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      A Case of Galactorrhea Associated with Excitalopram

      case-report

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          Abstract

          Escitalopram is one of the most popular selective serotonin reuptake inhibitors (SSRIs) in current use as a first-line treatment for depression. Escitalopram is well-tolerated and rarely associated with serious side effects. Endocrine and reproductive side effects of serotonergic antidepressants are uncommon and galactorrhea is very rarely mentioned among SSRI-related side effects. Serotonin-enhancing antidepressants may result in a rise in prolactin levels through suppression of dopamine neurotransmission. In the present study, we report a case of hyperprolactinemic galactorrhea associated with escitalopram. A 36-year-old woman developed galactorrhea after initiation of escitalopram for depression and was found to have an elevated prolactin level. Escitalopram was discontinued with resolution of the patient's galactorrhea and normalization of her prolactin level.

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          Depression: clinical, experimental, and theoretical aspects

          AT Beck, A. Beck, A.T. Beck … (1967)
          Article 0 comments Cited 33 times – based on 0 reviews     Review now
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            Antipsychotic-induced hyperprolactinaemia in women: pathophysiology, severity and consequences. Selective literature review.

            João Haddad, A. Wieck (2003)
            Hyperprolactinaemia has for decades been an inevitable and neglected side-effect of antipsychotic medication. The recent introduction of prolactin-sparing antipsychotic agents makes a re-examination of this problem timely. To review the literature on antipsychotic-induced hyperprolactinaemia and its consequences. A search was made of the Medline database (1966-2002) for key articles, supplemented by cross-referencing. During antipsychotic treatment prolactin concentrations can rise to ten times normal levels or above, and existing data indicate that 17-78% of female patients have amenorrhoea with or without galactorrhoea. Survey data, however, suggest that clinicians underestimate the prevalence of these conditions. Long-term consequences of antipsychotic-related hypo-oestrogenism require further research but are likely to include premature bone loss. Antipsychotic-induced hyperprolactinaemia should become a focus of interest in the drug treatment of psychiatric patients.
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              "Dopamine-dependent" side effects of selective serotonin reuptake inhibitors: a clinical review.

              Francesco Bianchi-Demicheli, Antonio Andreoli, Stefan Beyenburg … (2004)
              Neurophysiologic findings indicate an inhibition of dopaminergic neurotransmission by selective serotonin reuptake inhibitors (SSRIs). This article highlights the relationships between changes in dopaminergic neurotrans-mission induced by SSRIs and the occurrence of certain side effects such as hyperprolactinemia, extrapyramidal symptoms, sexual and cognitive dysfunction, galactorrhea, mammary hypertrophy, and, more rarely, gynecomastia. A systematic search of the literature in English, French, and German from 1980 to 2004 was performed in MEDLINE, EMBASE, and the Cochrane Library using the keywords SSRI, dopamine, serotonin, side effects, antidepressants, citalopram, escitalopram, sertraline, paroxetine, fluoxetine, fluvoxamine, and nefazodone. References cited in all trials were searched iteratively to identify missing studies. All studies concerning inhibition of dopaminergic neurotransmission by SSRIs and SSRI-related side effects were considered. We retained 62 significant articles debating the subject. We critically reviewed the studies, depending on the methodologies (case reports, clinical reports, randomized studies), and assessed the pertinence of "dopamine-dependent" SSRI-related side effects. The analytic review of these articles suggests that some specific SSRI-related side effects be classified as dopamine-dependent. At a clinical level, it could be useful to underline dopamine-dependent characteristics of some SSRI-related side effects. This approach would allow clinicians the opportunity to search other dopamine-dependent side effects systematically. At a pharmacologic level, this approach could stimulate the development of molecules with a "corrective" function on dopamine-dependent side effects of SSRIs by facilitating dopaminergic neurotransmission.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Psychiatry Investig
                Journal ID (publisher-id): PI
                Title: Psychiatry Investigation
                Publisher: Korean Neuropsychiatric Association
                ISSN (Print): 1738-3684
                ISSN (Electronic): 1976-3026
                Publication date (Print): September 2009
                Publication date (Electronic): 15 July 2009
                Volume: 6
                Issue: 3
                Pages: 230-232
                Affiliations
                [1 ]Department of Psychiatry, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea.
                [2 ]DANA Hospital, Ansan, Korea.
                Author notes
                Correspondence: Se-Hoon Shim, MD, PhD. Department of Psychiatry, Soonchunhyang University College of Medicine, Cheonan Hospital, 23-20 Bongmyeong-dong, Cheonan 330-721, Korea. Tel +82-41-570-2280, Fax +82-41-574-7992, shshim2k@ 123456korea.com
                Article
                DOI: 10.4306/pi.2009.6.3.230
                PMC ID: 2796073
                PubMed ID: 20046401
                SO-VID: 63852365-1b55-43bf-a36c-71b38ebe542b
                Copyright © Copyright © 2009 Official Journal of Korean Neuropsychiatric Association
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 04 May 2009
                Date revision received : 07 June 2009
                Date accepted : 11 June 2009
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: galactorrhea,escitalopram,side effect,prolactin,depression
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: galactorrhea, escitalopram, side effect, prolactin, depression

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