Lexapro (Escitalopram) Use During Breastfeeding
Yes, it is safe to take Lexapro while breastfeeding, with appropriate infant monitoring. Escitalopram is excreted into breast milk at low levels, with breastfed infants receiving only approximately 3.9% of the maternal weight-adjusted dose, which is well below the 10% safety threshold typically considered acceptable for breastfeeding 1.
Key Safety Data
Infant exposure through breast milk is minimal and clinically insignificant:
- Exclusively breastfed infants receive approximately 3.9% of the maternal weight-adjusted escitalopram dose and 1.7% of the demethylescitalopram (metabolite) dose 1
- The total relative infant dose is 5.3% as escitalopram equivalents, which is below the 10% safety threshold 2
- Escitalopram concentrations in infant plasma are typically below detectable levels (≤3 mcg/L) compared to average maternal plasma concentrations of 24 mcg/L 2
- Median infant plasma exposure is only 1.7% (range 0.5-5.9%) of maternal plasma levels 3
Required Infant Monitoring
The FDA label explicitly requires monitoring for specific adverse effects 1:
- Excessive sedation or somnolence
- Restlessness and agitation
- Poor feeding
- Poor weight gain
These effects are rare but have been reported in isolated cases with citalopram (the racemic mixture), though most infants show no adverse effects 1, 2.
Clinical Context and Comparative Safety
Escitalopram may actually be preferred over racemic citalopram for breastfeeding mothers:
- The absolute infant dose of escitalopram is lower than an equivalent antidepressant dose of racemic citalopram 2
- Research shows escitalopram has a favorable safety profile, with all studied infants meeting normal developmental milestones and showing no adverse effects 2
- Among SSRIs, paroxetine and sertraline are considered first-line agents for breastfeeding 4, 5, but escitalopram is also considered safe with appropriate monitoring 6
Risk-Benefit Considerations
The developmental and health benefits of breastfeeding must be weighed against the mother's clinical need for treatment 1:
- Untreated maternal depression poses significant risks to both mother and infant, including negative impacts on infant emotional development 6
- The degree of severity of maternal depression is the most relevant parameter in deciding whether to continue pharmacological treatment during breastfeeding 6
- Women already taking escitalopram during pregnancy can safely continue while breastfeeding, as the infant has already had in utero exposure 4
Practical Recommendations
If you are taking Lexapro 10-20 mg daily (standard therapeutic doses):
- Continue breastfeeding while maintaining your medication 1, 2
- Monitor your infant closely for the specific adverse effects listed above, particularly in the first few weeks 1
- Ensure regular pediatric follow-up to track infant weight gain and developmental milestones 2
- Contact your healthcare provider immediately if you notice excessive sleepiness, feeding difficulties, or inadequate weight gain in your infant 1
Common pitfall to avoid: Do not discontinue effective antidepressant treatment solely due to breastfeeding concerns, as the risks of untreated maternal depression often outweigh the minimal infant drug exposure 6. The decision should prioritize maternal mental health while implementing appropriate infant monitoring protocols.