POMC and manic or hypomanic episode: In female patients aged 45 years or above, higher levels of estradiol (Z = 2.275, P = 0.023), progesterone (Z = 2.174, P = 0.03), and CRP (Z = 5.083, P < 0.001), as well as lower levels of cortisol (Z=-4.694, P < 0.001) and ACTH (Z=-7.382, P < 0.001), were found during manic episodes in comparison with depressive episodes (Table 3).