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      Emerging Hyperprolactinemic Galactorrhea in Obsessive Compulsive Disorder with a Stable Dose of Fluoxetine

      case-report

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          Abstract

          While fluoxetine (FXT) is a frequently prescribed selective serotonin reuptake inhibitor (SSRI), with few major side-effects; altered serotonergic transmissions in hypothalamic pathways might lead to a distressing, and often embarrassing, manifestation of galactorrhea by altering prolactin release in those on FXT. We report here a case of FXT-induced hyperprolactinemic galactorrhea developing late into treatment on a stable regimen, who responded well to subsequent replacement with sertraline. Based on present finding, we suggest that while SSRIs may share similar mechanisms of action, there exist individual differences in their effects on prolactin secretion pathways.

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          Antipsychotic-induced hyperprolactinemia.

          Thomas Bostwick, Vicki L Ellingrod, S Guthrie (2008)
          Use of antipsychotic agents has been associated with hyperprolactinemia, or elevated prolactin levels; this hormonal abnormality can interfere with the functioning of reproductive, endocrine, and metabolic systems. As antipsychotic agents are increasingly used for both United States Food and Drug Administration-approved and nonapproved indications, many individuals are at risk for developing antipsychotic-induced hyperprolactinemia. First-generation antipsychotics pose the greatest risk of causing this adverse effect; however, second-generation antipsychotics, particularly risperidone and paliperidone, also often increase prolactin secretion. Hyperprolactinemia has short- and long-term consequences that can seriously affect quality of life: menstrual disturbances, galactorrhea, sexual dysfunction, gynecomastia, infertility, decreased bone mineral density, and breast cancer. Although many of these are definitively connected to elevated prolactin levels, some, such as breast cancer, require further study. Both clinicians and patients should be aware of hyperprolactinemia-associated effects. To prevent or alleviate the condition, tailoring an antipsychotic drug regimen to each individual patient is essential. In addition, the risk of hyperprolactinemia can be minimized by using the lowest effective dose of the antipsychotic agent. If the effects of prolactin are evident, the drug can be changed to another agent that is less likely to affect prolactin levels; alternatively, a dopamine agonist may be added, although this may compromise antipsychotic efficacy. Additional research is needed to clarify the appropriate level of monitoring, the long-term effects, and the optimal treatment of antipsychotic-induced hyperprolactinemia.
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            Stahl's essential psychopharmacology: neuroscientific basis and practical applications

            M. Stahl, SM Stahl, S.M. Stahl … (2002)
            Article 0 comments Cited 46 times – based on 0 reviews     Review now
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              From galactorrhea to osteopenia: rethinking serotonin-prolactin interactions.

              Ana B F Emiliano, Neva Fudge (2004)
              The widespread use of the selective serotonin reuptake inhibitors (SSRIs) has been accompanied by numerous reports describing a potential association with hyperprolactinemia. Antipsychotics are commonly known to elevate serum prolactin (PRL) through blockade of dopamine receptors in the pituitary. However, there is little awareness of the mechanisms by which SSRIs stimulate PRL release. Hyperprolactinemia may result in overt symptoms such as galactorrhea, which may be accompanied by impaired fertility. Long-term clinical sequelae include decreased bone density and the possibility of an increased risk of breast cancer. Through literature review, we explore the possible pathways involved in serotonin-induced PRL release. While the classic mechanism of antipsychotic-induced hyperprolactinemia directly involves dopamine cells in the tuberoinfundibular pathway, SSRIs may act on this system indirectly through GABAergic neurons. Alternate pathways involve serotonin stimulation of vasoactive intestinal peptide (VIP) and oxytocin (OT) release. We conclude with a comprehensive review of clinical sequelae associated with hyperprolactinemia, and the potential role of SSRIs in this phenomenon.
              Article 0 comments Cited 23 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Psychopharmacol Neurosci
                Journal ID (iso-abbrev): Clin Psychopharmacol Neurosci
                Title: Clinical Psychopharmacology and Neuroscience
                Publisher: Korean College of Neuropsychopharmacology
                ISSN (Print): 1738-1088
                ISSN (Electronic): 2093-4327
                Publication date (Print): December 2015
                Publication date (Electronic): 31 December 2015
                Volume: 13
                Issue: 3
                Pages: 316-318
                Affiliations
                [1 ]Department of Psychiatry, Medical College, Kolkata, India
                [2 ]Department of Psychiatry, Sarojini Naidu Medical College, Agra, India
                Author notes
                Address for correspondence: Sayantanava Mitra, MD, Department of Psychiatry, Sarojini Naidu Medical College, Mahatma Gandhi Rd, Raja Mandi Crossing, Bagh Muzaffar Khan, Shahganj, Agra, Uttar Pradesh 282002, India, Tel: +91-8298187766, E-mail: sayantanava@ 123456gmail.com
                Article
                Publisher ID: cpn-13-316
                DOI: 10.9758/cpn.2015.13.3.316
                PMC ID: 4662167
                PubMed ID: 26598592
                SO-VID: 197fd03b-ce64-4aa4-b3f2-d02068d60db5
                Copyright © Copyright © 2015, Korean College of Neuropsychopharmacology
                License:

                This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 14 January 2015
                Date revision received : 25 February 2015
                Date accepted : 28 March 2015
                Categories
                Subject: Case Report

                Keywords: fluoxetine,galactorrhea,hyperprolactinemia,selective serotonin reuptake inhibitors
                Data availability:
                Keywords: fluoxetine, galactorrhea, hyperprolactinemia, selective serotonin reuptake inhibitors

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