Galactorrhea after Paroxetine Treatment

 

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Tricyclic antidepressants have sometimes been associated with galactorrhea [1]. Selective serotonin reuptake inhibitors (SSRIs) have also been reported to cause galactorrhea and prolactin increase, such as fluoxetine [2], sertraline [3] and fluvoxamine [4]. However, we have only found two cases of galactorrhea as a side effect concerning paroxetine[5] [6]. Both patients suffered from a depressive illness.

In the present letter, we report the first case of galactorrhea following paroxetine treatment in a woman suffering from panic disorder with agoraphobia.

A 32-year-old female outpatient was treated for panic disorder with agoraphobia. For six months, she had experienced panic attacks with increasing frequency. Paroxetine (40 mg daily) was prescribed, and all the symptoms progressively resolved. The patient had never been pregnant before she received paroxetine. The drug was maintained for twelve months and no side-effects were observed. During the following year, she felt asymptomatic, got pregnant and gave birth to a healthy baby. Nevertheless, panic attacks appeared again two years after treatment discontinuance. Paroxetine at a dose of 40 mg per day was reintroduced. The symptoms improved once more, but four months later, she complained of milky discharge from her nipples. Paroxetine was then reduced to 30 mg daily and galactorrhea gradually resolved in a month. The patient only developed the special adverse reaction after she had become pregnant in the meantime. There was no other organic disease, the patient was on no other regular medication and it has been her only pregnancy.

We think the iatrogenic role of paroxetine was quite clear in the case reported. There is a temporal relationship between paroxetine administration and the onset of galactorrhea, and between its remission after dose reduction. In this way, some evidence for dose-related effects of SSRIs antidepressants raising prolactin levels has been reported [5].

Apart from the above, it seems interesting that the patient did not complain of any side-effects the first time she was on paroxetine, when she had not been pregnant before. Aproximately three years later, after the endocrinological changes of pregnancy, paroxetine at the same dose induced galactorrhea. We find it likely that not only some individuals may be susceptible to developing galactorrhea [5], but the same individual itself might be predisposed at different life stages.

In any case, although the relationship between serotonine and dopamine systems is unknown, 5HT neurons are believe to maintain a tonic inhibitory influence on dopamine function [6]. In fact, this physiological link may explain the stimulating effect of SSRIs on prolactin.

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M.D. Emilio González,

Complejo Hospitalario San Luis. Departamento de Psiquiatría

Carretera de Burgos s/n. 34004. Palencia

Spain

Email: san_luis@seker.es