Translate this page into:
Fluoxetine Induced Galatorrhea: A Rare Case Series
*Corresponding author: Dr. Depanjan Dutta Department of Psychiatry, Nil Ratan Sircar Medical College and Hospital. 138, Acharya Jagdish Chandra Bose Road. Sealdah, Rajabazar. Kolkata, West Bengal, 700014, India. depanjan18@gmail.com
-
Received: ,
Accepted: ,
How to cite this article: Dutta D, Saha SS. Fluoxetine Induced Galatorrhea: A Rare Case Series. Bengal J Psychiatry. doi: 10.25259/BJPSY_22_2025
Abstract
SSRI-induced hyperprolactinemia is an uncommon but clinically important adverse effect, likely mediated by serotonergic inhibition of hypothalamic dopaminergic tone. Fluoxetine, one of the most widely prescribed selective serotonin reuptake inhibitor (SSRIs), has been implicated in a small number of cases, yet its endocrine effects remain under-recognized in routine psychiatric practice. Four female patients receiving fluoxetine in different doses developed galactorrhea with amenorrhea in some cases, accompanied by normal or elevated serum prolactin levels. Neuroimaging excluded prolactinoma. Symptoms and hyperprolactinemia resolved following fluoxetine dose reduction or discontinuation, with clinical improvement maintained on alternative pharmacological and psychotherapeutic interventions.
Keywords
Fluoxetine
Galactorrhea
Prolactin
Psychiatry
INTRODUCTION
Galactorrhea refers to non-puerperal milk secretion and may arise from physiological, pathological, or pharmacological causes.1,2 Hyperprolactinemia is commonly associated with galactorrhea; however, normal prolactin levels do not exclude the diagnosis.3,4 Psychotropic medications are well-recognized contributors, particularly those that disrupt dopaminergic inhibition of prolactin release.1,5,6
Fluoxetine is one of the most prescribed selective serotonin reuptake inhibitors worldwide because of its efficacy and generally favorable safety profile.7 While its adverse effects are typically gastrointestinal or neuropsychiatric, endocrine disturbances such as menstrual irregularities, sexual dysfunction, and galactorrhea have been increasingly reported.1,7-9
Although uncommon, fluoxetine-induced galactorrhea may be underdiagnosed, particularly when prolactin levels remain normal or when symptoms are attributed to alternative etiologies.3,4,10
Published literature on this association remains largely limited to isolated case reports and small observational studies.1,5,8,9 Documentation of additional cases, therefore, contributes to the expanding understanding of selective serotonin reuptake inhibitor (SSRIs)-associated galactorrhea and its heterogeneous biochemical presentation.1,3,4
CASE SERIES
Case 1
A 35-year-old woman presented with a 2-year history of fear of contamination, compulsive checking and washing, restlessness, and sleep disturbances. She was diagnosed with obsessive compulsive disorder (OCD) Yale Brown Obsessive Compulsive Scale (YBOCS: 35). Fluoxetine was initiated at 20mg/day, gradually increased to 60 mg/day. Significant improvement in OCD symptoms (YBOCS: 16) was noticed. At 11 weeks, the patient developed amenorrhea and galactorrhea. Serum prolactin was found to be 130 ng/ml. Prolactinoma ruled out by MRI of the brain. Fluoxetine was tapered gradually to 20 mg/day, but symptoms came back eventually with a YBOCS score of 25. Low-dose aripiprazole 2.5 mg/day was added as augmentation therapy. cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) was introduced. OCD symptoms improved. Prolactin level got normalized in further follow-ups. Menstruation got regularized. Breast discharge also got resolved.
Case 2
A 31-year-old female suffered from an episodic illness of low mood, low interest in work, sleeplessness, lethargy for the last 6 years, and was diagnosed with 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 prolactin (PRL) level was raised (>200). Prolactinoma ruled out by MRI of the brain. She was switched to Bupropion 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).
Case 3
A 25-year-old girl presented with complaints of episodic shortness of breath, episodic loss of responsiveness with intact awareness, and sleep disturbance for about 2 years. Such episodes had no history of incontinence, tongue bite, or post-ictal confusions. Diagnosis of dissociative conversion disorder was made. Initially, she was prescribed Fluoxetine 20 mg/day, which we gradually increased to 60 mg/day in the course of 3 months. On the 4th follow-up, which is after 4 months, she reported secretions from the breasts. Her serum PRL level was raised (164.4 ng/ml). Prolactinoma ruled out by MRI of the brain. Then, she was kept on clonazepam 1 mg/day along with psychotherapy sessions. After stopping the medicines, the discharge stopped completely in 10 days. At present, the patient has been asymptomatic for the past 3 months and is not receiving any psychotropic medications.
Case 4
A 40-year-old female who suffered from an episodic illness of low mood, sleeplessness, decreased appetite, decreased concentration, and fatiguability for the last 7 years was diagnosed with recurrent depressive disorder. After 15 days of fluoxetine 40 mg, she reported heaviness in her breasts and increased breast size with creamy white discharge. Serum PRL level was raised (333 ng/ml). Prolactinoma ruled out by MRI of the brain. Hence, she was switched to sertraline 50 mg. After 1 month, breast secretions stopped completely with a normal prolactin level, and the patient was maintained on sertraline 75mg.
DISCUSSION
Published literature on this association remains largely limited to isolated case reports and small observational studies.1,5,8,9 Documentation of additional cases, therefore, contributes to the expanding understanding of SSRI-associated galactorrhea and its heterogeneous biochemical presentation.1,3,4
This case series adds to existing evidence that fluoxetine may induce galactorrhea through mechanisms involving serotonergic modulation of dopaminergic inhibition of prolactin release.1,5,7 The cases demonstrated variable biochemical profiles, with some patients showing elevated prolactin levels and others maintaining normal levels, consistent with previous findings that serum prolactin does not always correlate with symptom severity in SSRI-associated galactorrhea.3-5
Our findings highlight several clinically relevant points:
Our findings highlight several clinically relevant points. Onset is variable, with reports ranging from early treatment to long-term therapy.8,9 Dose does not reliably predict risk, which is consistent with the pharmacodynamic variability reported for SSRIs.11 Normal prolactin levels do not exclude medication-related galactorrhea, a feature that has been described in other SSRI- and psychotropic-related cases.3,10 Symptoms commonly resolve after discontinuation or dose reduction, reinforcing a causal relationship.8,9 Increased awareness of this association can prevent unnecessary investigations such as pituitary imaging.1,2
The underlying pathophysiology remains incompletely understood. Proposed mechanisms include serotonergic inhibition of dopaminergic tone within the tuberoinfundibular pathway and direct serotonin-mediated prolactin stimulation.1,5,7 Individual susceptibility factors—including endocrine sensitivity and interindividual pharmacogenetic differences—may also play a role [Figure 1].6,11
- Hypothalamus-pituitary-breast axis for prolactin secretion
While isolated case reports exist, larger population studies remain scarce. The current series contributes to the limited but growing literature emphasizing the importance of considering fluoxetine as a potential cause of galactorrhea.8,9
Limitations
In the 2nd case, two antidepressants were used, both of which were changed thereafter. So, any one of them can cause galactorrhoea.
CONCLUSION
Fluoxetine-induced galactorrhea, though uncommon, is a clinically significant adverse effect that may be overlooked. Clinicians should maintain a high index of suspicion when patients on SSRIs present with nipple discharge, even in the absence of hyperprolactinemia. Early recognition can prevent unnecessary diagnostic procedures and guide appropriate management, typically through dose adjustment or medication substitution.
Acknowledgement
I would like to express my sincere gratitude to all those who contributed to the successful completion of this case series on fluoxetine-induced galactorrhea. First and foremost, I am deeply thankful to my patients and their family members for their cooperation, patience, trust, and willingness to share their experiences, which were invaluable in presenting this case. I extend my heartfelt thanks to my teachers, mentors, and colleagues for their guidance, insight, and encouragement at every stage. Their expertise and critical feedback helped shape the clarity and depth of this report. This work would not have been possible without the collective efforts of all the individuals mentioned above.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
References
- Diagnosis and treatment of hyperprolactinemia: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:273-88.
- [CrossRef] [PubMed] [Google Scholar]
- Pituitary disorders: Current diagnostic approach. N Engl J Med. 2020;382:937-50.
- [CrossRef] [PubMed] [Google Scholar]
- Galactorrhea with normal prolactin levels: Mechanisms and clinical relevance. Endocr Pract. 2016;22:1106-12.
- [Google Scholar]
- Normoprolactinemic galactorrhea associated with SSRIs. Clin Neuropharmacol. 2021;44:123-7.
- [Google Scholar]
- SSRI-induced galactorrhea: Case reports and review of pathophysiology. Indian J Psychol Med. 2018;40:575-9.
- [Google Scholar]
- Antidepressants and prolactin elevation: A pharmacovigilance review. Psychopharmacology (Berl). 2019;236:1783-95.
- [Google Scholar]
- Management strategies for antidepressant-related sexual dysfunction: A clinical approach. J Clin Med. 2019;8:1640.
- [CrossRef] [PubMed] [Google Scholar]
- Antidepressant-induced hyperprolactinaemia. Aust N Z J Psychiatry. 2015;49:789-803.
- [Google Scholar]
- Fluoxetine-associated galactorrhea: Delayed onset and reversibility. Asian J Psychiatr. 2020;54:102276.
- [Google Scholar]
- SSRI-related galactorrhea without hyperprolactinemia. Indian J Psychol Med. 2018;40:575-9.
- [Google Scholar]
- Pharmacogenomics of antidepressant adverse effects. Dialogues Clin Neurosci. 2019;21:261-70.
- [Google Scholar]