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Paroxetine-induced galactorrhea

Published online by Cambridge University Press:  01 September 2022

S. Petrykiv ,
M. Arts  and
L. De Jonge
S. Petrykiv*
Affiliation:
GGZWNB, Psychiatry, Halsteren, Netherlands
M. Arts
Affiliation:
GGZWNB, Psychiatry, Bergen op Zoom, Netherlands
L. De Jonge
Affiliation:
Leonardo Scientific Research Institute, Neuropsychiatry, Bergen op Zoom, Netherlands
*
*Corresponding author.

Abstract

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Introduction

Antidepressant-induced galactorrhea and increases in prolactin levels have been sporadically reported among SSRI-related side effects.

Objectives

Current rapport presents a case of 39 y.o. female who developed several adverse effects on paroxetine - including galactorrhoea - which improved on discontinuation of the drug.

Methods

Case discussion of 39-year old woman who was treated with paroxetine for her panic disorder and developed galactorrhoea with hyperprolactinemia that resolved upon discontinuation of the drug. Additionally, authors performed the literature search using PubMed and Embase to review the similar cases and used PDSP Database to assess the latest pharmacodynamic (PD) properties of paroxetine and other SSRI’s.

Results

Literature review (1966–2020) revealed 24 prior published case reports of SSRI-induced galactorrhea in users of paroxetine (n=4), escitalopram (n=4), sertraline (n=2), citalopram (n=2), fluoxetine (n=3), fluvoxamine (n=2) and other non-assessable reports (n=7). Elevated prolactin levels were mostly observed with paroxetine and escitalopram and rarely with fluoxetine, fluvoxamine and sertraline. PD-assessment showed the highest binding affinity of paroxetine and escitalopram to SERT (kPi = 0.07-0.2 and 0.8-1.1 nmol/L respectively) compared to other SSRI’s, in absence of other relevant PD-properties

Conclusions

Increasing body of evidence shows that galactorrhea does occur among paroxetine female users. Pharmacodynamic mechanism of action is poorly understood but given the modern insights in relationship in serotonin and dopamine circuits, we suggest that strong SERT inhibitory properties of paroxetine might lead to a tonic suppressive influence on dopamine neurotransmission. This physiological link may explain an increase in prolactin levels through dopamine depletion in the tuberoinfundibular pathway.

Disclosure

No significant relationships.

Keywords

GalactorrheaParoxetineCase discussionLiterature review
Type
Abstract
Information
European Psychiatry , Volume 65 , Special Issue S1: Abstracts of the 30th European Congress of Psychiatry , June 2022 , pp. S873
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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