Can Sertraline Cause Galactorrhea? Understanding the Link

October 8, 2025 •

4 min read

While psychotropic medications are a common cause of medication-induced galactorrhea, selective serotonin reuptake inhibitors (SSRIs) like sertraline are rarely implicated [1.2.3, 1.6.5]. The question remains for many patients and clinicians: can sertraline cause galactorrhea, and what does the evidence show?

Quick Summary

Sertraline, an SSRI antidepressant, can rarely cause galactorrhea by affecting prolactin levels through complex interactions with serotonin and dopamine pathways. This side effect is uncommon but documented.

Key Points

Rare but Possible: Sertraline can cause galactorrhea, though it is considered an uncommon side effect compared to other psychotropic drugs like antipsychotics [1.2.1, 1.2.3].
Mechanism: The primary cause is hyperprolactinemia, which occurs when sertraline's boost in serotonin inhibits dopamine, the hormone that normally suppresses prolactin production [1.3.2].
Dopamine Interaction: Sertraline also has weak dopamine reuptake inhibiting properties, a unique characteristic among SSRIs that may contribute to this side effect in some individuals [1.2.2, 1.7.4].
Variable Onset: The onset of galactorrhea can range from a few days to several months after starting sertraline or increasing its dosage [1.2.2, 1.2.4].
Diagnosis is Key: If galactorrhea occurs, a healthcare provider should measure prolactin levels and rule out other medical causes like pituitary tumors or hypothyroidism [1.4.4].
Management Options: Treatment often involves stopping the medication, reducing the dose, or switching to a different antidepressant [1.4.3, 1.4.6].
Resolution: The galactorrhea typically resolves within weeks after discontinuing sertraline [1.2.3, 1.2.6].

Sertraline and Its Place in Pharmacology

Sertraline is a widely prescribed antidepressant belonging to the selective serotonin reuptake inhibitor (SSRI) class [1.7.4]. Its primary mechanism of action is blocking the reuptake of serotonin, a neurotransmitter involved in mood regulation, which increases its availability in the brain [1.7.4]. While highly effective for conditions like major depressive disorder and anxiety, sertraline, like all medications, comes with a profile of potential side effects. Among the less common but concerning adverse effects is galactorrhea, the spontaneous flow of milk from the breast, unassociated with childbirth or nursing [1.2.6].

The Unexpected Link: Can Sertraline Cause Galactorrhea?

Though considered a rare side effect, a growing number of case reports have documented instances of galactorrhea in patients taking sertraline and other SSRIs [1.2.1, 1.2.4]. The prevalence of this side effect is thought to be low, but the high number of patients taking SSRIs suggests the total number of affected individuals may be significant and underrecognized [1.2.3, 1.2.4]. In a French pharmacovigilance study, antidepressants accounted for 26% of reported drug-induced hyperprolactinemia cases [1.5.7]. Among SSRIs, galactorrhea appears to be more frequently reported with escitalopram and paroxetine, with fewer cases linked to sertraline [1.2.1, 1.2.3]. The onset can vary, with some cases developing within days of starting the medication or increasing the dose, while others appear after several months [1.2.2, 1.2.4].

The Mechanism: How SSRIs Induce Hyperprolactinemia and Galactorrhea

The primary driver behind galactorrhea is hyperprolactinemia, an elevation of the hormone prolactin [1.2.6]. Prolactin production is normally suppressed by the neurotransmitter dopamine in a region of the brain called the tuberoinfundibular pathway [1.3.3]. The mechanism by which SSRIs like sertraline cause hyperprolactinemia is not fully understood but is believed to be multifactorial:

Serotonergic Inhibition of Dopamine: The core theory is that increased serotonin activity can inhibit the tuberoinfundibular dopaminergic (TIDA) neurons. This 'serotonergic inhibition of dopamine' reduces dopamine's natural braking effect on prolactin, leading to its increased release [1.2.2, 1.3.2].
Indirect Pathways: Serotonin may also stimulate prolactin release indirectly. It can act on GABAergic neurons, which in turn inhibit the TIDA dopamine cells [1.3.1, 1.3.3]. Other proposed pathways involve serotonin stimulating the release of prolactin-releasing factors like vasoactive intestinal peptide (VIP) and oxytocin [1.3.1, 1.3.3].
Sertraline's Unique Dopaminergic Effect: Sertraline is unique among many SSRIs because it also has a minor effect on dopamine reuptake, which can increase dopamine levels in some brain regions [1.7.1, 1.7.4, 1.7.5]. While this might seem counterintuitive, this dopaminergic action could also be responsible for disrupting the delicate balance and leading to galactorrhea in susceptible individuals [1.2.2].

Interestingly, not all cases of SSRI-induced galactorrhea are accompanied by high prolactin levels (a condition known as euprolactinemic galactorrhea) [1.2.4]. The hypothesis for this is an indirect inhibition of the tuberoinfundibular dopaminergic neurons, even without a measurable spike in serum prolactin [1.2.2, 1.2.4].

Drug-Induced Galactorrhea: A Comparison

Many medications are known to cause galactorrhea, often with greater frequency than SSRIs [1.6.4, 1.6.5]. Understanding where sertraline fits in this context is crucial.


Drug Class	Primary Mechanism	Prolactin-Raising Potential	Common Examples
First-Generation Antipsychotics	Strong dopamine (D2) receptor blockade	High	Haloperidol, Fluphenazine [1.6.2]
Atypical Antipsychotics	Dopamine (D2) and serotonin receptor blockade	Variable (High with Risperidone)	Risperidone, Olanzapine [1.6.1, 1.6.5]
SSRIs	Serotonergic inhibition of dopamine pathways	Low	Sertraline, Paroxetine, Fluoxetine [1.6.2]
Gastrointestinal Agents	Dopamine receptor blockade	Moderate to High	Metoclopramide, Domperidone [1.5.3, 1.6.2]
Antihypertensives	Varies (e.g., calcium channel blockers)	Low	Verapamil, Methyldopa [1.6.2]
Opioids	Central nervous system effects	Low to Moderate	Morphine, Methadone [1.6.2]

Compared to antipsychotics like risperidone or the antiemetic metoclopramide, which directly and potently block dopamine receptors, sertraline's effect on prolactin is indirect and far less common [1.5.3, 1.6.5]. Medication-induced hyperprolactinemia typically results in prolactin levels between 25 and 100 ng/mL, though some antipsychotics can push levels well over 200 ng/mL [1.6.5].

Diagnosis and Management

If a patient on sertraline develops galactorrhea, the first step is to confirm the diagnosis and rule out other causes, such as pituitary tumors, hypothyroidism, or pregnancy [1.2.4, 1.4.4]. A healthcare provider will typically measure serum prolactin levels [1.3.8].

Management strategies for sertraline-induced galactorrhea include [1.4.3, 1.4.4]:

Watchful Waiting: If the symptom is mild and not bothersome, and prolactin levels are not excessively high, monitoring the situation may be an option [1.4.2].
Dose Reduction: Lowering the dose of sertraline may resolve the issue, though this must be balanced against the risk of the patient's depressive or anxiety symptoms returning [1.4.6].
Switching Antidepressants: This is a common and effective strategy. A patient who develops galactorrhea on one SSRI may tolerate another SSRI, an SNRI (like venlafaxine or desvenlafaxine), or a different class of antidepressant entirely [1.2.3, 1.2.4, 1.4.8].
Stopping the Medication: Discontinuing sertraline under medical supervision typically leads to the cessation of galactorrhea, often within days to weeks [1.2.3, 1.2.6].
Adding a Dopamine Agonist: In rare or persistent cases, medications like bromocriptine or cabergoline may be cautiously added to lower prolactin levels. However, this carries a risk of potentially worsening the underlying psychiatric condition [1.4.1, 1.4.5].

Conclusion

Yes, sertraline can cause galactorrhea, but it is a rare adverse event [1.2.1, 1.2.8]. The mechanism is primarily linked to the drug's serotonergic effects causing an increase in prolactin, a hormone that stimulates milk production [1.3.2]. While sertraline is less likely to cause this issue compared to antipsychotics, the sheer number of prescriptions means clinicians and patients should be aware of this possibility [1.2.3]. If galactorrhea occurs, it is essential to consult a healthcare professional. Management is typically straightforward and often involves adjusting the medication, leading to a resolution of the symptom without long-term consequences [1.2.6].

For further reading on medication-induced hyperprolactinemia, an authoritative resource is available from the National Center for Biotechnology Information (NCBI): Pharmacological Causes of Hyperprolactinemia [1.6.5]

Frequently Asked Questions

Galactorrhea is a rare side effect of sertraline. It is reported less frequently with sertraline compared to other SSRIs like paroxetine and escitalopram, and is much less common than with antipsychotic medications [1.2.1, 1.2.3, 1.5.4].

Sertraline increases serotonin levels in the brain. This can indirectly inhibit dopamine, a neurotransmitter that normally keeps the hormone prolactin in check. When prolactin levels rise (hyperprolactinemia), it can stimulate the breast glands to produce milk [1.3.2, 1.3.3].

Yes, in reported cases, galactorrhea induced by sertraline typically stops after the medication is discontinued, often within a few days to a few weeks, under a doctor's guidance [1.2.3, 1.2.6].

Absolutely. It is important to see a doctor to confirm the cause. They will need to measure your prolactin levels and rule out other serious conditions like a pituitary tumor or thyroid problems before concluding it is medication-induced [1.4.4].

Yes, switching to another antidepressant is a common management strategy. A person who experiences galactorrhea with one SSRI may not have the same reaction to a different one or to an antidepressant from another class, such as an SNRI [1.2.3, 1.4.8].

Yes, while less common, medication-induced galactorrhea and hyperprolactinemia can occur in men. Symptoms can also include gynecomastia (breast enlargement) and erectile dysfunction [1.2.6, 1.3.1].

Long-term, untreated hyperprolactinemia can potentially lead to issues like decreased bone density or fertility problems. However, since the condition usually resolves after stopping the medication, these long-term risks are not typically a concern with sertraline-induced cases [1.2.2, 1.3.3].