Transient psychosis in women on clomiphene, bromocriptine, domperidone and related endocrine drugs

Abstract

Background: There have been reports of transient psychosis in women medicated for gynecologic conditions.

Objective: The aim of this paper was to explore this literature.

Method: The PubMed and Google Scholar databases were searched for relevant case reports

Results: The following reports were found: psychosis induced by gonadotropin-releasing hormone in the treatment of endometriosis, by clomiphene treatment for infertility, by bromocriptine treatment for milk suppression and by the withdrawal of domperidone prescribed as a galactologue as well as by the withdrawal of estrogen replacement therapy.

Conclusion: In susceptible women, psychotic symptoms can result from treatments that reduce estrogen levels, such as leuprolide acetate or clomiphene, or treatments that increase dopamine levels (bromocriptine). Psychosis can also be caused indirectly when estrogen treatment is discontinued or dopamine antagonism (e.g. domperidone) withdrawn. Estrogen-reducing and dopamine-increasing treatments used in gynecology need to be carefully monitored.

Chinese abstract

背景：目前尚无应用药物治疗妇科相关疾病时短暂性精神疾病发生情况的研究报道。

目的：本研究旨在针对此方面文献进行综述。

方法：在PubMed以及Google学术数据库中针对相关文献进行检索。

结果：我们得到了以下结论：在治疗子宫内膜异位症过程中的促性腺激素释放激素、治疗不孕症过程中的克罗米芬、抑制乳汁分泌过程中应用溴隐亭、停止应用多潘立酮后（具有促进含半乳糖的乳汁分泌）、停止应用雌激素补充治疗，则可发生精神疾病。

结论：在较敏感的女性中，雌激素水平的降低，例如应用醋酸亮丙瑞林或者克罗米芬、或者是多巴胺水平升高（溴隐亭）都会导致精神症状的出现。雌激素治疗的间断、或者应用多巴胺拮抗剂（如多潘立酮）停止应用时，也可间接导致精神疾病的出现。妇科相关疾病治疗过程中，如治疗会导致雌激素减少以及多巴胺水平升高，则应当慎重。

• Bromocriptine
• clomiphene
• dopamine
• domperidone
• estrogen
• leuprolide acetate

Declaration of interest

The author is a Medical Consultant to Clera Inc. Neither this affiliation nor any other membership, funding or financial holdings affect the objectivity of this review. No sponsorship, funding or editorial assistance was received for this manuscript.