Lexapro & Pregnancy: Everything You Need to Know

Side Effects of Lexapro

Like any medication, Lexapro can cause side effects, varying in intensity from mild to serious. Since Lexapro impacts everyone a little differently, not everyone will experience these side effects.  The medication’s impact on the brain’s chemical balance can cause side effects. Serotonin, which Lexapro affects, is also involved in many other functions outside the brain. Many side effects will resolve over time as the body adjusts to a new medication. However, some side effects can be serious, requiring immediate medical care.

Common Lexapro side effects include:*^{1, 2}

• Dry mouth
• Increased sweating
• Nausea
• Diarrhea
• Constipation
• Indigestion
• Abdominal pain
• Influenza-like symptoms
• Fatigue
• Dizziness
• Headache
• Insomnia
• Decreased libido
• Decreased appetite

Serious side effects of Lexapro that require immediate medical attention include:*^{2, 3}

• Allergic reactions and anaphylaxis
• Increased suicidal thoughts
• Serotonin syndrome
• Seizures
• Mania
• Hallucinations
• Low blood sodium levels (hyponatremia)
• Increased risk of bleeding
• Angle-closure glaucoma

Some side effects may be more common depending on the disorder being treated. For example, side effects such as dry mouth, headache, and nausea were more common in those treated for anxiety. Also, higher doses of Lexapro are associated with an increased risk of side effects.² If you are experiencing serious side effects, contact your medical provider or seek medical attention immediately.

*All medications, including Lexapro, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Is Lexapro Safe During Pregnancy?

In general, it is typically recommended to avoid Lexapro during pregnancy. Exposure to Lexapro, especially in the third trimester, can increase the risk of problems with the baby’s eeding, breathing, and longer hospital stays. Although it remains unclear, there may also be negative impacts on fertility and an increased risk of birth defects.⁴

Can Lexapro Cause Birth Defects?

It is unclear if Lexapro causes birth defects. In animal studies, taking Lexapro at very high levels was associated with birth defects. However, the data suggests that there is no increased risk in humans. SSRI medications, however, may increase the risk of a serious lung condition called persistent pulmonary hypertension. However, this risk is below 1%.⁴

Can Lexapro Cause Withdrawal Symptoms in Your Baby?

If you are taking Lexapro throughout the pregnancy, it may lead to withdrawal symptoms in your baby. Withdrawal symptoms may include irritability, jitteriness, tremors, feeding difficulties, breathing difficulties, and problems maintaining body temperature.⁴ These symptoms are often mild and resolve on their own, but some babies may need closer monitoring in the NICU or nursery resulting in an extended time in the hospital.

Can Lexapro Interfere With Fertility?

Lexapro may negatively impact fertility, but this has not been adequately studied in humans. However, animal studies have shown a possible decreased fertility.

What If You Are Already Taking Lexapro When You Become Pregnant?

If you are taking Lexapro when you become pregnant, it is important to discuss this with your healthcare providers to determine the best next steps. Untreated anxiety or depression can negatively impact both the mother and fetus, and decisions should be made in conjunction with healthcare professionals.

What Lexapro Dosage Is Safe During Pregnancy?

Lexapro will impact each individual and pregnancy differently. Therefore, there is no way to determine a safe dosage during pregnancy. However, health providers typically aim to prescribe the lowest dose possible to achieve the goal response.

Does Lexapro Increase the Risk of Miscarriage in the First Trimester?

While some antidepressants may increase the risk of miscarriage, studies have shown no increased risk when taking Lexapro.⁴

Potential Risks of Taking Lexapro During the Third Trimester

Taking Lexapro during the third trimester increases the risk of the baby developing a serious lung condition called persistent pulmonary hypertension of the newborn (PPHN).² Although, this risk is less than 1%. This condition leads to high blood pressure in the vessels of the lungs impacting normal blood flow.

Lexapro Withdrawal

Abrupt discontinuation of Lexapro can lead to Lexapro withdrawal, also known as antidepressant discontinuation syndrome. When suddenly stopping Lexapro, it takes time for your body to adjust, resulting in withdrawal symptoms. Common withdrawal symptoms include dizziness, nausea, headache, mood changes, and flu-like symptoms. These symptoms are often mild and resolve within a few weeks. However, some symptoms can be more serious or persistent, requiring immediate medical attention.

Withdrawal during pregnancy poses additional risks. Abruptly stopping Lexapro during pregnancy can lead to the return of depressive or anxiety symptoms, which can negatively impact the well-being of both the mother and the developing fetus. Severe withdrawal symptoms can also lead to significant distress to the mother and can put a fetus at risk.

Preterm Birth & Low Birth Weight

Some studies have shown that taking Lexapro during pregnancy increases the risk of preterm birth and low birth weight.⁴ Preterm birth is defined as birth before 37 weeks of pregnancy. Low birth weight is considered a birth weight less than 5 pounds, 8 ounces (2500 grams).

Can You Breastfeed While Taking Lexapro?

Escitalopram is excreted at low levels in breast milk. Still, it would not be expected to cause negative effects on the baby. Because of this, Lexapro can be continued while breastfeeding if required by the mother.⁵

Do Other Antidepressants Have Similar Risks During Pregnancy?

Some antidepressants may be safer than others when taken during pregnancy. Other SSRIs such as citalopram (Celexa) and sertraline (Zoloft) may be safe during pregnancy but still come with risks. Other antidepressants, such as fluoxetine (Prozac) and paroxetine (Paxil), have higher risks of birth defects.⁶

Questions to Ask Your Healthcare Provider About Lexapro & Pregnancy

If you are considering using Lexapro while pregnant, it is important to have a comprehensive discussion with all healthcare providers involved, including your doctor, psychiatrist, and therapist. If you are in need of a new prescriber, online psychiatry services are an excellent option. These services allow you to receive necessary prescriptions and have regular check-ins with a psychiatrist in the comfort of your home.

Questions to ask your care team when considering using Lexapro while pregnant may include:

• Do you think I have a depressive disorder based on my symptoms?
• Do my symptoms warrant an antidepressant?
• I’m already on an antidepressant. Should I switch to another one?
• Which medication do you suggest, and how did you reach that conclusion?
• What doses are considered safe?
• Should I take this medication throughout my pregnancy or only for parts?
• Does this medication affect the baby? How?
• What happens if I decide to stop taking this medication?
• How does untreated anxiety/depression impact my pregnancy?
• Can I continue this medication if I choose to breastfeed?
• Will this medication help with postpartum depression?
• Can you provide information about the long-term developmental outcomes for children exposed to Lexapro during pregnancy?
• What other resources or support can be offered to help manage my mental health during pregnancy?

In My Experience

In my experience, Lexapro is an effective medication for the treatment of anxiety and depressive disorders. Although there are some risks when taking this medication during pregnancy, the risks are relatively low. I recommend having a thorough discussion with your healthcare provider, including your OBGYN physician, if you are taking this medication and planning to get pregnant. Decisions like this can be difficult, but they are easier when made in conjunction with your healthcare team.