Mirtazapine in Paroxetine Induced Hyper-prolactinemic Galactorrhoea

Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat a gamut of depression-anxiety- spectrum disorders. Paroxetine is preferred in cases with co-existent anxiety because of its sedating properties. One problematic side-effect of all SSRIs is galactorrhea,1,2) secondary to raised prolactin levels, which might compromise treatment of index symptoms and impose additional morbidity. A 48-years old, postmenopausal housewife, with nil contributory family/past medical/past psychiatric or substance related history; hysterectomy with bilateral salpingo- oophorectomy (for fibroid-uterus) one year ago; presented to us with chief complaints of low mood, feeling anxious, restlessness, and with decreased sleep for one year. She reported feeling sad for most of last year, with an inability to feel good in social company, family gatherings or while doing previously-pleasurable activities. She reported feeling anxious and restless for no particular reason; reduced interest in household activities and a feeling of fatigue while doing minor works, leading to gradual neglect of these. There was subjective reduction in body weight, and feeling of heaviness and generalized bodyache during this time. Her sleep time had also reduced significantly, from 6-8 hours to 3-4 hours, with difficulty in falling asleep and frequent awakenings. There was also a reduction in her libido for last one year. She was not on any hormone-replacement therapy.