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INTRODUCTION
Spontaneous milky discharge from the ducts of both mammary glands is known as galactorrhea. Galactorrhea occurs due to different medical conditions, including the use of antidepressant medications. Activation of the serotonergic system blocks dopamine¾an inhibitor of prolactin in the tuberoinfundibular tract¾resulting in an increase in the prolactin level and finally galactorrhea (Feuchtl et al. 2004). Another mechanism involved in elevated prolactin via serotonin is direct stimulation of hypothalamic postsynaptic serotonergic receptors (Bronzo and Stahl 1993). Monoaminoxidase inhibitors, tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRIs) can lead to a small increase in prolactin levels (Checkley 1991; Wieck and Haddad 2003). Hyperprolactinemia and galactorrhea associated with the use of SSRIs such sertraline and fluvoxamine has been reported (Bronzo and Stahl 1993; Spigset and Mjorndal 1997; Peterson 2001; Yang et al. 2009). On the other hand, data regarding hyperprolactinemia due to duloxetine, a novel serotonin-noradrenaline reuptake inhibitor, are limited (Ashton and Longdon 2007). Herein we report a hyperprolactinemia case with galactorrhea due to duloxetine treatment for depression.
Case
An unemployed 44-year-old female patient that was married, had 3 children, and was a primary school graduate presented to our clinic with milky discharge, fullness, and breast pain. The patient's history was positive for use of different classes of antidepressants due to a diagnosis of depression, whereas it was negative for other psychiatric illnesses, medical illness, surgery, and alcohol and substance abuse. Her physical examination and routine biochemical tests, including thyroid-stimulating hormone, urea, and creatinine, were normal. She was not pregnant and wasn't using oral contraceptives.
Anxiety,...