If you take Lexapro and are pregnant or planning to become pregnant, you may be wondering whether it’s safe to keep taking it. The decision to continue involves weighing the potential risks of Lexapro against the risks of leaving depression or anxiety untreated. Here’s what you may want to discuss with your provider.
Key Takeaways
Depression around pregnancy is common: About 1 in 10 women of reproductive age report symptoms of recent major depression, and roughly 1 in 8 who recently gave birth report postpartum depression symptoms.
This decision weighs two sets of risks, not one: Continuing an antidepressant carries some potential risks. So does leaving depression untreated. Lexapro's own prescribing label tells clinicians to weigh the risk of untreated depression when changing treatment.
Stopping on your own is not safe: Abruptly stopping can cause withdrawal symptoms and can raise the chance of relapse. This is a decision to make with a provider, ideally before pregnancy if you are planning one.
What Is Lexapro?
Lexapro is the brand name for escitalopram, a selective serotonin reuptake inhibitor, or SSRI. It is prescribed for depression and generalized anxiety disorder, and it works by increasing serotonin, a chemical messenger involved in mood regulation. It is a commonly prescribed antidepressant.
Lexapro is not a medication to start or stop casually. Providers usually lower the dose gradually rather than stopping all at once, which may help limit withdrawal symptoms.
While taking an SSRI during pregnancy can have some risks, stopping it has consequences too, since depression that returns during pregnancy affects both the mother and the pregnancy.
This is why providers talk about weighing risks of Lexapro use in pregnancy rather than avoiding them. Escitalopram's prescribing label makes the point directly, noting that stopping an antidepressant raises the likelihood of relapse and that the risk of untreated depression should be considered when changing treatment.
Many people continue an SSRI through pregnancy with their provider's support, many others may taper off with the same support. Which path fits you depends on how severe your symptoms have been, what happened when you tried stopping before, and what else is available to you.
What the Research Shows About the Risks
Escitalopram has been studied in a large number of pregnancies. Here is what that research points to, area by area.
Miscarriage: Studies so far have not found a higher chance of miscarriage.
Preterm birth and birth weight: Research suggests that taking Lexapro during pregnancy may lead to premature births and low birth weight.
Persistent pulmonary hypertension of the newborn, or PPHN: Evidence indicates that Lexapro use during late pregnancy may be associated with an increased risk of persistent pulmonary hypertension of the newborn.
Postpartum hemorrhage: SSRI exposure during late pregnancy has been associated with postpartum hemorrhage.
What Happens If Depression Goes Untreated
Untreated depression carries its own risks. The FDA notes the documented harms of untreated depression, which include poor birth outcomes and increased risk of maternal suicide. That is why it is advised to treat depression during pregnancy.
The treatment of perinatal depression is critical for the health of both the mother and baby. Symptoms can include persistent low mood, hopelessness, sleep and concentration problems, trouble bonding with the baby, and thoughts of self-harm.
Relapse is the practical worry. Stopping an antidepressant can raise the chance of symptoms returning, and pregnancy and the months after birth are hard times to manage without support.
What to Expect for Your Baby at Birth
Some newborns exposed to SSRIs in the third trimester show symptoms in their first days, which may last up to about two weeks after birth. These can include respiratory distress, bluish skin color, pauses in breathing, seizures, temperature instability, feeding difficulty, vomiting, low blood sugar, floppy or stiff muscle tone, tremor, jitteriness, and irritability. In some cases, these have required prolonged hospitalization, breathing support, or tube feeding.
These symptoms are usually mild and may resolve within weeks, and not every exposed baby has them. They are sometimes described as withdrawal, though poor neonatal adaptation is the more accurate term.
Let your delivery team know that you’re taking escitalopram. This gives them a chance to monitor your baby after birth and know what to look for.
Deciding Whether to Take Lexapro With Your Provider
Have this conversation early, ideally before you conceive if you are planning a pregnancy.
Below are a few things worth discussing with your provider:
How Lexapro has worked for you: Your dose, how well it controls your symptoms, and how long you’ve been stable all matter.
What happened when you stopped before: If your symptoms came back quickly, that’s important to consider.
How severe your symptoms are: The decision may look different for someone with mild, occasional anxiety than for someone with a history of severe depression or hospitalization.
What support you have in place: Therapy, support at home, and good sleep can all make a difference if you’re considering a taper.
The other medications you take: Your provider will look at the full picture, not just your antidepressant.
If you and your provider decide to stop, the taper should be carefully planned. Our guides on tapering off Lexapro and what happens when you stop antidepressants cold turkey cover why the difference matters.
If you are already pregnant and taking escitalopram, do not stop before you can talk to a provider. Finding out you are pregnant while on an antidepressant is a common situation, and your provider can help you navigate it.
When to Reach Out for Help
Reach out to your obstetric or psychiatric provider promptly if:
Your mood drops noticeably, or anxiety becomes hard to manage
You stopped escitalopram and symptoms are returning
You are having trouble bonding with your baby, or feel detached
You are sleeping very little even when you have the chance to rest
Your newborn seems unusually jittery, has trouble feeding, or breathes irregularly
Some situations need immediate help. If you are having thoughts of harming yourself or your baby, call or text 988 to reach the Suicide and Crisis Lifeline, or go to an emergency room. The National Maternal Mental Health Hotline is also available at 1-833-852-6262, free and confidential, 24 hours a day in English and Spanish.
Anxiety after birth deserves attention too, and it does not always look like sadness. Our guide on postpartum anxiety covers what it can look like.
How Blossom Health Can Help
Blossom Health offers virtual psychiatric care to help you manage Lexapro during pregnancy. A licensed psychiatric provider can review your symptoms, medication history, and pregnancy plans with you, then help you weigh your options and adjust treatment when appropriate. In-network insurance may be accepted, depending on your plan and location. To learn more, visit joinblossomhealth.
Medical Disclaimer
This article is for informational purposes only and is not a substitute for professional medical advice. Always consult a qualified healthcare provider before starting, changing, or stopping any medication. If you are experiencing a mental health crisis, call or text the 988 Suicide and Crisis Lifeline.
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