PCOS And Mental Health Fortunately, the topics of anxiety, depression, and general psychological well-being are becoming more popularly spoken about in recent years. This can only be a good thing, however, the intersection between certain medical conditions and one’s mental health are less spoken about, specifically, the relationship between PCOS, mood, and mental health. In this article we’ll be discussing whether PCOS puts you at risk for decreased mental wellbeing, what disorders are associated with PCOS, and what small, impactful tips you can implement that can have a massive positive impact on your mental wellbeing. Let’s begin. Is there a connection between PCOS and depression? Multiple studies appear to indicate that “PCOS can be associated with mood and psychiatric disorders.” One systematic review that included 57 studies (reporting on over 170,000 patients) found that women with PCOS were more likely to have a clinical diagnosis of repression, anxiety, bipolar disorder, and obsessive compulsive disorder compared to women without PCOS. It is worth noting there was no positive association found between a positive diagnosis of PCOS and social phobia or panic disorder, although researchers found that PCOS is correlated with “worse symptoms” of the previously mentioned disorders, and they recommend both physicians and patients watch for symptoms early on during a PCOS diagnosis. Is PCOS the cause or just a symptom? Of course, this raises the question as to whether PCOS is the cause of some of these psychiatric disorders, or whether it simply works to exacerbate a pre-existing mental health problem. For instance, a study conducted by a professor from the School of Nursing at Columbia, and later published in the Journal of Behavioral Health Services and Research, reported that some PCOS complications may be in part responsible for some mental health problems. Specifically, unwanted body hair and weight changes are mentioned as symptoms that have an outsized negative impact on mental health, probably due to the distress they induce in women with PCOS. Perhaps surprisingly, though, these aren’t the most highly correlated with negative emotion: researchers found that having an irregular menstrual cycle is the “symptom of PCOS most strongly associated with psychiatric problems.” Researchers in this study weren’t exactly sure on the ‘why’ behind this: it could be because of the uncertainty and stress associated with working to get a regular menstrual cycle, worries about infertility and ovulation, or something else. Cycle irregularity also points to imbalanced hormones, and even reproductive hormones can have an impact on mood. Clearly, though, experts agree on the following: a PCOS diagnosis is associated with a higher probability (and worse symptoms) of being diagnosed with anxiety, depression, OCD, and bipolar disorder. Tips for taking care of your mental health None of the following steps on their own are necessarily ‘curative’ for anxiety, depression, and other psychiatric disorders: indeed, what works and what doesn’t work will be different for each person. However, all the following suggestions are research-backed methods by which you can improve your mental wellbeing (in almost all cases, for very little or no cost). Using tools like these as “preventative maintenance” for your mental well-being means that you are refilling up your mental and emotional tank with self-care before it’s dipped too low, you’re burnt out, and out of fuel. Switch up your morning routine Instead of waking up and immediately answering texts on your phone or scrolling through social media, consider meditating, prayer, or deep breathing for 15 minutes. A 2014 literature review of 47 trials (including over 3000 participants) suggests that mindfulness meditation can have a moderate impact on improving anxiety and depression. It may also be helpful for fighting insomnia, as a smaller study following 54 adults with chronic insomnia, found mindfulness aided with getting a better night’s sleep. For getting the most out of your meditation practice each morning, we recommend the following: Find a quiet, distraction-free environment to meditate If just beginning meditating, try an app like Insight Timer or Calm for free practices Find a comfortable position, such as sitting or lying down Try cognitive-behavioral therapy (CBT) Cognitive-behavioral therapy, often simply shortened to CBT, is one of the most well-studied and research-backed treatments for helping anxiety and depression. For instance, a meta-analysis of 115 studies found that CBT with pharmacotherapy as a treatment for depression is more effective than pharmacotherapy alone, and CBT is best-suited for mild to moderate depressive episodes. This form of psychotherapy revolves around modifying thought patterns to help change moods and behaviors. For instance, it tackles problematic thought patterns such as catastrophizing (believing the worst will happen, even if there is evidence to the contrary), overgeneralizing (drawing big-picture, unsupported beliefs from one event), and all-or-nothing thinking (viewing things in black and white). Since CBT focuses on reframing negative thought patterns, as little as 10 to 20 sessions can be immensely useful in developing helpful stress-reducing strategies and coping mechanisms for recurring negative emotions. Incorporate exercise regularly Sometimes it can feel like you don’t have the energy or there’s not enough time to exercise, but the fact is, by intentionally cutting time out of your day to do even 10 or 20 minutes of exercise can be a great way to improve your mental wellbeing. No amount of time is ‘too little’ to have a positive impact on your headspace. Aerobic exercise (think swimming, cycling, jogging, walking, and dancing) in particular is proven to be helpful in reducing anxiety and depression. This is likely due to an exercise-induced increase in blood circulation to the brain and by an influence on the HPA axis (and thus on one’s physiologic reactivity to stress). As an added bonus, exercise is also proven to reduce stress, increase cognitive function, and improve energy and stamina. You can work this into your day by signing up to a group fitness class during the week, buddying up with a friend to go to the gym, walking instead of driving, and so on. Check out our article to get a more in-depth look into why exercise is so important for your physical and mental health, and how it works to deliver long-term health benefits. Find opportunities for creativity Journalling, also sometimes referred to as ‘expressive writing,’ entails writing about events, thoughts, feelings, and emotions that bother you. One meta-analysis of 13 studies found expressive writing “carried a health benefit similar to other psychological interventions, such as talk therapy.” Researchers found, on the whole, expressive writing was correlated with improved mood, reduced symptoms of depression, improved memory, and even improved immune system function. Researchers believe that expressive writing or drawing may help confront and process difficult emotions, and in the process, reduce one’s mental stress load. As such, it may be worth carving out an hour each week (or whenever the feeling strikes) to paint, draw, write, and otherwise creatively explore your emotions. Look after your good gut bacteria According to Harvard Health’s blog on nutritional psychiatry, 95% of your serotonin (a hormone responsible for managing anxiety, stabilizing your mood, and regulating feelings of wellbeing) is made in your gastrointestinal tract. This means that all the billions of “good” bacteria that make up your intestinal microbiome play an essential role in your mental health: they can limit inflammation, help your absorb nutrients in your food (leaving you feeling energized), and activate neural pathways that travel directly between the gut and the brain. So how does all this affect feelings of anxiety and depression? Well, research indicates that the risk of depression is 25% to 35% lower in traditional Mediterranean and Japanese diets (high in grains, fish, vegetables, fruit, and beans) than in those who follow a traditional Western diet. As such, researchers are putting more resources into investigating the possibility that good bacteria not only influences what your gut digests and absorbs, but also dictates the degree of inflammation throughout the body, while impacting your mood and energy levels too. Fun fact: Allara’s advice for the best balanced PCOS diet closely aligns with the traditional Mediterranean diet! Check out this article to understand what this may look like on your plate each day. Final thoughts Clearly, working on your mental health is an ongoing process that looks different for each person. However, we can use research and data to inform the best strategies in order to reduce feelings of stress, anxiety, and depression (as well as other negative emotions), in order to live a more content, happy life. After a PCOS diagnosis, it is perhaps extra important that you listen as closely to yourself and your psychological needs as you do your physical needs: that means checking in with yourself regularly and asking questions like: How do I feel right now? What went well today? In what moments did I feel my best? When did I feel least in touch with my emotions? What small, incremental step can I take tomorrow that may have a positive impact on my mental wellbeing? Therapy, journaling, meditation, exercise, and improved nutrition are all potential avenues you can explore in order to improve your mental wellbeing. If you would like more guidance when it comes to nutrition and expert medical insights, check out Allara’s blog for more resources, or get in touch with our virtual care team to schedule a complementary one-on-one meeting with our registered dietitians. Allara Health provides personalized treatment that takes the guesswork out of managing PCOS, and offers a customized, holistic plan of attack that merges nutrition, medication. supplementation, and ongoing, expert support to begin healing your body.