VOLUME 10 , ISSUE 1--4 ( January-December, 2024 ) > List of Articles
Nikitha J Reddy, Vishnuvardhan Gopalakrishnan, Sumanth T Parameshwaraiah, Vidhyavathi Malyam, Asha Chandahalli Sannappa
Keywords : Case report, Escitalopram, Euprolactinemic, Galactorrhea
DOI: 10.5005/jp-journals-10045-00295
License: CC BY-NC 4.0
Published Online: 30-09-2024
Copyright Statement: Copyright © 2024; The Author(s).
Aim and background: Escitalopram, a commonly prescribed selective serotonin reuptake inhibitor (SSRI) for psychiatric disorders, rarely causes endocrine and reproductive adverse effects like galactorrhea. This case report highlights newer adverse effects of escitalopram that must be considered for early diagnosis and better management. Case description: We present a case of a 39-year-old woman with complaints of palpitations, sweating, and shivering. She also has excessive worry regarding her health and has undergone numerous health check-ups. She was diagnosed with hypochondriacal disorder (ICD-10) and started on 5 mg of tablet escitalopram. A few weeks later, the dose was increased to 15 mg for better improvement. She developed breast enlargement and pain along with galactorrhea with normal prolactin levels after initiating tablet escitalopram at a dosage of 15 mg within 2 months. She was cross-tapered with tablet amitriptyline after attempting a re-challenge test once. The symptoms resolved upon discontinuation of escitalopram and did not recur with tablet amitriptyline. Conclusion: A 2021 study highlighted three cases of galactorrhea linked to paroxetine and fluvoxamine, associated with increased serum prolactin levels normalized upon drug discontinuation, likely due to D2 blockade. Clinicians must be aware of galactorrhea risk with these SSRIs. Our study presented a unique case of escitalopram-induced bilateral galactorrhea with normal prolactin levels, resolving postwithdrawal. This contrasts with a similar case of a 43-year-old woman on 20 mg escitalopram for 6 months. The rapid onset within 2 months at a lower dose (15 mg) in our case suggests thyrotropin-releasing hormone (TRH) hyperresponsiveness may play a role. Clinical significance: The resolution of galactorrhea following the discontinuation of escitalopram suggests it as a possible side effect. This condition can be particularly distressing and socially challenging, especially for women with adult children, as it may lead to unwarranted suspicions. As healthcare providers, particularly in mental health, it is crucial to recognize this rare side effect of SSRIs. We must handle this issue with sensitivity, offering appropriate interventions to alleviate the psychological and social impacts on our patients.