Objective: To evaluate the effects of polycystic ovary syndrome (PCOS) therapies in female adolescents on anxiety and depression outcomes and assess associations between baseline hormonal and metabolic characteristics and psychological outcomes.
Methods: Retrospective cohort study at a tertiary care center included 50 adolescents aged 12–21 years with PCOS who received oral contraceptive pills (OCPs), metformin, spironolactone, or combination therapy for at least 5 months. Participants had anxiety, depression, or both and were receiving psychological treatment. They were categorized into OCP monotherapy, metformin/spironolactone, or combination therapy. Changes in symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). Associations with clinical, anthropometric, and biochemical parameters were evaluated.
Results: Anxiety and depression were present in 92% and 84%, respectively. Combination therapy was associated with a significant reduction in GAD-7 scores (median –3.0; IQR –6.5 to –1.43; p = 0.0485), whereas no significant changes in GAD-7 or PHQ-9 scores were observed in other treatment groups. Higher baseline free testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEA-S) were associated with worsening GAD-7 scores (p = 0.043, 0.038, and 0.017, respectively).
Conclusions: Combination therapy was associated with improved anxiety, suggesting a synergistic benefit of hormonal and metabolic interventions. Positive correlations between baseline androgen levels and anxiety severity highlight a potential role of androgen excess in heightened anxiety. Routine psychological screening in adolescent PCOS care is crucial to optimize mental and reproductive health outcomes. Keywords: Adolescent PCOS; Anxiety; Depression; Free testosterone; Oral contraceptives; Metformin; Spironolactone; Mental health.
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