals that send signals to the brain and nervous system (20). Neurotransmitters like serotonin are key in depression and anxiety. Serotonin is a chemical messenger in the nervous system. It is linked to positive feelings (20). Some research shows that elevated testosterone levels impact serotonin signaling in the body. This may help explain why people with PCOS who have chronic hyperandrogenism are more likely to experience anxiety and depression (20).
What treatments for PCOS are available?
If you have PCOS and feel anxious or depressed, talk to your healthcare provider. There are many treatments that can help.
Lifestyle changes to improve mental health
There is very little data to support a specific diet to improve mood in people with PCOS. One study found that eating vegetables and legumes is protective against anxiety and depression, whereas drinking sugary beverages increases risk (21). Another study found that a high-protein, low-carb diet helped people with PCOS feel less depressed in the short term (22). Research is mixed, however, and any effect is minimal.
Leading an active lifestyle in general may help improve mental health. Some studies found that regular exercise helped people with PCOS feel less anxious and depressed (23). However, the research is unclear about which exercise is best, and more evidence is needed (23).
Medications and supplements to improve mental health
There is little research on treating PCOS with psychiatry. One study found that sertraline, a commonly prescribed selective serotonin reuptake inhibitor (SSRI) to treat anxiety and depression, decreased depression severity in people with PCOS (24). More research is needed on the use of antidepressants and anti-anxiety medications for PCOS.
Medications that help the body use insulin, such as metformin, may improve symptoms of depression in people with PCOS (25,26). Metformin may also help with anxiety symptoms (25).
Taking Omega-3 fatty acids from fish oil alone, or in combination with Vitamin D, may decrease symptoms of depression and anxiety in people with PCOS (27). Some evidence suggests that supplementing coenzyme q10 can improve self-reported anxiety and depression symptoms (28).
Complementary and alternative therapies for mental health
Acupuncture may help people with PCOS feel less depressed and anxious (29). People with PCOS who practice mindfulness-based therapy for two hours a week may feel less anxious and stressed (30). This therapy involves being aware of your body and your breath during daily activities and walking (30). Cognitive behavioral therapy (CBT) may also help people with PCOS feel less anxious (31).
Some people with PCOS get more facial hair, which may make them feel self-conscious. Laser hair removal may help people with PCOS feel less depressed and anxious (32,33).
More research is needed to find the best treatments for depression and anxiety in people with PCOS.
Where can I find support?
Your healthcare provider can help you sort through your symptoms and find the right treatment. Specialists in psychiatry or endocrine (hormonal) health may also be able to support you.
For people with PCOS struggling with moderate to severe symptoms of anxiety and depression, there are resources available.
United States:
Call or text the 988 Suicide and Crisis Lifeline for 24/7 support from trained counselors
For treatment or referral help, call the Substance Abuse and Mental Health Services Administration (SAMHSA) helpline at 1-800-662-HELP or visit the SAMHSA website
Visit the American College of Obstetricians and Gynecologists (ACOG) or the American Society for Reproductive Medicine (ASRM) websites for FAQs and the latest management strategies for PCOS
United Kingdom:
Reach out via text to the SHOUT Crisis Line at 85258
Adolescents under 19 can reach out to Childline at 0800 1111
Use the confidential Samaritan Help Line by calling 116 123, emailing jo@samaritans.org, writing a letter, or visiting in person
Check out the UK-based charity Verity for support groups, events, and conferences related to PCOS
Australia:
Call Lifeline at 13 11 14 for 24/7 mental health support, or reach out by online chat or text
Find professional or community support through SANE
Use the Beyond Blue helpline or connect with one of their mental health professionals or coaches
FAQs
How do I manage anxiety and depression when living with PCOS?
People with PCOS can manage anxiety and depression in different ways. Exercise may improve mental health (23). Some medications, like antidepressants, anti-anxiety medications, and metformin, may also improve mood symptoms (23-25). Acupuncture, mindfulness, and cognitive behavioral therapy can also help with mental health (29-31).
Are mood swings a symptom of PCOS?
Yes. Hormonal imbalances can cause mood swings in people with PCOS (34). The long-term health issues associated with PCOS are both physical and mental (1).
Does PCOS cause depression?
It’s not clear if PCOS is the cause of depression, but the two seem to be linked. People with PCOS are more likely to experience anxiety and depression, as well as other mental health difficulties (2-5). Insulin resistance is common in people with PCOS and is also linked to depression (12).
