Dr. A, a 51-year-old married man, required involuntary hospitalization because of grandiose delusions, expansive and irritable mood, and extreme psychomotor agitation in May. In January, he had begun taking DHEA, 50 mg daily, to increase his energy level. In retrospect, he denied experiencing depressive symptoms at that time. He was also taking multivitamins and a beef liver extract tablet. Within days of starting to take DHEA, he noted increased energy and a sense of drive. Within 2 weeks, his wife noted gradually worsening psychomotor acceleration, insomnia, irritability, and grandiosity. About a week before hospitalization, he decreased his dose of DHEA to 25 mg/day because of his wife’s concern about his irrational and hyperactive behavior. He had no history of prior mania, depression, or psychiatric treatment. However, his baseline mood status may have been mildly hypomanic, with a high level of energy and drive that had contributed to his professional success. His mother’s half sister had been repeatedly hospitalized for depression, but the family history was otherwise negative for psychiatric disorder, alcoholism, and suicide.

The severity of his psychosis necessitated the appointment of a temporary personal guardian with power of attorney. In the hospital, he responded slowly but well to a combination of haloperidol, 10 mg/day, and divalproex, 1500 mg/day, with serum levels of 81.3 ng/ml. Dr. A’s symptoms disappeared completely over several weeks. As his condition improved, he became increasingly insightful into the extent of his illness and experienced transient mild depressive symptoms in response to feelings of humiliation related to his acute mental illness. Haloperidol treatment was tapered and discontinued without recurrence of psychosis or insomnia, while Dr. A continued receiving divalproex. Four months after his hospitalization, he was symptom free, and he remained well on divalproex monotherapy.