Can Citalopram Cause Galactorrhea?
Yes, citalopram can cause galactorrhea, though this is a rare side effect of SSRIs that is often underrecognized in clinical practice.
Mechanism and Evidence
Citalopram and other SSRIs can induce galactorrhea through serotonergic modulation of prolactin secretion. Serotonin-enhancing antidepressants suppress dopamine neurotransmission in the tuberoinfundibular pathway, releasing prolactin from its tonic dopaminergic inhibition 1, 2. This can occur even with normal prolactin levels (euprolactinemic galactorrhea) 3, 2.
Clinical Presentation
- Galactorrhea may occur with or without elevated prolactin levels - case reports document both hyperprolactinemic and euprolactinemic presentations with citalopram 1, 4
- Temporal relationship is key - symptoms typically develop after SSRI initiation and resolve upon discontinuation 4
- Bilateral presentation is typical when caused by SSRIs 4
Important Clinical Considerations
This side effect is significantly underreported and underrecognized. While major guidelines discussing SSRI adverse effects (including comprehensive reviews from the American Academy of Child and Adolescent Psychiatry and American College of Physicians) extensively detail common side effects like sexual dysfunction, gastrointestinal symptoms, behavioral activation, serotonin syndrome, QT prolongation with citalopram, and discontinuation syndrome 5, galactorrhea is notably absent from these guideline discussions despite documented case reports 1, 3, 2, 4.
Differential Diagnosis Pitfalls
- Do not automatically attribute galactorrhea to other causes without considering SSRI contribution - one case was initially misattributed to hypothyroidism when citalopram was the actual culprit 4
- Rule out medication interactions - trazodone can potentiate serotonergic activity of citalopram and precipitate galactorrhea 6
- Consider prolactin level testing but recognize that normal levels do not exclude SSRI-induced galactorrhea 3, 2
Management Approach
Discontinue or switch the SSRI if galactorrhea develops - case reports consistently demonstrate resolution of galactorrhea and normalization of prolactin levels following citalopram discontinuation 1, 4. The temporal relationship between drug cessation and symptom resolution supports causality 4.
While psychiatrists commonly associate galactorrhea with antipsychotic use, awareness that SSRIs including citalopram can cause this side effect is essential for appropriate diagnosis and management 4.