Obesity and hyperandrogenism are implicated with anxiety, depression and food cravings in women with polycystic ovary syndrome

Introduction: PCOS is associated with mood/eating disorders. Negative body image due to obesity, acne, hirsutism seems to play significant role, but hormonal derangements are probably implicated. Aim: To investigate the relation between insulin resistance (IR), obesity and hyperandrogenism with mood and eating disorders in women with PCOS. Methods: Forty-nine (60.5%) PCOS women and 32(39.5%) age- and BMI-matched healthy controls were enrolled. Emotional/food disorders were evaluated by using self-administered questionnaires: Eating Attitudes Test (EAT)-26, Beck Depression Inventory-II (BDI-II), Hamilton anxiety scale (HAS) and Food Craving Questionnaire-Trait (FCQ-T). Results: The two groups had no significant differences regarding age, BMI and HOMA2-IR. PCOS women had significantly higher DHEA-S (p< 0.0001), Δ4Α (p< 0.0001) and Testosterone (p< 0.0001). When the two groups were subclassified according to the BMI, in lean (BMI < 25 kg/m²) or overweight (BMI ≥ 25 kg/m²), no significant differences were found with respect to EAT-26 and HAS. BDI-II was associated with obesity (overweight vs lean PCOS: 20.5 ± 6.4 vs 9.8 ± 3.9; p= 0.037) and hyperandrogenism (overweight PCOS vs overweight controls: 20.5 ± 6.4 vs 14.8 ± 8.1; p< 0.0001; lean PCOS vs overweight controls: 16.7 ± 4.7 vs 14.8 ± 8.1; p= 0.01). Additionally, a significant correlation between BDI-II and DHEA-S (rho = 0.305; p= 0.006), Δ4Α (rho = 0.259; p= 0.02) and Testosterone (rho = 0.328; p= 0.003) was reported. FCQ-T was associated with obesity (overweight PCOS vs lean PCOS: 47.6 ± 9.9 vs 29.3 ± 8.9; p< 0.0001; overweight controls vs lean PCOS: 45.5 ± 15.7 vs 29.3 ± 8.9; p< 0.0001), whereas a correlation between FCQ-T and BMI (rho = 0.593; p= 0.0001), waist circumference (rho = 0.554; p= 0.0001) and HOMA2-IR (rho = 0.328; p= 0.003) was documented. Conclusions: Obesity and hyperandrogenism increase the risk of depression and food cravings in women with PCOS, leading to a vicious circle of further aggravation of obesity and metabolic syndrome.