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 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.