A 36-year-old woman with two children visited a psychiatric outpatient clinic on an ambulatory basis. She had no history of endocrine or reproductive pathology or psychiatric problems. Although she had been receiving a conservative treatment for iron deficiency anemia and transient hematuria, there was no specific hematologic and nephrologic finding and she had not taken any dopamine antagonistic agents including gastrointestinal motility drugs and antipsychotic agents except ferrous sulfate. Her son had been diagnosed with pervasive development disorder and mental retardation. She had suffered symptoms of depressed mood, nihilistic ideation, decreased volition, decreased psychomotor activity, loss of appetite, and sleep disturbance, which occurred after her son's diagnosis 2 years ago. Diagnostic tests were performed to ascertain whether she had neurologic or any other systemic organic disease that could explain her symptoms. Following a detailed psychiatric examination with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), escitalopram 10 mg per day was prescribed to the patient with the diagnosis of major depressive disorder. She scored 26 on the Hamilton rating scale for depression (HRSD), and 25 on the Beck depression inventory (BDI)., After 2 weeks of medication, her complaints declined, her HRSD score was 18 and her BDI score further decreased to 20. However, she developed galactorrhea with breast pain (the nonpuerperal discharge of milk-containing fluid from the breast). She had no history of galactorrhea. She first noticed the discharge on treatment day 14 and described it as white-creamy and from both nipples. She did not notice any bloody, greenish, or foul-smelling discharge nor report sexual dysfunction. She consulted her gynecologist, who recommended mammography and breast ultrasonography. The results of these tests were normal. However, serum prolactin level on treatment day 14 was 200 ng/mL (reference range: 1.2-24.2 ng/mL). There were no abnormalities in blood chemistry, thyroid function tests, or electrocardiogram. She was recommended to undergo magnetic resonance imaging (MRI) of the hypothalamic/pituitary area to exclude mass lesions. However, she refused the test, which was not done. Because her galactorrhea developed after initiations of her medication with escitalopram, we stopped her medication. After cessation of the medication, the discharge abated and breast pain was relieved. Her serum prolactin level decreased to 2.38 ng/mL five days after discontinuing escitalopram.
A 36-year-old married female was presented to the psychiatry outpatient services with 2 years of delusion of infidelity and significant sociooccupational dysfunction in the absence of any impairment in sleep or appetite. Vitals were stable, body mass index (BMI) was calculated to be 26 and systemic examinations revealed no abnormality. Baseline prolactin level was 14 ng/ml.\nIn view of the high BMI and poor insight, she was started on aripiprazole. It was expected that the favorable side effect profile of aripiprazole with relatively less weight gain and extrapyramidal symptoms would ensure compliance. Aripiprazole was started at an initial dose of 5 mg at night and was increased to 10 mg and later 15 mg after 4 days each and 15 mg was continued as maintenance. However, 3 weeks later, she was presented with galactorrhea and a missed menstrual period. Her psychotic symptoms had subsided. There was no weight gain or extrapyramidal symptoms. A urine pregnancy test was done to rule out pregnancy. Serum prolactin level was found to be 96 ng/ml. Neuroimaging was done to rule out a prolactinoma. The possibility of aripiprazole-induced hyperprolactinemia was considered and aripiprazole was stopped. As she was otherwise asymptomatic, no other medication was started and she was sent home. At follow-up, 1-month later, galactorrhea had subsided, she had menstruated, and repeat prolactin levels were 18 ng/ml. Her psychotic symptoms continued to be in remission, and she returned home medication-free.\nThree months later, she presented with the relapse of psychotic symptoms. Aripiprazole was restarted as previously, but was maintained at 10 mg owing to the previous history of hyperprolactinemia. She reported back within a month with the complaints of galactorrhea and amenorrhea at which time her psychotic symptoms were in complete remission. Serum prolactin levels were repeated and found to be elevated (84 ng/ml). Again, aripiprazole was stopped and patient returned home. Serum prolactin levels were normalized (19 ng/ml) and hyperprolactinemia symptoms were subsided within 1-month.\nThe patient and her spouse have provided consent for publishing this case report.