Is it safe to continue taking Lexapro (escitalopram) while pregnant?

Continuing Lexapro (Escitalopram) During Pregnancy

Continuing Lexapro (escitalopram) during pregnancy is generally considered safe, with benefits typically outweighing potential risks for women who need treatment for depression or anxiety. 1

Risk-Benefit Assessment

Treating depression during pregnancy is crucial because:

• Untreated depression is associated with:
  • Premature birth
  • Decreased breastfeeding initiation
  • Increased risk of relapse during pregnancy when medication is discontinued 1

When considering Lexapro use during pregnancy:

Potential Risks

• SSRI exposure during the third trimester may lead to neonatal adaptation syndrome, characterized by:
  • Crying, irritability, tremors
  • Jitteriness and restlessness
  • Respiratory distress
  • Feeding difficulties
  • Sleep disturbance
  • Hypoglycemia 1

Important Reassurances

• These symptoms typically resolve within 1-4 weeks after birth
• Several reviews have not identified adverse neurodevelopmental outcomes among infants born to women treated with SSRIs during pregnancy 1
• The American Academy of Family Physicians and American Academy of Pediatrics suggest that SSRIs have a favorable safety profile for use during pregnancy 1

Management Recommendations

1. Continue medication if clinically indicated

   • Abrupt discontinuation can lead to withdrawal syndrome and depression relapse 2
   • If a woman decides to discontinue medication, it should be gradually tapered rather than stopped abruptly 2

2. Consider dose adjustments

   • Pharmacokinetic changes during pregnancy may require dose adjustments 1
   • Use the lowest effective dose during pregnancy 1

3. Monitor during pregnancy

   • Regular assessment of depression symptoms
   • Consideration of non-pharmacological treatments as adjuncts (not replacements)

4. Prepare for infant monitoring after birth

   • Monitor newborn for signs of drug effects or withdrawal during the first week of life
   • Arrange early follow-up after initial hospital discharge 1
   • Watch for irritability, poor feeding, or sleep disturbances in breastfed infants 1

Common Pitfalls to Avoid

1. Abrupt discontinuation

   • Many women discontinue antidepressants when they discover they're pregnant (80.38% discontinued antidepressants vs. 19.62% continued) 3
   • This can lead to withdrawal symptoms and depression relapse

2. Overestimating risks

   • Despite receiving evidence-based reassuring information, women continue to fear taking antidepressants during pregnancy more than non-psychiatric drugs 4
   • Medical decision-making is complex, but the evidence suggests that for many women, using SSRIs is favorable compared to exposing mother and child to untreated depressive illness 5

3. Failing to consider individual factors

   • Severity of depression
   • Previous response to medication
   • Support systems available

Bottom Line

The decision to continue Lexapro during pregnancy should be based on scientific evidence rather than unfounded concerns. For women with significant depression or anxiety, the benefits of continuing treatment typically outweigh the potential risks. Close monitoring and appropriate dose adjustments can help minimize any potential risks while maintaining effective treatment.