Hindawi Publishing Corporation Case Reports in Medicine Volume 2011, Article ID 191735, 3 pages doi:10.1155/2011/191735 Case Report Marked Mydriasis and Neuritis Nervi Optici Associated with Galactorrhea Following Citalopram Treatment: A Case Report and Discussion Horst J. Koch and Heike Zellmer Department of Psychiatry and Psychotherapy, HELIOS Clinic Aue, D-08280 Aue, Germany Correspondence should be addressed to Horst J. Koch, horst.koch@helios-kliniken.de Received 9 February 2011; Accepted 27 May 2011 Academic Editor: Wico W. Lai Copyright © 2011 H. J. Koch and H. Zellmer. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We report the case of a 25-year-old women suﬀering from major depression who was treated with citalopram for several weeks with doses between 20 mg and 60 mg. She gradually developed marked mydriasis within 2 months after treatment and sub- sequently neuritis nervi optici. Moreover, abrupt galactorrhea occurred after 2 months of treatment. All neuro-ophthalmologi- cal, neurophysiological, clinical laboratory, and neuroradiological diagnostic eﬀorts did not reveal an underlying organic patho- physiology. The ocular symptoms disappeared rapidly after the discontinuation of citalopram and pulse therapy with methyl-pred- nisolone. However, galactorrhea persisted for a few weeks necessitating treatment with bromocriptine. 1. Introduction Anisocoria and mydriasis are neurological symptoms which necessitate immediate medical attention including neurolog- ical, ophthalmological, and neuroradiological diagnostics. Brain stem lesions, cranial nerve damage, or even brain tumors may be possible underlying conditions. Moreover, Adie syndrome may cause mydriasis in combination with weak reﬂex responses and provoke diagnostic pitfalls. Aniso- coria and mydriasis or related ocular ﬁndings following intake of SSRIs (selective serotonin reuptake inhibitors) are rare side eﬀects, and only few cases are documented in sci- entiﬁc literature. Okzan and Kivrak [1] published the case of 24-year-old nurse who developed anisocoria after one- month treatment with sertraline. Dorell et al. [2] observed a case of diplopia after therapeutic use of citalopram. Already in 1994, Barrett published one case of anisocoria associated with administration of sertraline [3]. Obviously, anisocoria appears to be a very rare side eﬀect occurring during clinical use of paroxetine [4] so that a class eﬀect of SSRIs cannot be excluded. Whereas maculopathy appears to be very rare side eﬀect during treatment with citalopram [5] dopamine-mediated galactorrhea is occasionally associated with citalopram, escitalopram and other SSRIs [6–9]. We present the case of a 25-year-old women who devel- oped a trias of marked mydriasis, neuritis nervi optici, and ﬁnally galactorrhea after treatment with citalopram. 2. Case Report The 25-year-old, slightly overweighted women for the ﬁrst time suﬀered from increasing depression in summer 2008. Possible trigger factors were the work on a ward of apallic patients, a new partnership, and the move to a new apartment. In October, she consulted a psychiatrist, her psychopathology corresponding to a moderate depression (ICD 10 F32.1). Due to ineﬀectiveness of opipramol (max- imum dose 2∗50 mg) citalopram outpatient-treatment was added with increasing doses (20 to 60 mg). Although the depression symptoms improved slightly, she was admitted to the psychiatric ward due to undulating mood in November 2008. During the interview, she showed a moderate-to-severe depression with somatic syndrome without suicidal ideation. Due to disturbed sleep, zolpidem (5 mg) was administered transiently, and after a few days after admission, mirtazapine with increasing doses (15 up to 30 mg) was initiated. In the neurological examination on admission she showed a marked mydriasis with normal reaction to light