Abstract: Euprolactinemic Galactorrhoea in a patient of Obsessive Compulsive Disorder on Fluvoxamine therapy.

BACKGROUND: Only few studies have implicated anti-depressants in serotonergic modulation of prolactin. Galactorrhoea is rare but distressing side effect, especially for young, unmarried women.There is some literature which attributes galactorrhoea to hyperprolactinemia caused by serotonin enhancing agents- including paroxetine, fluoxetine and escitalopram. However, in this case report, we describe a case of fluvoxamine induced reversible euprolactinemic galactorrhoea. CASE DETAILS: A 19 year/female presented to us with complaints of recurrent intrusive thoughts regarding dirt and contamination which resulted in washing her hands 15-20 times a day, repeatedly checking electrical switches. Patient was diagnosed with Obsessive Compulsive Disorder and started on Fluvoxamine 50mg, later optimised to 150mg/day to which she responded well. Two months later, she noted a milky white, non-haemorrhagic, non-purulent discharge from bilateral breasts. All investigations were unremarkable including sr prolactin(19.9ng/ml) No other cause of galactorrhoea could be identified. There was a temporal association between the onset of galactorrhoea and Fluvoxamine use. So we decided to cross taper Fluvoxamine with Escitalopram, following which Galactorrhoea resolved within 15 days.Patient responded well and showed no adverse effects. CONCLUSION: The distressing symptoms of galactorrhoea in young, unmarried women necessitate extensive research on prolactin metabolism and possible causes for normo-prolactinemic galactorrhoea. Further research on the role of serotonin on prolactin release is needed, along with the possible causal relationship between SSRIs and galactorrhoea.