Mania in a patient receiving testosterone replacement postorchidectomy taking St John's wort and sertraline.
We describe the case of a patient who developed depression following bilateral orchidectomy for cryptorchidism. He was treated with a conventional selective serotonin reuptake inhibitor antidepressant, but continued to take St John's wort (hypericum) against medical advice. He subsequently developed a manic episode. We discuss postulated modes of action of St John's wort and the possible aetiological importance of testosterone replacement and abnormal gonadotrophin levels in this case.
Barbenel
D M
DM
Division of Neuroscience and Psychological Medicine, Imperial College School of Medicine, London, UK.
Yusufi
B
B
O'Shea
D
D
Bench
C J
CJ
D000284:Administration, Oral; D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001143:Arousal / Q000187:drug effects; D001714:Bipolar Disorder / Q000188:drug therapy*; D003456:Cryptorchidism / Q000601:surgery; D003866:Depressive Disorder / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D020902:Hypericum / Q000009:adverse effects*; D008297:Male; D009919:Orchiectomy; D010946:Plants, Medicinal; D011183:Postoperative Complications / Q000139:chemically induced; D020280:Sertraline / Q000008:administration & dosage / Q000009:adverse effects*; D013739:Testosterone / Q000008:administration & dosage / Q000009:adverse effects*
D000928:Antidepressive Agents; D013739:Testosterone; D020280:Sertraline