Is escitalopram (Lexapro) safe to use during pregnancy?

From the Guidelines

Escitalopram (Lexapro) can be used during pregnancy, but the decision should be based on weighing the benefits of treating depression or anxiety against potential risks to the developing baby, and using the lowest effective dose is recommended. The use of escitalopram during pregnancy has been associated with a small increased risk of birth defects, particularly heart defects, though the absolute risk remains low 1. Additionally, there may be a slight risk of persistent pulmonary hypertension of the newborn (PPHN) and neonatal adaptation syndrome (temporary withdrawal symptoms like irritability, feeding difficulties, and respiratory distress) in babies exposed to escitalopram late in pregnancy 1.

Some key points to consider when using escitalopram during pregnancy include:

• The typical dosage ranges from 10-20 mg daily
• Regular prenatal care and monitoring are essential
• Healthcare providers may consider tapering the medication before delivery to minimize neonatal adaptation issues
• Women with a history of severe suicide attempts or severe depression who have previously experienced symptom reduction with antidepressant treatment may respond to antidepressants better than psychotherapy 1
• The American Psychiatric Association and the American College of Obstetricians and Gynecologists recommend that women and their doctors should work together and consider severity of current symptoms, previous mental health history, and patient treatment preferences when making decisions about antidepressant use during pregnancy 1.

It's also important to note that abruptly stopping the medication can lead to withdrawal symptoms and worsening mental health, which itself poses risks during pregnancy. Therefore, it is recommended to continue escitalopram treatment during pregnancy at the lowest effective dose, under the guidance of a healthcare provider.

From the FDA Drug Label

Taking Escitalopram late in pregnancy may lead to an increased risk of certain problems in your newborn. Talk to your healthcare provider about the benefits and risks of treating depression during pregnancy Advise patients that escitalopram use later in pregnancy may lead to increased risk for neonatal complications requiring prolonged hospitalization, respiratory support, tube feeding, and/or persistent pulmonary hypertension (PPHN) of the newborn

Escitalopram use in pregnancy is associated with potential risks, including increased risk of certain problems in the newborn, such as neonatal complications requiring prolonged hospitalization, respiratory support, tube feeding, and/or persistent pulmonary hypertension (PPHN) of the newborn.

• Women should discuss the benefits and risks of treating depression during pregnancy with their healthcare provider.
• Pregnant women taking escitalopram should notify their healthcare provider if they become pregnant or intend to become pregnant during treatment.
• There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to Escitalopram during pregnancy 2.

From the Research

Escitalopram Use in Pregnancy

• Escitalopram, also known as Lexapro, is a selective serotonin reuptake inhibitor (SSRI) used to treat major depression disorder 3, 4.
• The safety of escitalopram during pregnancy has been evaluated in several studies, with most suggesting that it may be considered safe, particularly in terms of major malformations 3, 4, 5.
• However, some studies have reported an increased risk of perinatal complications, such as lower rates of live births and higher rates of newborns with low birth weight, associated with escitalopram exposure 3, 4.

Major Malformations and Perinatal Complications

• The rate of major malformations associated with escitalopram exposure during early pregnancy is substantially in the range of those reported in unexposed women 3, 4.
• Some cases of major malformations have been reported after maternal exposure to escitalopram, but the overall risk is considered low 3, 4.
• Perinatal complications, such as lower rates of live births and higher rates of newborns with low birth weight, have been reported in association with escitalopram exposure 3, 4.

Breastfeeding and Escitalopram

• No short-term adverse effects in newborns have been reported in studies evaluating the safety of escitalopram during breastfeeding 3, 4.
• Two infants exposed to escitalopram during breastfeeding did not show any health problems in one study 5.
• However, the available data on escitalopram use during breastfeeding are limited, and no definitive conclusions can be drawn 3, 4.

Comparison with Other SSRIs

• Citalopram, another SSRI, has been studied in pregnancy and breastfeeding, with results suggesting that it may be associated with an increased risk of poor neonatal adaptation syndrome when used late in pregnancy 6.
• Other SSRIs, such as sertraline and paroxetine, have also been evaluated in pregnancy and breastfeeding, with varying results 7.
• The choice of SSRI during pregnancy and breastfeeding should be made on a case-by-case basis, taking into account the individual patient's needs and the available evidence 7.