Eventually, she was switched from fluoxetine to mirtazapine 15 mg/day. Menstrual abnormalities were resolved in February 2012 and serum prolactin level dropped down to 12 ng/ml. As of April 2012, she was psychiatrically stable without

any manifestation of hyperprolact-inemia, while being maintained on mirtazapine 15 mg/day. Case three The patient was advised to continue 20 mg/day Inhibitors,research,lifescience,medical fluoxetine, but her amenorrhea and galactorrhea persisted without further elevation of prolactin level until August 2011. In September 2011, she was switched to escitalopram 15 mg/day without the resolution of any of hyperprolactinemia-associated symptoms until the first week of January 2012. A therapeutic trial with venlafaxine titrated to 150 mg/day brought a near-complete symptomatic remission of all associated hyperprolactinemic features with resumption of normal menstruation

Inhibitors,research,lifescience,medical cycle within 3 weeks. On February, 2012 her serum prolactin level was found to be essentially within the lower limit of normal value (0–20 ng/ml). The patient selleck remained psychiatrically stable without hyperprolactinemia from the time she was switched to venlafaxine until April 2012. Case four In March 2011, treatment was first modified by discontinuing fluoxetine and adding alprazolam 0.5 mg/day to decrease anxiety, and progressively increasing the dose of sertraline up to 200 mg/day. In May 2011, approximately 2 months after initiation of the sertraline treatment, her Inhibitors,research,lifescience,medical serum prolactin levels was normalized (12 ng/ml) and menstrual abnormalities were resolved. Until April 2012, the patient remained on the same therapeutic regimen and continued to be psychiatrically stable with absolutely regular menstrual cycles. Inhibitors,research,lifescience,medical Case five Fluoxetine was discontinued in January 2012, and it was decided to switch her over to venlafaxine 75 mg/daily in two divided doses, which Inhibitors,research,lifescience,medical was gradually increased to 100 mg/daily over the next 2 weeks

with complete cessation galactorrhea at the 17th day after stopping fluoxetine. She resumed her normal menstruation after 1 month (February 2012) and her serum prolactin level returned to a normal level (9.3 ng/ml). At the 3-month follow-up visit in May 2012, the patient was well maintained on venlafaxine and there was no re-emergence of either galactorrhea or amenorrhea. Essential review of the literature and discussion A literature survey revealed that a correlation exists between weight loss and menstrual cessation, and between regain of weight and menstrual Oxymatrine resumption [Mitan, 2004]. There are several published articles that depicted high prevalence of menstrual disturbances among women associated with bipolar disorder. Although the mechanism had not been ascertained, disruption of the hypothalamic–pituitary–adrenal (HPA) axis function similar to that seen in depression is likely [Rasgon et al. 2000; Rasgon et al. 2003]. However, there is a dearth of published scientific articles justifying the correlation between OCD and hypochondriasis with amenorrhea.