From the Guidelines
Escitalopram (Lexapro) is generally considered relatively safe during pregnancy, but it should only be used when the benefits outweigh the potential risks. The decision to use escitalopram during pregnancy should be made in consultation with a healthcare provider who can evaluate your specific situation. Escitalopram is a selective serotonin reuptake inhibitor (SSRI) that is typically prescribed at doses of 10-20 mg once daily for depression and anxiety disorders. If you're already taking escitalopram and discover you're pregnant, don't stop taking it suddenly as this could lead to withdrawal symptoms and worsening of your mental health condition. Some studies suggest a small increased risk of certain birth defects with first-trimester exposure, though the absolute risk remains low. There is also a potential risk of neonatal adaptation syndrome in newborns when escitalopram is used late in pregnancy, which can cause temporary symptoms like irritability, feeding difficulties, and respiratory distress.
Key Considerations
- Untreated depression during pregnancy carries its own risks for both mother and baby, including poor prenatal care, inadequate nutrition, increased substance use, and complications during delivery 1.
- The American Psychiatric Association and the American College of Obstetricians and Gynecologists have published recommendations about decision-making regarding antidepressant treatment during pregnancy, suggesting that antidepressants may be a superior treatment option to psychotherapy for some women 1.
- 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.
- Your doctor may recommend regular monitoring throughout pregnancy if you continue taking escitalopram.
Important Factors to Discuss with Your Healthcare Provider
- Severity of current symptoms
- Previous mental health history
- Patient treatment preferences
- Potential risks and benefits of escitalopram use during pregnancy
- Alternative treatment options, such as psychotherapy or other medications It's essential to weigh the potential benefits and risks of escitalopram use during pregnancy and make an informed decision with your healthcare provider, considering the most recent and highest quality study available 1.
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 If you become pregnant while taking Escitalopram tablets, talk to your healthcare provider about registering with the National Pregnancy Registry for Antidepressants. are pregnant or plan to become pregnant
Escitalopram use during pregnancy is associated with potential risks. The drug label advises that taking escitalopram late in pregnancy may lead to an increased risk of certain problems in the newborn. It is recommended to discuss the benefits and risks of treating depression during pregnancy with a healthcare provider.
- Key considerations:
- Potential increased risk of problems in the newborn if taken late in pregnancy
- Importance of discussing benefits and risks with a healthcare provider
- Option to register with the National Pregnancy Registry for Antidepressants if becoming pregnant while taking escitalopram 2
From the Research
Safety of Escitalopram During Pregnancy
- 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.
- Some studies have reported an association between escitalopram exposure and perinatal complications, such as lower rates of live births and higher rates of newborns with low birth weight 3, 4.
- A clinical overview of pharmacological treatment of unipolar depression during pregnancy and breastfeeding suggests that citalopram and sertraline can be used during pregnancy, while some controversy remains over in utero exposure to paroxetine and fluoxetine 6.
- Escitalopram has been used during pregnancy in several case series, with no major malformations or miscarriages reported, although mild withdrawal syndrome was reported in one newborn who was also exposed to a benzodiazepine 5.
- The use of escitalopram during breastfeeding has also been evaluated, with no short-term adverse effects reported in newborns 3, 4, 5.
Key Findings
- Escitalopram may be considered safe during pregnancy, particularly in terms of major malformations 3, 4, 5.
- Perinatal complications, such as lower rates of live births and higher rates of newborns with low birth weight, may be associated with escitalopram exposure 3, 4.
- Escitalopram can be used during breastfeeding, with no short-term adverse effects reported in newborns 3, 4, 5.
- More research is needed to fully understand the safety profile of escitalopram during pregnancy and breastfeeding, as the current evidence is limited 3, 4, 5.
Considerations for Use
- Escitalopram should be used during pregnancy only when the benefits outweigh the risks, and under close monitoring by a healthcare provider 7.
- Women taking escitalopram during pregnancy should be informed of the potential risks and benefits, and should be closely monitored for any adverse effects 7.
- The use of escitalopram during breastfeeding should also be closely monitored, with regular check-ups and assessments of the newborn's health 3, 4, 5.