Depression is a prominent characteristic of women who have polycystic ovary syndrome. Part of the depression stems from the emotional difficulty of being infertile, overweight, too hairy, or having acne, hair loss or some other disturbing symptom. However, the primary cause of depression in PCOS appears to be hormonal in nature. A number of studies have shown a connection between a negative mood and elevated androgens, which are male hormones such as testosterone. In one interesting study, there was a correlation between the most intense depression and testosterone levels slightly above normal, but not when testosterone was low or extremely high.
Of course, depression is not limited to elevated testosterone. Depression has also been associated with insulin resistance and depressed thyroid function. Disturbed LH (luteinizing hormone) levels and rhythms have been found in depressed women compared to women who are not depressed. Disturbed LH is a primary reason why you don't ovulate. Abnormal estrogen and cortisol are additional hormonal factors connected to depression.
Women with mixed anxiety-depression disorder have high levels of homocysteine in the follicular and luteal phase of the menstrual cycle, and they have higher blood homocysteine levels as compared to healthy women. Women with PCOS commonly have elevated homocysteine, which is a byproduct of metabolic activity. Normally, homocysteine is broken down and made harmless. However, a poor diet that is deficient in calcium and B vitamins, and drugs such as Metformin (Glucophage) help to elevate homocysteine.
All of the above factors for depression are common in PCOS women. There are additional factors that we won't go into here. But you can see that if you have PCOS and depression, you have a complex situation on your hands, a situation that does not have a simple solution.
The good news is that you can favorably alter your hormones and thus lift your depression at least to some extent with a healthy diet, regular exercise, stress management, selected nutritional supplements, and possibly medications. The diet would include plenty of whole, fresh vegetables, fresh fruit in moderation, fish, poultry, some other meats, nuts and seeds in moderation, greatly reduced consumption of grain products, and possible reduction of some legumes. As for nutritional supplements, a high quality multi-vitamin/mineral would be a good place to start.
Sources
Dr. Nancy Dunne,
Androgens and mood dysfunction in women: comparison of women with polycystic ovarian syndrome to healthy controls, Psychosom Med. 2004 May-Jun;66(3):356-62
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Hey, SoulCysters! Need to eat more veggies, but can't find recipes??
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I suffered my first bout of depression within a few weeks of starting Metformin. I was reasonably good at steering clear of all the bad foods - high fat, high sugar and refined carbs and lost a some weight which was great.
I came off Met about a month ago and have started on a high fibre, high protein diet through a university study. My moods have never been so balanced and I'm a much cheerful person. Again people are asking me if I've lost weight because I look much healthier - I dont think i have, its only been 2 weeks on the new diet plan!, but I am definately a better person 'inside'. It will be interesting to see if I still feel the same in 2 months time at the end of the study.
I find the point about a diet low in calcium interesting - I had to avoid a lot of dairy when on Met due to the awful side effects and calcium supplements are expensive so I wasn't taking them regulary. This new diet plan means I am consuming at least 2 servings of dairy a day. I wouldn't be surprised if this is playing a part in my health - my moods in particular - as its the most significant change to my diet.
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Diagnosed Aug 2005. Symptoms: No periods, obese, excessive hair
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I came off Met about a month ago and have started on a high fibre, high protein diet through a university study. My moods have never been so balanced and I'm a much cheerful person. .
I've never tried met, but the 'wrong' diet for me is like flipping on the depression switch. Especially a low fat diet. Even if everything I'm eating is very healthy, if it's two low fat my brain literally starts to spiral into depression. Add the 'good fat' back, and my moods are back to normal.
Quote:
Originally Posted by februarystar
I find the point about a diet low in calcium interesting - I had to avoid a lot of dairy when on Met due to the awful side effects and calcium supplements are expensive so I wasn't taking them regulary. This new diet plan means I am consuming at least 2 servings of dairy a day. I wouldn't be surprised if this is playing a part in my health - my moods in particular - as its the most significant change to my diet.
There's a program here in the states on now called "The Truth About Food". They looked at a 3 month study of women and severe PMS. They had to eat multiple servings of dairy and fish (or fish oil) each day...at the end of the study, their pms mood and other disturbances were all reduced.
Also see the Vitamin D thread down in Alternative Remedies.
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Hey, SoulCysters! Need to eat more veggies, but can't find recipes??
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I'm new here and this is interesting to me. I'm a thin cyster and suffered from some depression as a teenager. I went on antidepressant for a little while and then on BC at 17 since I had rare AFs. I went off BC last summer since DH and I are TTC and have noticed some depression coming back - not sure if it's linked and it's not severe but keeping an eye on it. Current dr just kind of breezed over it when I mentioned emotional issues.
I might be starting Met next week if the labs come back OK - has anyone found that Met helped with emotional problems?
If you can find these articles where doctors are stating that depression is linked to PCOS and hormones, etc. Why then, have the 2 RE's that I have seen here in Dallas,TX told me that its not? I am so confused and about to start Met.
If you can find these articles where doctors are stating that depression is linked to PCOS and hormones, etc. Why then, have the 2 RE's that I have seen here in Dallas,TX told me that its not? I am so confused and about to start Met.
As for why doctors don't bother to look up the info? That's the $64,000 question... Especially when there's PLENTY of research on Depression and PCOS...and depression and pcos MEDS.
I wouldn't let this scare you away from met. Just be mindful of any mood changes. That advice goes for any med.
Back when I was first diagnosed, I was Rx'd Demulen (a bcp) and aldactone, and developed SEVERE depression and major sweating and night sweats. The doctor tried to tell me that BCP's didn't cause depression, and that I was depressed because I was fat (at the time I weighed nearly 250 pounds), and that I was sweaty because I was fat and it was summer.
I would have been livid, but I was too depressed to be livid.
I KNEW it was the pills, since I had never felt like this before, and it was literally ruining my life.
So I pulled out the leaflet for the BCP's (that thin paper with a gazillion words), and sure enough, in teensy print, DEPRESSION was listed as a side effect.
Just like the OP, the week I came off of the meds, I felt like the clouds lifted, the sun came out, and my head was clear.
And also like the OP, I became 100% dedicated to living a healthy lifestyle so that I wouldn't have to depend on hormonal meds to keep my pcos under control.
Speaking of me finding research that doctors can't bother to look up...I also found studies about the drug Flutamide being used to treat hirsutism in women in Europe. No doctors hear wanted to hear ANYTHING about it. I gathered my research, and went doctor to doctor, and found one that would Rx it for me, as long as I promised to come in for regular liver testing, and wouldn't drink alcohol.
With Flutamide, diet and exercise, I lost 90 pounds in 14 months, and have been completely med free since then. That was 10 years ago...
It was the PERFECT med for me. When a few national newspapers did stories on me, the outrage and criticism from 'so called prominent pcos doctors' was crazy...
But now...look at all of the research on PCOS and flutamide (especially since high androgens are linked to depression, and flutamide can help attack belly fat in pcos.)
Don't get me started...seriously.
I would encourage all women with pcos to AT LEAST read the research articles forum. And if you have some extra time, spend a few minutes each week reading the new PCOS research in PubMed.
I havent talked about this on Fit Cysters because I dont think that is the proper place for it, but I have posted a couple of times here. I have had trouble with depression and have been struggling for years to find the best answer. The supplements, dietary changes, etc. have helped. I am not on BCPs anymore and with Met I have had a regular cycle. Met has also helped regulate my moods. There is no doubt in my mind that hormones, both sex hormones and others like insulin, are what my own depression is linked to.
The question that has been burning in my mind is what to do about the Met. It has helped me. It also gets in the way of my training. WHen I lift weights I bottom out with low blood sugar symptoms - sometimes worse than others - and there is no way I can do a good amount of cardio on my weight training days. SOmetimes I can do 10 min of CC after weight training, but days like yesterday I leave the gym after weight training feeling shaky and off, even tho I ate before I worked out and have a gatorade in my hand.
So the thing is, do I stay on Met and appreciate the good it does and adjust accordingly? Or do I try to go off it to tackle the problems without drugs? I was taking only half a dose, in the morning but not at dinner, and that turned out to be a huge error for me. Big time depression symptoms hit me within days and resolved within days when I started taking both doses. How do you know if you need to be on Met for always or if you should try lifestyle only?
So the thing is, do I stay on Met and appreciate the good it does and adjust accordingly? Or do I try to go off it to tackle the problems without drugs? I was taking only half a dose, in the morning but not at dinner, and that turned out to be a huge error for me. Big time depression symptoms hit me within days and resolved within days when I started taking both doses. How do you know if you need to be on Met for always or if you should try lifestyle only?
I've never taken met, so I don't have any personal experience to offer. I was able to control my IR/blood sugar with intense lifestyle intervention.
If you have a doctor who fully understands the positive impact of the type of training you're doing, you might want to talk to him/her about either going off of met for awhile or adjusting your dose. (But I wouldn't make any changes without first talking to someone.)
Adjusting your pre and post workout nutrition might also help with the shakes (but also mention this to your doctor.) Some of us over at Fit Cysters had to make significant adjustments in our pre/post since we're working out 2x a day. Please come join us there. It's great to be in a 'fitness' environment with cysters. There's a thread in the P90x forum on post workout nutrition. I just made a significant change in mine, and it's made a huge difference. (we're here: http://www.FitCysters.com . We don't do much 'diet' talk...it's a group of cysters VERY focused on fitness.)
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Hey, SoulCysters! Need to eat more veggies, but can't find recipes??
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We don't do much 'diet' talk...it's a group of cysters VERY focused on fitness.)
Teehee, that is SO TRUE that you didnt even know it was me.... I am Stephanie at Fit Cysters. I dont talk about this on Fit Cysters. I love that place and the atmosphere, and I agree 100% that it isnt the place for topics like this.
The research I have done leads me to believe that it makes sense that I bottom out when I lift weights but not when I do cardio. Apparently taking Met can cause you to deplete your intramuscular glucose more quickly. It is true for me, and I have yet to find a true fix for it. Eating something balanced with protien and carbs about 90 minutes prior and drinking a PowerAde throughout the workout helps, but hasnt fixed it. Lowering my dose of Met a bit also helped.
Met has been such a huge help to me, and I guess I am scared that I would not be able to manage some of the things without it. I will keep talking with my doc about this and try to decide what is best. At this point I am resigned that I do cardio on cardio days and lift weights only on weight training days.
If you have any other thoughts or info on managing PCOS using Met vs lifestyle only let me know. THanks, Kat.
Metformin & Depression 
The good news is that you can favorably alter your hormones and thus lift your depression at least to some extent with a healthy diet, regular exercise, stress management, selected nutritional supplements, and possibly medications. The diet would include plenty of whole, fresh vegetables, fresh fruit in moderation, fish, poultry, some other meats, nuts and seeds in moderation, greatly reduced consumption of grain products, and possible reduction of some legumes. As for nutritional supplements, a high quality multi-vitamin/mineral would be a good place to start. 
