Lexapro and Pregnancy

If you're taking Lexapro and pregnancy is in your plans, you should talk to your doctor about the risks and benefits of continuing this medicine. Here's some basic information about the drug and its safety during pregnancy.

Lexapro and pregnancy may not be a good mix

Lexapro (generic name, escitalopram) is FDA-approved to treat depression and generalized anxiety disorder. Lexapro is a selective serotonin reuptake inhibitor (SSRI). Serotonin is a chemical, naturally produced by the brain, which regulates mood. Serotonin is released by nerve cells, is detected by receptors on other nerve cells, and then is taken back up into the cells again. SSRIs prevent that reuptake, forcing the serotonin to remain longer in the gap between cells. Although doctors don't fully understand why, the presence of that extra serotonin seems to help lift depression.

The safety of SSRIs during pregnancy isn't fully established. Lexapro is labeled Pregnancy Category C, which means that there isn't enough research to show if it is safe for the fetus. For now, the FDA recommends taking Lexapro and other SSRIs during pregnancy only if the benefits outweigh the possibility of harm.

Lexapro and other SSRIs have been linked to a condition called Infant Persistent Pulmonary Hypertension (IPPH). IPPH involves abnormal blood flow through the heart and lungs. Babies with IPPH do not get enough oxygen to their bodies. This condition can be very serious, and babies with it may even die.

So far, studies have shown that babies born to mothers who took Lexapro or other SSRIs after the twentieth week of pregnancy were 6 times more likely to develop IPPH than babies of moms who did not take antidepressants. Check the FDA's web site for the most up-to-date information.

Occasionally, babies born to moms who took Lexapro have had other problems, as well. Some babies have had to spend extra time in the hospital because they needed help with breathing and weren't eating properly. These problems have been observed in newborns whose mothers look Lexapro during the third trimester.

Other problems that may be linked to Lexapro and pregnancy include:

• Seizures
• Hypotonia ("floppy" arms and legs due to weak muscles)
• Hypertonia (stiff arms and legs)
• Hyperreflexia (fast reflexes which can signal neurological problems)
• Unstable body temperature
• Vomiting
• Low blood sugar
• Jitteriness
• Constant crying

Doctors think these effects could be due to withdrawal from the drug, but they may also be a direct effect of the drug itself.

Other side effects of Lexapro can occur whether or not you're pregnant. Most of these are rare, but they have been observed in people taking this drug or other SSRIs. Things to watch out for include:

• Suicidal thoughts or actions. This is most common when first starting the drug or changing the dose.
• Bleeding problems. The risk of abnormal, internal bleeding is higher when Lexapro is taken with aspirin, ibuprofen, or similar drugs.
• Mania. SSRIs can "unmask" manic depression, leading to hyperactivity, excitability, or an abnormally euphoric mood.
• Sexual problems. SSRIs can cause decreased sexual desire and make it difficult to have an orgasm.
• Insomnia. Some people who take Lexapro report difficulty sleeping. Others feel sleepy all the time.
• Increased sweating. SSRIs can cause sweat glands to become overactive.

Lexapro is found in the breast milk of new mothers who are taking the drug. It's not clear what effect this has on babies who breastfeed. There have been at least two reports of babies becoming overly sleepy, losing weight, and not feeding properly, but presumably there have been many more babies who had not problems at all.

As with Lexapro and pregnancy, it's best to talk the situation over with your doctor. If you must continue taking Lexapro, you may want to consider bottle feeding instead.

If you decide that, for you, Lexapro and pregnancy don't mix, you may want to stop taking the drug right away. This may not be a good idea, though. Doctors recommend tapering off Lexapro slowly, to avoid symptoms of withdrawal.

Stopping Lexapro abruptly can lead to problems including irritable or sad mood, mood swings, agitation, dizziness, strange feelings in skin or limbs, anxiety, confusion, insomnia, and headache.

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