PRL and hyperprolactinemia: Mirtazapine-induced galactorrhea with elevated thought to be mediated via serotonin-driven prolactin release through hypothalamic 5-HT receptors [32]. Although earlier reports suggested mirtazapine does not cause hyperprolactinemia, this case highlights a possible paradox, indicating that serotonin-mediated mechanisms may still be relevant in select individuals [32].