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ORIGINAL ARTICLE
Year : 2018  |  Volume : 10  |  Issue : 2  |  Page : 55-59  

Polycystic ovarian syndrome–related depression in adolescent girls: A Review


Institute of Pharmacy, Lahore College for Women University, Lahore, Pakistan

Date of Web Publication4-Jun-2018

Correspondence Address:
Dr. Saleha Sadeeqa
Institute of Pharmacy, Lahore College for Women University, Lahore
Pakistan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JPBS.JPBS_1_18

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   Abstract 

Polycystic ovarian syndrome (PCOS), a common endocrinal disorder of reproductive age characterized by heterogeneous complications, is nowadays prevailing among females at adolescent stage. Infrequent or prolonged menstrual periods, excess hair growth, acne, and obesity can occur in women with PCOS. In adolescents, infrequent or absence of menstruation may raise chances for this condition. The increased prevalence of PCOS among general population throughout the world is found to be 5%–10% in the women of reproductive age, and about 40% women with PCOS experience depression, particularly young girls. The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications. Depression and anxiety are common in women with PCOS but are often overlooked and therefore left untreated. Along with the physical disturbances, many mental problems are also associated with PCOS. Therefore, PCOS not only has problems associated with reproduction but also has associated crucial metabolic and psychological health risks with increasing age of the patients. Because of the increased number of cases with PCOS around the world in present times, with prominent symptom of, specifically, depression at the adolescent stage, it is important to highlight the disease.

Keywords: Adolescent, Depression, Polycystic Ovarian Syndrome


How to cite this article:
Sadeeqa S, Mustafa T, Latif S. Polycystic ovarian syndrome–related depression in adolescent girls: A Review. J Pharm Bioall Sci 2018;10:55-9

How to cite this URL:
Sadeeqa S, Mustafa T, Latif S. Polycystic ovarian syndrome–related depression in adolescent girls: A Review. J Pharm Bioall Sci [serial online] 2018 [cited 2018 Jun 25];10:55-9. Available from: http://www.jpbsonline.org/text.asp?2018/10/2/55/233699




   Introduction Top


Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women, having 15%–20% prevalence among infertile women.[1] It occurs in 6%–10% of women of reproductive age with a higher prevalence in obese women.[2] It is a genetic condition that is complex with multiple phenotypes and various appearances. The highly occurring heterogeneous syndrome can be characterized by polycystic ovaries (PCO), ovulatory dysfunction, and clinical and/or biochemical androgen excess. Patients with PCOS are more prone to serious health troubles, particularly reproductive dysfunctions. Metabolic disturbances are prevalent in two-thirds of women with PCOS, which may lead to the high risk of cardiovascular and type-2 diabetes mellitus in them.[3] Psychosocial problems arise in patients with PCOS, as shown by various investigators,[4],[5] particularly due to obesity, excessive body hairs, infertility, and changes in the physical appearances. As a whole, different reasons for psychological stress, particularly among the adolescent girls associated with PCOS, is discussed in this article with probable management and treatment overview to cope with the PCOS stress for young girls.


   Materials and Methods Top


A literature research was performed on Google Scholar and Medline databases. Various studies on metformin were analyzed. The search terms used were Polycystic ovarian syndrome, Depression, and Adolescent.


   Results Top


Prevalence

Studies reviel the increased prevalence of PCOS among the general population throughout the world, which ranges from 5% to 10%[6] in women of reproductive age, and about 40% women with PCOS experience depression,[7] particularly the young girls. The rate of PCOS in South-Western United States was found to be 4%. The incidence screened out to be 9.13% in Indian adolescents.[8] As per the National Institute of Health, the rate of PCOS increases from 6.5% to 6.8% in adult reproductive-aged woman worldwide.[9]

Pathophysiology of the disease

The pathophysiology of PCOS is contributed by both the genetic and the environmental factors.[10] Genetically, it can be explained as an increase in the levels of ovarian hyperandrogenism[11] due to the influence of luteinizing hormone (LH) and insulin. Elevated LH level that ultimately causes an increase in the production of androgens from cells, called theca cells in young girls and women having PCOS, may provide an insight of aberrant secretion levels of Gonadotropin-Releasing Hormone.[12] The environmental factors primarily include obesity, nutrition or eating disorders,[13] and insulin resistance.[14]

Moreover, the pathophysiology of depression and mental stress during PCOS is linked to various changes that include psychological changes such as high activity of pro-inflammatory markers and immune system during stress.[15]

Signs and symptoms

Patients with PCOS usually express symptoms from puberty.[10] It may include transient postmenarcheal anovulation and multicystic ovaries. The general three criteria featuring PCOS established by PCOS consensus were; clinical hyperandrogenism, oligo/amenorrhea, and PCO identified in ultrasonography, which are the definitions, not sufficient to diagnose PCOS in adolescents, where PCOS even if present can be identified till adulthood. Oligomenorrhea exists if menstrual cycle lasts for above 35 days whereas acne, androgenic alopecia, or hirsutism are the clinical symptoms of hyperandrogenism.[16],[17],[18]

The etiology of PCOS can be contributed to both genetic predisposition and lifetime factors.[19] The mechanism of genetic disposition in the development of PCOS is well established, but environmental factors may include sedentary lifestyle, imbalanced diet that may result in insulin resistance, and obesity, which are potential factors in the development of PCOS.[20] Although women having PCOS have advanced chances of developing depression than women who are not affected by PCOS,[21] obesity aggravates the condition. Obesity usually coexists with PCOS. The 40%–60% of women who have PCOS are obese.[22] In patients with PCOS, the major determinant of metabolic phenotype is obesity, whereas teen juveniles are observed as protected from the metabolic disturbances of PCOS.[23] The clinical and biochemical phenotype of PCOS are greatly influenced in the case of genetically predisposed individuals.[24]

Diagnosis

The criteria for the diagnosis of PCOS in adults are also applicable to the adolescents as the PCOS’s diagnosis criteria in an adolescent are not defined yet.[21] Some simple clinical tests can be performed to diagnose PCOS as suggested by PCOS consensus workshop group. These include; 1) the level of testosterone should be checked in girls who showed symptoms of high androgen levels 2) the levels of Follicle-Stimulating Hormone (FSH), LH, prolactin, and estradiol should be measured in the case of oligo- or amenorrhea (anovulation); and 3) the transabdominal scanning of ovaries by ultrasound can prove helpful in an adolescent with menstrual disturbances or hyperandrogenism. Routine 75g oral glucose tolerance test in an adolescent with body mass index (BMI) of >30 kg·m−2 is advisable.

Mental stress among adolescent with PCOS

PCOS-related mental stress is well studied by Himelein et al.,[25] which indicates the symptoms of PCOS mostly affecting the patients include increased androgen levels, menstrual disturbances, infertility,[5] obesity, hirsutism, or alopecia, but nowadays behavioral scientists start observing significant levels of mental stress in patients with PCOS,[26] particularly among the young girls. This may be because young girls are more concerned about their physiology and physical health during adolescence. One of the studies reveals clear stress symptoms explicated in a group of women who are having PCOS than the women who are not affected by PCOS.[27] Depression and stress are the high-risk factors among the patients with PCOS along with the impaired metabolic and reproductive features. This high level of depression and anxiety in the patients with PCOS may be due to various reasons such as high BMI and demoralization faced by patients with PCOS in the society, which when severe may lead to social withdrawal.[12] The clinical symptoms of PCOS, i.e., hyperandrogenism and infertility, add significantly to the severity of the conditions.[28]

In addition, studies carried out by Hollinrake et al.[21] determined some more reasons for increased risk of depression among patients with PCOS than in control group. Patients with family history of infertility and depression along with high BMI factor and sleep disturbances[29] and exhaustion followed by decreased interest in daily chores and appetite changes are the most common factors of depression among the patients with PCOS.

Interesting findings were obtained when clinical/biochemical parameters were correlated with stress in young women with PCOS.[30] These studies reveal significantly higher levels of hirsutism and testosterone in the group of women with PCOS along with the higher BMI, LH/FSH, and Waist-to-Hip Ratio (WHR). Depression and emotional stress were analyzed with Turkish version of the Beck Depression Inventory and 12-item General Health Questionnaire. Both parameters were found to be high in the patients with PCOS than that of the control group, which when correlated with the clinical/biochemical parameters depict the positive relation between them. Among all the factors in patients with PCOS, obesity is the most prominent feature causing an elevation in emotional stress level and depression among adolescent girls than BMI, and WHR also causes a notable increase in the levels of mental stress and depression. Factors such as high sympathetic activity, elevated cortisol levels, and low level of serotonin are associated with both, insulin and depression.[19] It is reported that different factors of PCOS to develop depression in a woman will lead to induce higher insulin resistance and impaired fasting glucose than undepressed PCOS women.[31] There are several types of researches that reported a correlation between levels of serum androgen and depression scores.[32] It is observed that due to the appearance of physical characteristics of hyperandrogenism, which includes obesity, cystic acne, hirsutism, hair loss (alopecia), and seborrhea, more negative self-image with low self-esteem is induced, which cause high depression levels and psychological distress among women with PCOS.[19],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34]

PCOS depression management and treatment in adolescents

According to the recent management guidelines by Consensus on treatment of PCOS, the counseling related to the lifestyle changes, i.e., obesity control, daily walk, prevent smoking and alcohol consumption, clinical symptoms (menses irregularities) particularly in young girls, insulin resistance before medical treatment can produce positive outcomes[35] by lowering the stress level in PCOS patients. Standard metformin treatment in PCOS cases if practiced regularly for 6 months can help to reduce various reproductive, physiological, and psychological problems.[36]

Several stress management interventions are also suggested to normalize Hypothalamic-Pituitary-Adrenal (HPA) axis at a normal pace, which may act as stressors by exaggerating Sympathetic Nervous System response in women with PCOS.[37] It may include cognitive behavioral therapy and relaxation at the stage when standard metformin treatment fails to produce the expected stress relief in patients with PCOS.[38]

The reason of distress along with the hirsutism among adolescents with PCOS is mostly due to the excess levels of androgens. Antiandrogen therapy can be carried out (if necessary) along with the cosmetic management[39] (provided that hair removal method is authorized). The major challenge is the prevention of long-term complications of PCOS. The strong control of diet and an active lifestyle can effectively reduce the risk of diabetes in at-risk adults.[40]


   Discussion Top


Polycystic ovarian syndrome is a chronic, heterogeneous disorder of endocrine system with prominent features of androgens, menstrual disturbances, and depression. It is a leading cause of pregnancy complications and infertility among women and causes depression among young girls. The reason for the extreme mental stress and depression in an adolescent with PCOS is due to the appearance of embarrassing symptoms such as hirsutism, obesity, and acne during adolescence.[4]

Obesity was pointed to be the major factor causing depression and emotional stress among adolescents with PCOS,[22] which needs to be managed both psychologically and clinically to overcome mental stress in patients. Thus, it is concluded that major psychological and behavioral intervention approaches that are dominantly useful in relieving depression in patients with PCOS particularly at the adolescent stage are quality sleep, improved lifestyle (healthy diet and preventing sedentary lifestyle), and regular exercise. These psychosocial techniques prove useful in reducing stress and depression through weight loss and physiological maintenance.

It is now an established fact that maintenance of healthy and active lifestyle can support to lessen both the physiological and the psychological symptoms.[41] So, it is recommended that stress in women having PCOS is treated primarily psychosocially and clinically in a later stage, which is also a more economical and promising option.


   Conclusions Top


PCOS is a chronic, heterogeneous disorder of endocrine system with prominent features of androgens, menstrual disturbances, and depression. Depression and stress are the high-risk factors among the patients along with the impaired metabolic and reproductive features. Obesity was pointed to be the major factor causing depression and emotional stress among adolescents.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Farideh ZZ, Mina J, Mohammad MN, Nasrine A, Fedyeh H. Psychological distress in women with polycystic ovary syndrome from imam Khomeini hospital, Tehran. J Reprod Infertil 2012;10:111-5.  Back to cited text no. 1
    
2.
Hamdi CE, Aysun B, Burçin N, Ayşin N, Cem Ç, Yasemin Y, et al. Anxiety and depression states of adolescents with polycystic ovary syndrome. Turk J Med Sci 2017;10. doi:10.3906/sag-1708-131.  Back to cited text no. 2
    
3.
Dennett CC, Simon J. The role of polycystic ovary syndrome in reproductive and metabolic health: overview and approaches for treatment. Diabetes Spectrv 2015;10:116-20.  Back to cited text no. 3
    
4.
McCook JG, Reame NE, Thatcher SS. Health-related quality of life issues in women with polycystic ovary syndrome. J Obstet Gynecol Neonatal Nurs 2005;10:12-20.  Back to cited text no. 4
    
5.
Trent ME, Austin B, Rich M, Gordon CM. Overweight status of adolescent girls with polycystic ovary syndrome: body mass index as mediator of quality of life. Ambu Pediat 2005;10:107-11.  Back to cited text no. 5
    
6.
Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004;10:2745-9.  Back to cited text no. 6
    
7.
Kerchner A, Lester W, Stuart SP, Dokras A. Risk of depression and other mental health disorders in women with polycystic ovary syndrome: a longitudinal study. Fertil Steril 2009;10:207-12.  Back to cited text no. 7
    
8.
Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R. Prevalence of polycystic ovarian syndrome in Indian adolescents. J Pediatr Adolesc Gynecol 2011;10:223-7.  Back to cited text no. 8
    
9.
Asunción M, Calvo RM, San Millán JL, Sancho J, Avila S, Escobar-Morreale HF. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab 2000;10:2434-8.  Back to cited text no. 9
    
10.
Diamanti-Kandarakis E, Piperi C, Spina J, Argyrakopoulou G, Papanastasiou L, Bergiele A, et al. Polycystic ovary syndrome: the influence of environmental and genetic factors. Hormones-Athens 2006;10:17.  Back to cited text no. 10
    
11.
Rosenfield RL, Ehrmann DA. The pathogenesis of polycystic ovary syndrome (PCOS): the hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocr Rev 2016;10:467-520.  Back to cited text no. 11
    
12.
Veldhuis JD, Pincus SM, Garcia-Rudaz MC, Ropelato MG, Escobar ME, Barontini M. Disruption of the joint synchrony of luteinizing hormone, testosterone, and androstenedione secretion in adolescents with polycystic ovarian syndrome. J Clin Endocrinol Metab 2001;10:72-9.  Back to cited text no. 12
    
13.
Månsson M, Holte J, Landin-Wilhelmsen K, Dahlgren E, Johansson A, Landén M. Women with polycystic ovary syndrome are often depressed or anxious—a case control study. Psychoneuroendocrinology 2008;10:1132-8.  Back to cited text no. 13
    
14.
McCartney CR, Blank SK, Prendergast KA, Chhabra S, Eagleson CA, Helm KD, et al. Obesity and sex steroid changes across puberty: evidence for marked hyperandrogenemia in pre- and early pubertal obese girls. J Clin Endocrinol Metab 2007;10:430-6.  Back to cited text no. 14
    
15.
Diamanti-Kandarakis E, Christakou C, Palioura E, Kandaraki E, Livadas S. Does polycystic ovary syndrome start in childhood? Pediatr Endocrinol Rev 2008;10:904-11.  Back to cited text no. 15
    
16.
Diamanti-Kandarakis E. PCOS in adolescents. Best Pract Res Clin Obstet Gynaecol 2010;10:173-83.  Back to cited text no. 16
    
17.
Cooney LG, Lee I, Sammel MD, Dokras A. High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod 2017;10:1075-91.  Back to cited text no. 17
    
18.
Cooney LG, Dokras A. Depression and anxiety in polycystic ovary syndrome: etiology and treatment. Curr Psychiatry Rep 2017;10:83.  Back to cited text no. 18
    
19.
Ibáñez L, Díaz R, López-Bermejo A, Marcos MV. Clinical spectrum of premature pubarche: links to metabolic syndrome and ovarian hyperandrogenism. Rev Endocr Metab Disord 2009;10:63-76.  Back to cited text no. 19
    
20.
Holte J. Disturbances in insulin secretion and sensitivity in women with the polycystic ovary syndrome. Baillieres Clin Endocrinol Metab 1996;10:221-47.  Back to cited text no. 20
[PUBMED]    
21.
Hollinrake E, Abreu A, Maifeld M, Van Voorhis BJ, Dokras A. Increased risk of depressive disorders in women with polycystic ovary syndrome. Fertil Steril 2007;10:1369-76.  Back to cited text no. 21
    
22.
Moran LJ, Pasquali R, Teede HJ, Hoeger KM, Norman RJ. Treatment of obesity in polycystic ovary syndrome: a position statement of the androgen excess and polycystic ovary syndrome society. Fertil Steril 2009;10:1966-82.  Back to cited text no. 22
    
23.
Arslanian SA, Lewy VD, Danadian K. Glucose intolerance in obese adolescents with polycystic ovary syndrome: roles of insulin resistance and beta-cell dysfunction and risk of cardiovascular disease. J Clin Endocrinol Metab 2001;10:66-71.  Back to cited text no. 23
    
24.
Littlejohn EE, Weiss RE, Deplewski D, Edidin DV, Rosenfield R. Intractable early childhood obesity as the initial sign of insulin resistant hyperinsulinism and precursor of polycystic ovary syndrome. J Pediatr Endocrinol Metab 2007;10:41-51.  Back to cited text no. 24
    
25.
Himelein MJ, Thatcher SS. Polycystic ovary syndrome and mental health: a review. Obstet Gynecol Surv 2006;10:723-32.  Back to cited text no. 25
    
26.
Franks S. Polycystic ovary syndrome in adolescents. Int J Obes (Lond) 2008;10:1035-41.  Back to cited text no. 26
    
27.
Weiner CL, Primeau M, Ehrmann DA. Androgens and mood dysfunction in women: comparison of women with polycystic ovarian syndrome to healthy controls. Psychosom Med 2004;10:356-62.  Back to cited text no. 27
    
28.
Jones G, Balen A, Ledger W. Health-related quality of life in PCOS and related infertility: how can we assess this? Human Fertil 2008;10:173-85.  Back to cited text no. 28
    
29.
Dantzer R. Cytokine-induced sickness behavior: where do we stand? Brain Behav Immun 2001;10:7-24.  Back to cited text no. 29
    
30.
Adali E, Yildizhan R, Kurdoglu M, Kolusari A, Edirne T, Sahin HG, et al. The relationship between clinico-biochemical characteristics and psychiatric distress in young women with polycystic ovary syndrome. J Int Med Res 2008;10:1188-96.  Back to cited text no. 30
    
31.
Rasgon NL, Rao RC, Hwang S, Altshuler LL, Elman S, Zuckerbrow-Miller J, et al. Depression in women with polycystic ovary syndrome: clinical and biochemical correlates. J Affect Disord 2003;10:299-304.  Back to cited text no. 31
    
32.
Weber B, Lewicka S, Deuschle M, Colla M, Heuser I. Testosterone, androstenedione and dihydrotestosterone concentrations are elevated in female patients with major depression. Psychoneuroendocrinology 2000;10:765-71.  Back to cited text no. 32
    
33.
Elsenbruch S, Benson S, Hahn S, Tan S, Mann K, Pleger K, et al. Determinants of emotional distress in women with polycystic ovary syndrome. Hum Reprod 2006;10:1092-9.  Back to cited text no. 33
    
34.
Dixon JB, Dixon ME, O’Brien PE. Depression in association with severe obesity: changes with weight loss. Arch Intern Med 2003;10:2058-65.  Back to cited text no. 34
    
35.
Motta B. Metformin in the treatment of polycystic ovary syndrome. Cur Pharm Des 2008;10:2121-5.  Back to cited text no. 35
    
36.
Hahn S, Benson S, Elsenbruch S, Pleger K, Tan S, Mann K, et al. Metformin treatment of polycystic ovary syndrome improves health-related quality-of-life, emotional distress and sexuality. Hum Reprod 2006;10:1925-34.  Back to cited text no. 36
    
37.
Phillips KM, Antoni MH, Lechner SC, Blomberg BB, Llabre MM, Avisar E, et al. Stress management intervention reduces serum cortisol and increases relaxation during treatment for nonmetastatic breast cancer. Psychosom Med 2008;10:1044-9.  Back to cited text no. 37
    
38.
Benson S, Arck PC, Tan S, Hahn S, Mann K, Rifaie N, et al. Disturbed stress responses in women with polycystic ovary syndrome. Psychoneuroendocrinology 2009;10: 727-35.  Back to cited text no. 38
    
39.
Koulouri O, Conway GS. A systematic review of commonly used medical treatments for hirsutism in women. Clin Endocrinol (Oxf) 2008;10:800-5.  Back to cited text no. 39
    
40.
Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Scand Med Sci in Spor 2003;10:208.  Back to cited text no. 40
    
41.
Farrell K, Antoni MH. Insulin resistance, obesity, inflammation, and depression in polycystic ovary syndrome: biobehavioral mechanisms and interventions. Fertil Steril 2010;10: 1565-74.  Back to cited text no. 41
    




 

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