SSRI-Induced Galactorrhea in Adolescents

Selective serotonin reuptake inhibitors (SSRIs) are generally regarded as safe and widely used in children and adolescents. Although rare, SSRIs can cause neuroendocrine side effects such as hyperprolactinemia and galactorrhea. Galactorrhea is inappropriate milk secretion outside of pregnancy or breastfeeding and may occur with normal prolactin levels. Although numerous cases have been reported in adults, only a few have been reported in adolescents.

A PubMed and Embase search was conducted to identify English-language case reports and case series involving patients ≤18 years with SSRI-associated galactorrhea. Seven adolescent female cases were identified, including five case reports and two cases from pharmacovigilance data.

SSRIs involved included citalopram, escitalopram, fluoxetine, sertraline, and paroxetine, as well as sequential exposure to other serotonergic antidepressants. Time to onset ranged from days to several weeks after initiation or dose escalation, with longer latency reported in a pharmacovigilance case. Prolactin levels ranged from normal to markedly elevated. In all cases, galactorrhea improved or resolved after dose reduction, discontinuation of the offending agent, or treatment modification, with recurrence observed in some patients following exposure to another serotonergic antidepressant.

Reports show that SSRI-induced galactorrhea and hyperprolactinemia, though uncommon, can occur in adolescents. Clinicians should be aware that SSRI-related galactorrhea may occur even when prolactin levels are normal or mildly elevated and should actively inquire about this adverse effect. Further research is needed to clarify prevalence, risk factors, and mechanisms involved.