Demirci K, Unubol M, Korucu CC, Demirci S
Escitalopram induced euprolactinemic galactorrhea: a case report
Escitalopram is a selective serotonin reuptake inhibitor that is the s-enantiomer of citalopram. Galactorrhea is defined as discharge of milk or milk like secretions from the breast spontaneously. Here we report the case of a postmenopausal woman, who was treated with escitalopram for depression and developed galactorrhea without hyperprolactinemia. A 32-year-old married female with two children applied to psychiatry outpatient clinic due to depressive complaints five months ago. There was galactorrhea from both breasts for a month. A medical history and review of her medical records revealed that she was treated with escitalopram dose of 10 mg per day given by psychiatrist for 4 months. In mental state examination there were mild depressive complaints. She underwent hysterectomy salpingo-phorectomy operation six years ago due to ovarian cyst. She wasn’t on hormone replacement or any other medication treatment. Her general physical examination was normal except for galactorrhea. She was evaluated by endocrinologist and her serum prolactin level was normal (10.03 ng/ml, normal limit: 4.79-23.3 ng/ml). Serum prolactin levels were also normal in repeated measurements. Results of other laboratory investigations such as hemogram, liver, kidney, thyroid function test were normal. FSH, LH levels were high due to post-oophorectomy. Neurological examination was normal. Magnetic resonance image of the brain and hypophysis particularly the pituitary gland were normal. Her breast ultrasonogram was normal. In cytological examination of secretion from the breasts, there was no inşammation and secretion was not consistent with cyst şuid. In the result of investigations, galactorrhea was thought to be escitalopram induced and escitalopram treatment was stopped. The patient was advised to avoid from coitus and breast stimulation for a one week. Four days after stopping escitalopram her galactorrhea discontinued. Subsequently she was prescribed sertraline for depression treatment. During three months of follow-up, the patient maintained well on sertraline, serum prolactin level was normal and there was no galactorrhea. Galactorrhea may be induced by the use of various medications. Drugs especially antipsychotics, gastrointestinal motility increasing agents and verapamil may cause galactorrhea. Antidepressant drugs rarely may lead to galactorrhea. Prolactin levels in galactorrhea due to drugs are normal or lower than 100 ng/ml. It has been suggested that hyper responsiveness of TRH is probable reason for euprolactinemic galactorrhea. Even if prolactin levels are normal, clinicians should think of escitalopram as a probable cause of galactorrhea.