Depression in women with polycystic ovary syndrome: clinical and biochemical correlates

Abstract

Background: We assessed the prevalence of mood disturbance among women with prospectively documented polycystic ovary syndrome (PCOS). Methods: Thirty-two women with PCOS completed the Center for Epidemiological Studies-Depression Rating Scale (CES-D). Clinical and biochemical characteristics were assessed. Results: Sixteen women had CES-D scores indicative of depression. Depression was associated with greater insulin resistance (P=0.02) and higher body mass index (P=0.05). Women receiving oral contraceptives for the treatment of PCOS were less depressed than patients not receiving treatment (P=0.03). Limitations: Possible selection bias, use of a screening tool alone without further diagnostic evaluation of depression, small samples size and lack of direct comparison with an age matched control group, should be considered in interpretation of these results. Conclusion: Findings suggest a high prevalence of depression among women with PCOS, and an association between depression and PCOS markers.

Introduction

The relationship between affective illness and endocrine systems has generated considerable interest in recent years (Weber et al., 2000, Horacek et al., 1999, Fava et al., 1989). We have previously reported an increased prevalence of menstrual abnormalities among women with primary psychiatric diagnosis (bipolar affective disorder) (Rasgon et al., 2000). Based on these findings we were interested to evaluate mood among patients with primary endocrine dysfunction, namely polycystic ovary syndrome (PCOS).

PCOS is the most common endocrine disorder among women of reproductive age (Franks, 1995). PCOS is characterized by androgen hypersecretion, insulin resistance and chronic anovulation (Franks, 1995, Futterweit, 1999). Clinical manifestations include hirsutism, acne, alopecia, menstrual irregularities, obesity (in 50% of cases; Dunaif et al., 1989) and infertility. Hyperandrogenism in PCOS can be the result of androgen overproduction by the adrenals as well as the ovaries (Gonzalez, 1997), and in turn it can lead to hyperinsulinemia and insulin resistance (Dunaif et al., 1989). Hyperinsulinemia plays a significant role in the pathogenesis of PCOS. Insulin promotes androgen production by ovarian thecal cells (Yen, 1991). Obesity itself increases the risk of insulin resistance, although insulin resistance can also occur in the absence of obesity (Dunaif et al., 1989, Chang et al., 1983). The treatment with oral contraceptives (OCP) can interrupt the ‘vicious circle’ between hyperandrogenism and insulin resistance through the modulation of the hypothalamic–pituitary–gonadal (HPG) regulatory system (Yen, 1991).

Women with hyperandrogenic syndromes may be at an increased risk for mood disorders (Fava et al., 1989, Bruce-Jones et al., 1993) due to an association between elevated androgen levels and depression (Shulman et al., 1992, Baischer et al., 1995, Weber et al., 2000). Our assessments of mood among women who identified themselves as having PCOS (i.e. visitors to the National PCOS Association Website and participants of PCOS Society meetings) yielded extraordinarily high rates of depression (89% and 65%, respectively; Rao et al., 2001). These findings although potentially biased by self-selection, provided data for speculation and were provocative enough to undertake the current investigation. The present study aimed to assess the prevalence of depression among women with documented PCOS, and to examine associations between depression and the clinical characteristics of PCOS.