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
Serum androgens and depression in women with facial hirsutism.
Serum androgens and depression in women with facial hirsutism.
Shulman LH, DeRogatis L, Spielvogel R, Miller JL, Rose LI.
J Am Acad Dermatol. 1992 Aug;27(2 Pt 1):178-81.
Department of Medicine, Hahnemann University School of Medicine, Philadelphia, PA.
BACKGROUND: Studies on the psychopathologic aspects of hirsutism are sparse. Attempts to correlate these aspects with either the extent of the facial hirsutism and/or circulating serum androgens are virtually nonexistent. This study evaluates the psychopathologic aspects of hirsutism and correlates these findings with the extent of the facial hirsutism as well as with the circulating serum androgens.
OBJECTIVE: Our purpose was to assess the psychopathologic aspects of facial hirsutism and to determine whether any correlation exists between these findings and either the extent of the facial hirsutism or the circulating serum androgens.
METHODS: Twenty consecutive women with facial hirsutism were studied by administration of psychologic tests (DeRogatis Symptom Inventory and the Affects Balance Scale). The results of these tests were correlated with the grade of facial hirsutism as well as serum levels of total testosterone (T), biologically active testosterone (BT), free testosterone (FT), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S), and androstenedione (A-dione).
RESULTS: Significant levels of depression were found. No correlation was found between the psychopathologic measurements and the extent of facial hirsutism or serum levels of T, DHEA, DHEA-S, and A-dione. Significant correlations were found between depression and serum levels of FT and BT.
CONCLUSION: There is an increased incidence of depression in facially hirsute women and this correlates with their circulating active testosterone levels and not with the extent of their facial hirsutism.
Serum androgens and psychopathology in hirsute women
Serum androgens and psychopathology in hirsute women.
Derogatis LR, Rose LI, Shulman LH, Lazarus LA.
J Psychosom Obstet Gynaecol. 1993 Dec;14(4):269-82.
Department of Mental Health Sciences, Hahnemann University School of Medicine, Philadelphia, PA.
Twenty consecutive women referred for evaluation and treatment of idiopathic hirsutism were evaluated with regard to levels of serum androgens, degree of hirsutism, nature and prevalence of psychological symptoms, and mood and affects. Androgens measured were total testosterone, free testosterone, biologically active testosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate and androstenedione. Psychological symptoms were quantified via the Derogatis Symptom Inventory, and mood and affects were measured by the Affects Balance Scale. Results revealed very significant correlations between unbound fractions of testosterone (i.e. free and biologically active testosterone) and both symptom and mood measures of depression (r = 0.60; p < 0.01). Significant inverse correlations were also observed between unbound fractions of testosterone and positive affects measures (e.g. 'contentment' r = -0.51; p < 0.05). Correlations between total testosterone and psychological variables were non-significant in all instances. Measures of degree of hirsutism correlated approximately zero (o) with psychological symptom and mood measures in this sample. When psychiatric 'caseness' criteria were applied to the cohort, seven of the 20 women (35%) were found to be positive. Results are interpreted to suggest that depression among hirsute women appears more likely to have its basis in a deranged neuroendocrine mechanism than in psychosocial causes.
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PCOS, Depression, and High Testosterone... 
