Acute manic and psychotic symptoms following subcutaneous leuprolide acetate in a male patient without prior psychiatric history: A case report and literature review

Abstract

Leuprolide acetate is usually used in the treatment of advanced prostate cancer. The adverse events associated with administration of leuprolide acetate include fatigue, hot flashes, loss of libido, impotence, and depression. These side effects can be treated conservatively. Acute manic and psychiatric symptoms following leuprolide acetate injection are very rare. Few case reports have been published documenting these symptoms. Here, we describe the case of a 62-year-old male with metastatic prostate cancer, who developed acute manic and psychiatric symptoms 2 months after subcutaneous leuprolide acetate injection. These symptoms were relieved after administration of neuroleptic drugs, such as risperidone. Administration of leuprolide acetate was eventually stopped. The exact mechanism causing the manic and psychiatric adverse events is unclear. Some experts have theorized that estrogen withdrawal following leuprolide acetate therapy may induce psychiatric symptoms. Manic episodes may arise from a deficit in central serotonergic neurotransmission. Based on these hypotheses, risperidone, lithium, and some anticonvulsants, such as divalproex sodium and carbamazepine, have been used effectively in the treatment and prophylaxis of manic episodes. Although psychiatric adverse events are rare following administration of leuprolide acetate, clinicians should be aware of the possibility.