A 37-year-old female suffered from an episodic illness of 6 years and was diagnosed as recurrent depressive disorder with migraine and hypothyroidism. At the time of presentation, her thyroid function tests were normal on thyroxin 150 mcg/day, and she was on venlafaxine 150 mg, fluoxetine 20 mg, and propranolol 40 mg with minimal improvement and complaints of weight gain, amenorrhea, and galactorrhea. Her serum PRL level was raised (>200). Hence, she was switched to dosulepin 150 mg and propranolol 40 mg. In 1 month, she improved significantly, and breast secretions were stopped completely with normal serum PRL (24 ng/ml). However, due to relapse in depressive symptoms in the next 3 months, the dose of dosulepin was hiked to 225 mg, but after 20 days, she again developed galactorrhea and hyperprolactinemia (170 ng/ml). Finally, she was switched on bupropion 300 mg. In around 1 month, she became asymptomatic (PRL: 21.33 ng/ml) and presently maintaining well on the same medication for the past 6 months.
A 40-year old female suffered from an episodic illness of 7 years and was diagnosed as recurrent depressive disorder. After 15 days of fluoxetine 40 mg and amitriptyline 25 mg, she reported heaviness in breasts and increased breast size with creamy white discharge. Serum PRL level was raised (333 ng/ml). Hence, she was switched to sertraline, and after 1 month, breast secretions stopped completely with normal PRL. Due to relapse in depressive symptoms, she was switched back to fluoxetine as a single agent, and dose was gradually hiked to 60 mg. Now, she is asymptomatic for the past 15 months.