Can GnRH analogue (Leuprolide) be a reason of manic episode?

Progesterone and estrogen receptors are present throughout the brain, including hypothalamus and limbic system, two areas involved in regulating emotion and mood. Some medications may produce mood changes, including GnRH agonists, hormonal contraceptives, antihypertensive agents and lipid- lowering agents. In this case report, we present a woman with bipolar disorder who used leuprolide two months before her manic episode. A 40-year-old, married, null par, housewife was hospitalized with a diagnosis of bipolar disorder-manic episode because of irritability, homicidal behavior, increasing PMA and insomnia. She has a 2-year-history of BPD. Before her affective symptoms appeared, she had used GnRH analogue (leuprolide) for 2 months. Her LH, FSH and estrogen levels were decreased and prolactin level was increased. Hormonal contraception or hormonal imbalance may be a reason of human mood change. In a research, it is reported that ovarian suppression in young women was associated with depressed and anxious mood and decreased serotonin transporter density. In another study it was discussed that plasma prolactin, LH and cortisol concentrations were increased compared with the control values. Thereby we need to be careful when using hormonal medications in our patients.