Hereditary Hemochromatosis and Exacerbation of Psychiatric Manifestations Following Therapeutic Phlebotomy Sessions: A Case Report

Abstract

Background: Hereditary hemochromatosis, characterized by iron overload, is well known for its systemic effects; however, psychiatric clinical manifestations are underreported. Previous research articles discussed the link between excessive iron accumulation and mood disorders that were resolved following therapeutic phlebotomy treatment. In this case study, we presented a unique case that revealed the emergence of mood disorders following phlebotomy sessions. Our aim is to explore the relationship between them. This case report describes a 24-year-old Caucasian male who was admitted to the hospital with severe depression and suicidal ideations along with poor insight and tangential thought process following a financial trauma. He was diagnosed with a Major Depressive Disorder based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V). The patient reported a diagnosis of hereditary hemochromatosis in 2023 and has received two phlebotomy treatments since then. After the second phlebotomy session, he experienced worsening depressive symptoms (passive suicidal ideations); his blood tests revealed normal iron and ferritin levels on the 5th day of admission. He had been taking Escitalopram and Lamotrigine over the past six months. Methods: We developed and searched keywords in multiple databases (PubMed, Google Scholar, etc.) after obtaining informed written consent from the patient. We then reviewed the literature thoroughly to identify cases of psychiatric exacerbation associated with hemochromatosis and phlebotomy. Results: Our case report highlights a possible linkage between phlebotomy sessions for hemochromatosis and worsening depressive symptoms despite iron normalization. Conclusion: This study stresses the need for routine mental health screening and iron profile checking following phlebotomy sessions and a multidisciplinary approach. Background: In hemochromatosis, iron accumulates excessively in many organs, such as the liver, pancreas, heart, and joints, and rarely in the brain, leading to neuropsychiatric manifestations such as anxiety, depression, mood swings, autism, and movement disorders [1, 2, 3, 4, 5, 6, 7]. Iron dysregulation can result in mood disorders, psychosis, anxiety, and neurodevelopmental problems [8]. A study showed an increased risk of psychiatric manifestations in patients with hemochromatosis, with a prevalence of 79% and 65% for depression and anxiety, respectively [9]. Although patients with hemochromatosis show a higher incidence of mental illness, specific psychiatric disorders that significantly impact quality of life are rarely reported [3, 7, 10]. Over one billion people globally are living with a mental disorder, causing increased disability and premature mortality [11]. Previous existing studies have reviewed iron dysregulation on brain function; however, the correlation between hemochromatosis with or without therapeutic phlebotomy and manifestations of psychiatric disorders still requires further research to understand better [7, 8, 12]. In this case report, we aim to explore the link between hemochromatosis and increased psychiatric manifestations following successive therapeutic phlebotomies.