Escitalopram During Pregnancy

Depression is one of the most common mental health conditions experienced by individuals worldwide. Unfortunately, the onset of pregnancy can trigger depression. As such, it is common to question if it is safe to use escitalopram during pregnancy.

Using escitalopram during pregnancy may be the right option if the benefits outweigh the risks to your developing baby. It is important to discuss escitalopram use during your pregnancy with your healthcare provider. Your doctor may prescribe an alternative that may be better for both you and your baby.

Escitalopram During Pregnancy

  • Brand name: Lexapro
  • Manufacturer: Forest Pharmaceuticals

Therapeutic Effect: Lexapro is  indicated for the acute treatment of generalized anxiety disorder in adults. Lexapro is also indicated for both acute and maintenance treatment of major depressive disorder in adults as well as adolescents ages 12 to 17.

Pregnancy Safety Rating: Category C

Pregnancy Recommendation: Human data suggest there may be risk in the third trimester.

Side Effects:

  • Frequent: (21%-11%) Dry mouth, nausea, insomnia, drowsiness, diaphoresis.
  • Rare (3%-2%): Sinusitis, menstrual disorder, agitation,  sexual dysfunction, decreased libido, abdominal pain.

Pregnancy/Lactation Considerations: Escitalopram is distributed in breast milk.

Pregnancy Summaries:

The following summaries are cited directly from the sources of Briggs, Freeman, & Yaffe, the Physicians’ Desk Reference, and the Reprotox Toxicology Center.

Briggs, Freeman, & Yaffe – Human pregnancy experience with escitalopram is very limited. The animal data suggest that the risk to an embryo-fetus is low. Two large case-control studies did find increased risk for some birth defects, but the absolute risk appears to be small.

However, the selective serotonin reuptake inhibitor (SSRI) antidepressants have been associated with several developmental toxicities, including spontaneous abortions, low birth weight, prematurity, neonatal serotonin syndrome, neonatal behavioral syndrome (withdrawal), possibly sustained abnormal neurobehavioral beyond the neonatal period, respiratory distress, and persistent pulmonary hypertension of the newborn (PPHN).

Physicians’ Desk Reference –There are not adequate and well-controlled studies in pregnant women; therefore, escitalopram should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Neonates exposed to Lexapro and other SSRIs or SNRIs, late in the third trimester, have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. Such complications can arise immediately upon delivery.

Infants exposed to SSRIs in late pregnancy may have an increased risk for persistent pulmonary hypertension of the newborn (PPHN). When treating a pregnant woman with Lexapro during the third trimester, the physician should carefully consider both the potential risks and benefits of treatment. For further information, please refer to the Physicians’ Desk Reference or contact your Healthcare Provider.

Reprotox Toxicology Center – Based on experimental animal studies and human reports, standard therapeutic use of citalopram or escitalopram is not expected to increase the risk of congenital anomalies. Use of serotonin reuptake inhibitors late in pregnancy can be associated with a mild transient neonatal syndrome of central nervous system, motor, respiratory, and gastrointestinal signs.

Next Steps:

If you are pregnant and have questions related to medication use during pregnancy, Reprotox Toxicology Center is the most comprehensive resource on medication use during pregnancy.

The American Pregnancy Association does not prescribe medication nor do we serve as a consult for medication use during pregnancy.  It is imperative that you discuss the use of any medication during pregnancy with your health care provider.

The purpose of this document is to provide you with information to support discussions with your health care provider.

Sources:

Hudgson, Barbara and Kizior, Robert, Saunders Nursing Drug Handbook 2012, Elsevier, St. Louis, MO. ISBN: 978-1-4377-2334-2.

Briggs, Gerald, Freeman, Roger and Yaffe, Sumner, Drugs in Pregnancy and Lactation, 9th Ed., Wolters Kluwer/Lippincott Williams & 3. Wilkins, Philadelphia, PA. ISBN: 978-1-60831-708-0, 2011.

Physicians’ Desk Reference (PDR), PDR Network, LLC, Motvale, NJ 07645 ISBN: 978-1-56363-780-3

Reproductive Toxicology Center, http://www.reprotox.org, agent # 4062