Common symptoms of PCOS are anxiety and depression. It’s something many of us struggle with, either as a one time thing or on and off over the years. Mental health is something that’s really difficult to talk about because of the stigma that comes attached to it. Because of that stigma, it’s often quite difficult to recognise what’s going on with us, and even harder to reach out and ask for help. We think we’re weak. We think we’re tired. We write off much of our self-loathing as having a cause…but the truth is that there are valid reasons for feeling miserable with this illness and then there are actual chemical imbalances that drag us down, irrespective of our desire to keep ourselves on the level.
It would be easy to think that our low mood could be ascribed to our physical or perceived flaws. As a woman, to have to get up every morning and face the mammoth task of dealing with your hirsutism is a painful and ugly thing. To look in the mirror and not feel feminine is degrading in a way I can’t even describe, and I’m a writer so that should tell you something about the depth of that feeling. To slave away at a diet and exercise program, watching everyone around you stripping off the pounds while you maybe drop half a pound here and there, is soul-destroying. Carrying all this excess weight around while society bombards you with the concept that slim is beautiful is just a self-loathing sandwich, every second of every day. Being forced to live a lifestyle that makes you give up many of the things you love and then reminds you of it every time you want to eat at a restaurant or a friend’s house is adding insult to injury. I’m not even going to start in on the guilt we feel for the impact that our constant fatigue and/or illness can have on the people we love, or the way we hate ourselves for being too tired to get up and do basic chores a lot of the time.
And all of these things pale into insignificance when it comes to that most basic of biological urges – procreation. PCOS is the number one cause of infertility in the world. As an obstacle it can be overcome in most cases with medical intervention and strict lifestyle control, but not until after years of trying in most cases. If you’re a woman reading this, you’ll understand on some level the constant pressure on women to feel like they have to have children, like it’s a basic human right that’s mandatory for everyone. Saying that you don’t want children is often met with looks of utter horror, demands for explanation or (my personal favourite) “oh sweetie, you’ll change your mind when you meet the right man”. If you want children, the struggle to get there can make you question every single thing about your self value and it gets compounded every single time those first spots of menstrual blood appear. The whole of society and biology is constructed in a way that makes you feel like an abject failure as a woman AND as a human being. Worse than that, PCOS has been shown to increase risks of single and recurrent miscarriage. Imagine that…you overcome all the obstacles to get to your dream and then it’s snatched from you at the 11th hour. And if, by some small mercy, you can keep that baby, the American Pregnancy Association states that women who have PCOS also have a higher risk of gestational diabetes, pregnancy induced hypertension and premature birth. The hits just keep on coming.
So with all of that, you would assume that maybe we have a reason to feel down, but actually it’s a lot more complicated than that and the figures are both sobering and startling. A comprehensive review of available scientific literature carried out in 2015 is well worth reading as an eye-opener about the long term concerns related to PCOS, but of interest today are the findings they present about psychological disorders and reduced quality of life. Up to 67% of women with PCOS also have depression. Women with PCOS are four times more likely than healthy women to have depression and that risk still stands even after body weight and everything else has been taken into account. Women with PCOS, including adolescents, are more likely to suffer from generalised anxiety.
With such a clear correlation and high incidence of psychological disorders, you’d think that there would be an obvious cause, but it’s just not that clear cut. There are a number of contributing factors, over and above everything I mentioned previously.
The first is the high levels of circulating androgens in women who suffer from PCOS. A study from 2004 concluded that levels just above normal of free testosterone in the body directly correlate with negative mood levels (although very high levels didn’t appear to have an effect). This is further compounded by a study from 2015 which concluded that exposure to excess testosterone as foetuses actually alters the activity of our brains. PCOS, as we’ve discussed earlier in the month, is well established to be hereditary, so a significant proportion of sufferers will have been born to mothers who have excess androgen. The study concludes that the testosterone interfered with the gene for androgen receptors in the amygdala. They also identified alterations in the receptors for oestrogen, as well as changes in the genes that regulate serotonin and GABA, which are mood-regulating neurotransmitters involved in the regulation of anxiety. We are pre-disposed to depression and anxiety before we even take our first breath.
There’s a link between insulin resistance and emotional processing. A study from 2013 concludes that insulin-resistant PCOS sufferers activate more of their limbic system than healthy women during processing of emotion based tasks and tended more towards negative emotions and anxiety. Treatment with Metformin brought them back in line with the control group. This is believed to be something to do with opioid receptors in the brain but I’m going to be honest and say that I don’t completely understand the science behind it so I’m just going to put a bunch of references at the bottom and if you want to try and figure it out, be my guest.
The final brick in the wall that I’ve been able to find is the scientists recently making links between inflammation and a whole host of things, including depression and chronic fatigue syndrome. While there are studies that disprove a link between chronic low grade inflammation and depression specifically in PCOS, they’re in the minority. There are numerous studies linking inflammation and depression, including this one that directly correlates elevated CRP with depression. If you’ve clicked on any of the links to studies in previous posts about PCOS and inflammation, you’ll notice that CRP is one of the common markers associated with inflammation in PCOS. This link appears to have been relatively recent in scientific terms (2011 – 2012) so there’s still not much data publicly available, but a review specifically of PCOS patients highlighted a strong correlation and called for further research to be carried out. Go science.
While this was, in many ways, an incredibly difficult blog post to write, albeit fascinating to research, I hope that if you are reading this as a woman with PCOS and depression, what you will take away from it is that your feelings are valid. You are not alone. Help is available to you. There are things you can do to mitigate your susceptibility to it. Improve your insulin sensitivity, lower your inflammation and decrease your circulating testosterone and those will all count towards an improved management of anxiety and depression. Most of all, I want you to know that it’s okay to talk about these things. Seek help. Speak out. And somewhere, deep down, cast off everything that society tells you you should be and be proud of who and what you are – a warrior.