Mood Swing Induced by Clomiphene in Woman with Secondary Infertility and Bipolar Remission: A Case Report

Previous studies have found that clomiphene citrate (CC), as an infertility medication, may be a significant independent risk factor for the development of depression and has been associated with increased irritability and mood swing. Psychopathological complaints can occur through the mechanism of the Hypothalamic-Pituitary-Gonadal (HPG) axis. While studies of CC in bipolar patients are still lacking, a few reports linked it to exacerbations of prior psychiatric disorders. A case of an adult female who had 7 years of secondary infertility because of endometriosis and a history of bipolar mixed episode, with almost a year of remission, was reported. After 5 days of oral CC for ovulation induction, there was a rapid mood alteration and insomnia on the seventh day, which led to a hypomanic and depressive episode relapse. A clinical case of a bipolar I disorder patient receiving ovarian stimulation with CC to conceive supported this case report, and the relapse symptoms were mild reactive mood swings with no alteration in sleeping pattern. Ovarian stimulation with CC for bipolar women still needs to be approached with caution. Successful management is greatly influenced by the involvement and collaboration care with different specialties. One therapeutic approach could be the prescription of second-generation antipsychotics as mood stabilizers.

Keywords: Infertility, bipolar disorder, irritable mood, clomiphene