Metformin‐induced first‐episode psychosis in patient with polycystic ovary syndrome using drospirenone
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting 5–15% of reproductive-aged women. The oral contraceptive pill (drospirenone) for improving menstrual cycle regularity and metformin for lowering body mass index are two common medications for treatment of PCOS. Here we detail a case of first-episode psychosis after taking drospirenone and metformin in a woman with PCOS and further discuss the possible mechanism. A 21-year-old female college student was brought to the emergency room due to suddenly becoming violent towards her roommate. She had insomnia first, followed by persecutory delusion, delusion of reference, and bizarre behavior for a week. One year previously (September 2017), she had been diagnosed with PCOS due to irregular menstrual cycle, dysmenorrhea, and menorrhagia, and her gynecologist had suggested she take metformin, but she discontinued the medication. Before this first episode of psychosis, she had taken drospirenone 3 mg/day and metformin 250 mg/day again for 1 month. As drospirenone or metformin may have induced the psychotic symptoms, both were discontinued and antipsychotics (paliperidone) were used. Psychotic symptoms were controlled within 1 week and the patient was discharged after 7 days’ admission. This patient had had no psychotic experiences previously, only some mood changes after using drospirenone, but her hypomanic-like symptoms had been eliminated after discontinuation of the drug. Meta-analysis studies have reported…
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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