Is breast enlargement a known side effect during treatment with SSRI? Are there any differences bet

Fråga: Is breast enlargement a known side effect during treatment with SSRI? Are there any differences between SSRI concerning an increase in prolactin levels? Background: A woman with obsessive compulsive disorder (OCD) has been treated with Zoloft 100 mg daily since September 1995. She has had a problem with breast swelling for the last three months. The patient has also sometimes been taking Exlutena (gestagen) though she has had problems with breast swelling since she was a teenager.

Sammanfattning: We have not found in literature any differences between different SSRIs according to endocrine symptoms. Some case reports judged galactorrhoea, breast enlargement and hyperprolacinaemia as side effects. These cases emphasize that the presence of side effects with one SSRI do not necessarily predict the same side effect with another. It seems rational to try another antidepressant, on example clomipramin, for this patient

Svar: A literature search including Drugline, Medline and SADRAC (Swedish Adverse drug Reactions Advisory Committee) has not revealed any specific information for SSRI concerning enhanced levels of prolactin. According to data in Drugline (1) treatment with SSRI and increased levels of prolactin have been seen in experiments on animals and humans. However, in studies the raised effect of prolactin has been moderate. The mechanism behind this is not clearly understood, but it is presumed that serotonin facilitates the release of prolactin. There are some case reports where women treated with sertraline or fluvoxamine have experienced galactorrhoea.

A Medline search revealed a case report concerning galactorrhoea induced by sertraline. This woman reported lactation five weeks after initiating sertraline treatment. Sertraline was discontinued and her lactation disappeared after three weeks (2).

Another woman had aggravation of her fibrocystic breast disease when having treatment with different SSRIs. Both fluoxetine and paroxetine therapy aggravated her fibrocystic breast disease by increasing the pain and discomfort and by enlarging the palpable breast cysts. Both drugs were given 20 mg daily for three to six months. During treatment with sertraline 100 mg per day she experienced no further aggravation of her fibrocystic breast disease at a seven month follow-up (3).

Also two cases of breast discomfort and enlargement without galactorrhoea occurred in two women treated with sertraline (4).

The files of SADRAC contain in total twelve case reports where different SSRI (citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline) have been judged a possible or probable cause of endocrine side effects. These side effects were five cases of galactorrhoea, five cases of breast enlargement and two cases of hyperprolacinaemia. The symptoms were equally distributed among the drugs.

We suggest that this case is referred to the Swedish Adverse Drug Reaction Advisory Committee.