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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"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."
This part is interesting to me, I have elevated testosterone levels and I am looking for relief from depression w/o having to use any SRI. I would like improvements in memory, concentration, and physical malaise associated with depression. I hope the metformin provides some relief it it lowers my testosterone levels.
I'm going through the same situation. I have extremely high levels of testosterone. When my doctor saw my lab results he said i have enough testosterone to give a man an erection. Guess how this made me feel?
He put me on Metformin and thyroid medication. Ever since I started taking the medication I have felt severly depressed. I've started to have suicidal thoughts. When I told my doctor about this he said he was going to test me for cushing's syndrome. I was reading the symptoms and I have a lot of them, but it's confusing because the symptoms are much like those of PCOS.
I do know one thing. Something just has to give because I can't live like this long-term, nor can my family. I know what it's like to live with someone who is depressed. My mom was depressed ever since I can remember. I always felt like I was walking on egg shells. I didn't want to do anything to upset her. Now that i'm going through it myself I can relate to my poor mother who passed away at 52 years of age. I'm trying to do anything and everything humanly possible to improve my quality of life, but I have to admit that I am fighting an uphill battle.
He put me on Metformin and thyroid medication. Ever since I started taking the medication I have felt severly depressed. I've started to have suicidal thoughts. When I told my doctor about this he said he was going to test me for cushing's syndrome. I was reading the symptoms and I have a lot of them, but it's confusing because the symptoms are much like those of PCOS.
Your doctor should have NEVER diagnosed you with PCOS without first testing you for Cushing's. That's the procedure...FIRST exclude Cushing's.
If your depression started AFTER you started the meds, I would call your doctor and INSIST on switchin meds.
Look up both meds online (find a credible resource), and see if either had any reports of depression as a side effect. Even if 'only' 1% reported depression, you might be in that 1%.
When I was originally put on Demulen and Aldatone for my pcos, I, too, developed HORRIBLE depression which doctors chalked up to "me being depressed over being fat."
Well, I had been obese all of my life, so I knew the depression was due to the meds. Like you, there was NO way I could live like that. I was actually worried that I might hurt myself, and those types of thoughts were 'not like me.'
I researched both meds and Demulen had DEPRESSION listed as a side effect.
After haggling with doctors for weeks, I called and asked, "Am I going to die if I stop these meds?" He said, "No" and I replied, "Is there any danger in abruptly stopping them?" He said, "No."...and I told him, "then I'm done today." I hung up the phone and threw the meds in the trash. (I'm not necessarily recommending that course of action...just sharing what I did.)
My depression lifted almost overnight.
It was at that point I knew that I would have to get VERY serious about what I ate, and my exercise habits. I also went on the search for a new med, and stumbled upon some French studies on Flutamide. It's only approved in the US for the treatment of prostate cancer in men, and it's approved for any uses in women (in the US).
As you can imagine, if it's used to treat prostate cancer, it's a VERY strong anti-androgen. I had to go through 7 doctors to find one to Rx it for me. The 8th one agreed as long as I came in for regular liver testing, and promised not to drink alcohol.
Getting my androgens under control, coupled with extreme lifestyle changes was the 'trick' for me.
But for you...the first thing is to feel better mentally, and the second thing is to get an accurate diagnosis.
hth
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Hey, SoulCysters! Need to eat more veggies, but can't find recipes??
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I'm going in tomorrow morning to get tested for Cushing's. I think the thyroid meds. do cause depression. The thing is my thyroid levels are within normal range so why am I on thyroid medication, you know? I want to stay on Metformin since it has such a good track record. I'll look into this prostate medication. My sister in law has a severe case of PCOS. Poor girl can't get a brake. Her doctor has tried various types of meds. so I'll mention flutamide to her.
Thanks again for what you do. It truly makes a difference!
I'm going in tomorrow morning to get tested for Cushing's. I think the thyroid meds. do cause depression. The thing is my thyroid levels are within normal range so why am I on thyroid medication, you know?
I don't know too much about thyroid stuff. You might want to ask this over in the thyroid forum.
Quote:
Originally Posted by lvtgirl
I'll look into this prostate medication. My sister in law has a severe case of PCOS. Poor girl can't get a brake. Her doctor has tried various types of meds. so I'll mention flutamide to her.
Run a search here on the boards. Search on both FLUTAMIDE and the brand name EULEXIN. You can also find many studies on it over at PubMed.
Quote:
Originally Posted by lvtgirl
Thanks again for what you do. It truly makes a difference!
__________________
Hey, SoulCysters! Need to eat more veggies, but can't find recipes??
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Hi Ladies, Let me start by saying that this forum is a God send. I have been suffering with pcos for the past 8 years. I have the high testrone levels, extreme excessive hair growth in all the wrong places, no periods unless induced, obesity, and acne and high blood pressure which i take medicine for. I use so much of the hair removal products i should be able to write it off at tax time. Over the last few years i find myself extremely tired and frustrated all the time. Sometimes i feel so low, its hard to get out of bed, its to the point to where i barely go to work. Like so many of us, i wish it was a pill or a treatment that could make this go away. I would love to get dressed in a color other than black. I would love to not spend 2 nights a week locked in a bathroom removing facial hairs, so my husband dont have to see it. I needed to say all of this because i feel soooo alone sometimes, and it hurts so bad. I Thank God for what i have because it could be worse, however, as a 30 year old women living with pcos, i also wish to be normal again.
Your doctor should have NEVER diagnosed you with PCOS without first testing you for Cushing's. That's the procedure...FIRST exclude Cushing's.
If your depression started AFTER you started the meds, I would call your doctor and INSIST on switchin meds.
Look up both meds online (find a credible resource), and see if either had any reports of depression as a side effect. Even if 'only' 1% reported depression, you might be in that 1%.
When I was originally put on Demulen and Aldatone for my pcos, I, too, developed HORRIBLE depression which doctors chalked up to "me being depressed over being fat."
Well, I had been obese all of my life, so I knew the depression was due to the meds. Like you, there was NO way I could live like that. I was actually worried that I might hurt myself, and those types of thoughts were 'not like me.'
I researched both meds and Demulen had DEPRESSION listed as a side effect.
After haggling with doctors for weeks, I called and asked, "Am I going to die if I stop these meds?" He said, "No" and I replied, "Is there any danger in abruptly stopping them?" He said, "No."...and I told him, "then I'm done today." I hung up the phone and threw the meds in the trash. (I'm not necessarily recommending that course of action...just sharing what I did.)
My depression lifted almost overnight.
It was at that point I knew that I would have to get VERY serious about what I ate, and my exercise habits. I also went on the search for a new med, and stumbled upon some French studies on Flutamide. It's only approved in the US for the treatment of prostate cancer in men, and it's approved for any uses in women (in the US).
As you can imagine, if it's used to treat prostate cancer, it's a VERY strong anti-androgen. I had to go through 7 doctors to find one to Rx it for me. The 8th one agreed as long as I came in for regular liver testing, and promised not to drink alcohol.
Getting my androgens under control, coupled with extreme lifestyle changes was the 'trick' for me.
But for you...the first thing is to feel better mentally, and the second thing is to get an accurate diagnosis.
hth
I get anxiety with depression almost methodically. I mean this in such a way because it happens on a cycle. Just like if I got a period. Which I don't. I have been studying off and on about how to get my testosterone down. But how, most Dr's are either too egotistic to care and just want to dope me up on glucophage, been there done that, gained a ton of weight. Or just stick me on birth control but that doesn't really solve the problem.
I definatly have PCOS. Overweight, hair in the wrong places, I have seen my ovaries many times. It is not good. I have never had a period naturally and I am at my wits end. These levels of testosterone send me in to complete rages. I have no control. I've asked God for help... and I dunno I am still waiting and searching. I hate the mood swings soo much. I can't handle them. I'm already on so many meds. Everyone is having babies around me. I want to smile but all I really want to do is cry. Not even that brings relief.
How on earth did you ever find out about Flutamide? AND how did you even approach your doc about it. Was it an Endocrinologist? How long did it take to work? Have you had children?
This is sooo true... I suffer from anxiety attacks easily..which turn into depression... It's not something I can control.. At first I thought I was just super sensitive... but it's something i can't control... Years back, (before being diagnosed) my doctor tried giving me depression pills which was supposed to also cure my anxiety attacks.. I refused to take them...with the help of my husband im doing way better..
I am on Cymbalta and Xanax for the Anxiety which helps a lot. And it won't and doesn't intteract with all the oher crap I have to take. The Cymbalta is also good for Fibromyalgia.
Holy Cow- can't believe what I am reading. My grandmother and her sister both committed suicide because of the side affects of what I am sure was undiagnosed PCOS. The died in 1940 and 1950, but I am almost positive. Both were infertile (well,my grandmother conceived once after seven years of marriage), hairy, and depressed. Unbelieveable.
The family still "blames" them , as if they could have controlled their depression.
PCOS, Depression, and High Testosterone... 
i hate testosterone 
