Insulin resistance, obesity, inflammation, and depression in polycystic ovary  syndrome: biobehavioral mechanisms and interventions

Kristen Farrell; Michael H Antoni

doi:10.1016/j.fertnstert.2010.03.081

PMOS / PCOS Pathophysiology

Insulin resistance, obesity, inflammation, and depression in polycystic ovary syndrome: biobehavioral mechanisms and interventions

Farrell K, Antoni MH

Published October 2010 Fertility and Sterility, 94(5), 1565-1574

DOI 10.1016/j.fertnstert.2010.03.081 PMID 20471009 PMC PMC2941530

RRM Academy Synopsis

Insulin resistance, inflammation, and depression are linked in PCOS

Insulin resistance, inflammation, and depression are strongly linked in PCOS, a 2010 review concludes. The authors pulled together studies on body chemistry, mood, and treatment. They conclude that PCOS care would benefit from adding mental health and behavior support. PCOS is now also called polyendocrine metabolic ovarian syndrome (PMOS).

Key Findings

70% of women with PCOS are insulin resistant, the review reports.
In U.S. studies of women with PCOS, type 2 diabetes prevalence was 7.5% to 10%, against 0.7% in healthy young women.
Depression prevalence in women with PCOS has been reported as high as 40%. A German internet survey of 448 women with PCOS found clinical depression in 21%.
Obese women with PCOS had more depressive disorders than obese controls (44% versus 7%). Women with PCOS may be at greater risk of depression regardless of obesity.
In one study, a 6-month program of diet and exercise advice brought back normal periods in 60% of women with PCOS who were not ovulating.

Interpretation

This is a narrative review pulling together research on metabolism, inflammation, and mood in PCOS. Insulin resistance emerges as a central link connecting body chemistry to mood, in part through inflammation. The authors note that behavioral treatments remain thinly tested in PCOS, with cognitive behavioral therapy studied so far only in a small pilot in teens. The authors call for larger studies testing mental health and behavior support as part of PCOS care.

RRM Context

The review describes PCOS as a linked condition of metabolism, hormones, and mood. That fits the root-cause, whole-person view of restorative reproductive medicine. The authors say insulin resistance appears to play a central role. In one lifestyle study they cite, insulin resistance did not improve in women who stayed without ovulation.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To summarize physiological and psychological characteristics that are common among women diagnosed with polycystic ovary syndrome (PCOS) and provide evidence suggesting that addressing psychological disturbances can reduce or alleviate physical symptoms of PCOS through behavioral pathways and physiological pathways.

Methods

Empirical studies and expert consensuses pertaining to physiological, psychological, and medical management aspects of PCOS were identified and presented in this review. Articles were identified by searching Pubmed, PsycInfo, Medline ISI, CINAHL, or a Web browser (i.e., Google) using numerous combinations of terms pertaining to physiological, psychological, and medical management aspects of PCOS. An article was chosen to be included in this review if it reported findings and/or provided information that related to and helped support the main purpose(s) of this review article.

Results

Available literature on the physiological (i.e., hyperandrogenism, central obesity, inflammation, insulin resistance) and psychological (i.e., depression, anxiety, eating disorders) factors among women with PCOS provides evidence that these various aspects of PCOS are strongly interrelated.

Conclusions

The existence of these relationships among physiological and psychological factors strongly suggests that medical management of PCOS would greatly benefit from inclusion of psychological and behavioral approaches.

Read the guide

PMOS / PCOS: Causes, Diagnosis, and Treatment

PMOS / PCOS has four diagnostic phenotypes and distinct metabolic, reproductive, and mental health implications. How RRM-trained clinicians approach diagnosis and treatment differently.

20 min read

Topics

PMOS / PCOS › Pathophysiology › Insulin Resistance · Mental Health and Psychosocial Care › Psychosocial Support › Counseling and Therapy

Kristen Farrell, Michael H Antoni

K Farrell, Mike Antoni, M Antoni

PMID 20471009 20471009 DOI 10.1016/j.fertnstert.2010.03.081 10.1016/j.fertnstert.2010.03.081 Farrell et al. 2010, Farrell 2010

Insulin resistance, obesity, inflammation, and depression in polycystic ovary syndrome: biobehavioral mechanisms and interventions

Insulin resistance, inflammation, and depression are linked in PCOS

Key Findings

Interpretation

RRM Context

Abstract

Read the guide

PMOS / PCOS: Causes, Diagnosis, and Treatment

Topics

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Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics

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Anxiety, Depression, and Quality of Life in Women with Polycystic Ovarian Syndrome