Psikoneuroimunologi Depresi pada Polycystic Ovary Syndrome (PCOS)

Asti Yuliadha, Rohmaningtyas Hidayah Setyaningrum

Abstract

Introduction: Polycystic ovary syndrome (PCOS) is heterogeneous, complex endocrine disorder with unknown etiology, affecting 4%−18% of reproductive age women and associated with reproductive, metabolic and psychological dysfunction. Along with physical disorders, many mental disorders are also associated with PCOS, about 40% of women with PCOS have depression. This literature review aims to explore how PCOS can lead to depression in term of psychoneuroimmunology aspects.

Method: Literature review was conducted through search engine from Google Scholar and Clinical Key with keywords “Polycystic ovary syndrome”, “depression”, “psychoneuroimmunology”, “distress”, and “inflammation” from 2015-2020.

Result: The important role of the HPG axis in the pathophysiology of mood disorder has concluded that high comorbidity between depression and PCOS are caused by hyperandrogenism and insulin resistance mediated by low grade chronic inflammation. The activation of HPA by stress exerts an inhibitory effect on the female reproductive system. CRH can inhibit GnRH secretion from the hypothalamus. The anti-reproductive action of CRH in the ovaries of women with high psychosocial stress lead to early ovarian failure. In addition, the pathophysiology of depression and mental stress in PCOS is associated with various changes including high activity of pro-inflammation markers and the body's immune system during stress, it has also been linked to increased cortisol levels, increased sympathetic activity and decreased serotonin levels in the central nervous system.

Result: There’s close relationship between PCOS and depression in terms of psychoneuroimmunology aspects, by HPG axis role. Comprehensive management of depression is improving outcome strategy in women with PCOS by involving CLP.

Keywords: Polycystic ovary syndrome (PCOS), Depression, Psychoneuroimmunology, HPG axis

Keywords

Polycystic ovary syndrome (PCOS), Depression, Psychoneuroimmunology, HPG axis

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References

  1. Azizi M, Elyasi F. Psychosomatic aspects of polycystic ovarian syndrome: A review. Iran J Psychiatry Behav Sci. 2017 June; 11(2): e6595.
  2. Zangeneh FZ, Jafarabadi M, Naghizadeh MM, Abedinia N, Haghollahi F. Psychological distress in women with polycystic ovary syndrome from imam khomeini hospital, tehran. J Reprod Infertil. 2012; 13(2):111-115.
  3. Barry JA. Psychological aspects of polycystic ovary syndrome. Palgrave Macmillan; 2019; 35-54.
  4. Podfigurna-Stopa A, Luisi S, Regini C, Katulski K, Centini G, Meczekalski B. Mood disorders and quality of life in polycystic ovary syndrome. Gynecol Endocrinol. 2015; 31(6):431–4.
  5. Zangeneh FZ, Naghizadeh MM, Jafarabadi M. Immune modulation of interleukin-1α by noradrenaline and cortisol in women with PCOS (Psychoneuroimmunology Aspect). Annual Research & Review in Biol. 2015; 7(6): 390-8.
  6. Brummelte S, Galea LA. Depression during pregnancy and postpartum: contribution of stress and ovarian hormones. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2010; 34(5): 766-76.
  7. Ozkan ZS, Deveci D, Kumbak B. What is the impact of Th1/ Th2 ratio, SOCS3, IL17, and IL35 levels in unexplained infertility? J Reprod Immunol. 2014; 103:53‐8.
  8. Young JJ, Bruno D, Pomara N. A review of the relationship between proinflammatory cytokines and major depressive disorder. J affective disord. 2014; 169: 15-20.
  9. Azziz R. Polycystic Ovary Syndrome. Obstet Gynecol. 2018; 132(2): 321-36.
  10. Hestiantoro A, Wiweko B, Harzif AK. Konsensus tata laksana sindrom ovarium polikistik. Himpunan Endokrinologi Reproduksi dan Fertilitas Indonesia (HIFERI) Perkumpulan Obstetri dan Ginekologi Indonesia (POGI); 2016.
  11. Hung J-H, Hu L-Y, Tsai S-J, Yang AC, Huang M-W, Chen P-M. Risk of psychiatric disorders following polycystic ovary syndrome: a nationwide population-based cohort study. PloS one. 2014; 9(5): e97041.
  12. Yu Q, Hao S, Wang H, Song X, Shen Q, Kang J. Depression-like behavior in a dehydroepiandrosterone-induced mouse model of polycystic ovary syndrome. Biology of reproduction. 2016; 95(4):79, 1-10.
  13. Zangeneh FZ. Polycystic ovary syndrome and sympathoexcitation: management of stress and lifestyle. J. Biol. Today's World. 2017; 6(8):146-54.
  14. Wickenheisser J, McAllister J. Ovarian steroidogenic abnormalities in PCOS. In: Azziz R, editor. The polycystic ovary syndrome: current concepts on pathogenesis and clinical care. Springer: 2007; 69-82.
  15. Marlieke A. de Wilde, Angelique J. Goverde, Susanne M. Veltman-Verhulst, Marinus J. C. Eijkemans, Arie Franx, Bart C. J. M. Fauser, Maria P. H. Koster, Insulin action in women with polycystic ovary syndrome and its relation to gestational diabetes, Human Reproduction, 2015; 30(6): 1447–53.
  16. Rojas J, Chavez M, Olivar L. Polycystic ovary syndrome, insulin resistance, and obesity: Navigating the Pathophysiologic Labyrinth. Intl J Reprod Med. 2014; (1):1-17.
  17. Repaci A, Gambineri A, Pasquali R. The role of low-grade inflammation in the polycystic ovary syndrome. Mol Cell Endocrinol. 2011; 335(1):30-41.
  18. Barry JA, Qu F, Hardima PJ. An exploration of the hypothesis that testosterone is implicated in the psychological functioning of women with polycystic ovary syndrome (PCOS). Medical Hypotheses. 2018; 110: 42–5.
  19. Day F, Karaderi T, Jones MR, Meun C, He C, Drong A, et al. Large-scale genome-wide meta-analysis of polycystic ovary syndrome suggests shared genetic architecture for diffrent diagnosis criteria. PLoS Genetics. 2018; 14(12), e1007813.
  20. Borghi L, Leone D, Vegni E, Galiano V, Lepadatu C, Sulpizio P, et al. Psychological distress, anger and quality of life in polycystic ovary syndrome: Associations with biochemical, phenotypical and sociodemographic factors. J Psychosomatic Obstetr Gynecol. 2018; 39(2): 128–37.
  21. Roose C, Lidfeldt J, Agardh CD, Nyberg P, Nerbrand C, Samsioe G. Insulin resistance and self-rated symptoms of depression in Swedish
    women with risk factors for diabetes: the Women's Health in the Lund Area study. Metabolism. 2007; 56(6):825-9.
  22. Bianchi, ME. DAMPs, PAMPs and alarmins: all we need to know about danger. J leukocyte biol. 2007; 81(1): 1-5.
  23. Martelli D, McKinley MJ, McAllen RM. The cholinergic anti-inflammatory pathway: a critical review. Auton Neurosci. 2014 May; 182:65-9.
  24. Duman RS, Monteggia LM. A neurotrophic model for stress-related mood disorders. Biological psychiatry. 2006; 59(12): 1116-1127.
  25. Gordon-Elliott JS, Ernst CL, Fersh M, Albertini E, Lusskin S, Altemus M. The hypothalamic-pituitary-gonadal axis and women's mental health: PCOS, premenstrual dysphoric disorder, and perimenopause. Psychiatric Times. 2017; 34(10).
  26. Goldstein JM, Handa RJ, Tobet SA. Disruption of fetal hormonal programming (prenatal stress) implicates shared risk for sex differences in depression and cardiovascular disease. Frontiers in neuroendocrinol. 2014; 35(1): 140-58.
  27. Handa RJ, Weiser MJ. Gonadal steroid hormones and the hypothalamo-pituitary-adrenal axis. Front Neuroendocrinol. 2014;35(2):197-220.
  28. Bao AM, Hestiantoro A, Van Someren EJ, Swaab DF, Zhou JN. Colocalization of corticotropin-releasing hormone and oestrogen receptor-α in the paraventricular nucleus of the hypothalamus in mood disorders. Brain. 2005; 128(6): 1301-13.
  29. Jacobs RH, Orr JL, Gowins JR, Forbes EE, Langenecker SA. Biomarkers of intergenerational risk for depression: a review of mechanisms in longitudinal high-risk (LHR) studies. J affective disord. 2015; 175: 494-506.
  30. Han KS, Kim L, Shim I. Stress and sleep disorder. Experimental neurobiol. 2012; 21(4):141-50.
  31. Benarroch EE. Basic neurosciences with clinical applications. Elsevier Health Sciences; 2006.
  32. Chaudhari AP, Mazumdar K, Mehta PD. Anxiety, depression, and quality of life in women with polycystic ovarian syndrome. Indian J Psychol Med. 2018; 40(3):239-46.
  33. Qaseem A, Barry MJ, Kansagara D. Clinical guidelines committee of the American College of P. Nonpharmacologic versus pharmacologic treatment of adult patients with major depressive disorder: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016; 164:350–9.
  34. Cooney LG, Dokras A. Depression and anxiety in polycystic ovary syndrome: etiology and treatment. Curr Psychiatry Rep. 2017; 19(11):83.
  35. Stefanaki C, Bacopoulou F, Livadas S, Kandaraki A, Karachalios A, Chrousos GP, Diamanti-Kandarakis E. Impact of a mindfulness stress management program on stress, anxiety, depression and quality of life in women with polycystic ovary syndrome: a randomized controlled trial. Stress. 2015 Jan;18(1):57-66. doi: 10.3109/10253890.2014.974030.
  36. Syamsulhadi M, Septiawan D. Implementasi Consultation-Liaison Psychiatry di Beberapa Bidang Medis. Muhammadiyah University Press: 2016; 1-2.
  37. Leigh H. Nature and evolution of consultation-liaison psychiatry and psychosomatic medicine. In: Leigh H, Streltzel J editor. Handbook of Consultation-Liaison Psychiatry. Second Edition. Springer; 2015.

DOI: https://doi.org/10.13057/smj.v5i1.43238

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