Pregnancy Warnings

Can I Use Lexapro (Escitalopram) During Pregnancy?

Pregnancy can be a time of joy and stress. Research suggests that about 7% of pregnant women experience depression during pregnancy. Rates might be higher in low and middle income countries. Depression, a mood disorder that causes a persistent feeling of sadness and loss of interest, is the most common mood disorder in the general population. The condition occurs twice as often in women than in men, and the initial onset of depression peaks during a woman’s reproductive years.

Some symptoms of depression, including changes in sleep, energy level, appetite and libido, are similar to symptoms of pregnancy. As a result, you or your health care provider might attribute these symptoms to your pregnancy, rather than depression.

What is Escitalopram and How does work?

Escitalopram belongs to the group of medications called selective serotonin reuptake inhibitors (SSRIs). It is used to treat depression, obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD). It works by increasing levels of a neurotransmitter called serotonin in the brain. Increased serotonin levels can lead to an improved mood.

The medication usually begins to work within 2 to 4 weeks. However, it may take several weeks of treatment before the full effects are seen.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here. This drug is approved for the treatment of major depressive disorder (MDD) and generalized anxiety disorder (GAD).

Can I Use Lexapro (Escitalopram) During Pregnancy?

If you are planning on becoming pregnant, notify your health care provider to best manage your medications. People living with MDD who wish to become pregnant face important decisions. Untreated MDD has risks to the fetus, as well as the mother. It is important to discuss the risks and benefits of treatment with your doctor and caregivers. For women who take antidepressant medications during weeks 13 through the end of their pregnancy (second and third trimesters), there is a risk that the baby can be born before it is fully developed (before 37 weeks).

For mothers who have taken SSRIs during their pregnancy, there appears to be less than a 1% chance of infants developing persistent pulmonary hypertension. This is a potentially fatal condition that is associated with use of the antidepressant in the second half of pregnancy. However, women who discontinued antidepressant therapy were five times more likely to have a depression relapse than those who continued their antidepressant. If you are pregnant, please discuss the risks and benefits of antidepressant use with your health care provider.

There are no 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.

Caution is advised with breastfeeding since escitalopram does pass into breast milk.

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • changes in heart rate
  • congested or runny nose
  • constipation
  • diarrhea
  • difficulty sleeping
  • dizziness
  • drowsiness
  • dry mouth
  • fatigue
  • fever
  • heartburn
  • increased sweating
  • insomnia
  • loss of appetite
  • muscle or joint pain
  • nausea
  • sexual dysfunction including:
    • decreased libido (sex drive)
    • erectile dysfunction (difficulty getting or keeping an erection)
    • inability to have an orgasm
  • stomach pain
  • stomach upset
  • yawning

Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • anxiety
  • bruising or unusual bleeding from the skin or other areas
  • difficulty controlling blood sugar levels
  • feeling of skin prickling
  • hallucinations
  • inability to urinate
  • involuntary movements of the body or face
  • low blood sodium (confusion, seizures, drowsiness, dryness of mouth, increased thirst, lack of energy)
  • mania (overactive behavior and thoughts)
  • new or worsening emotional symptoms
  • severe agitation or restlessness
  • symptoms of glaucoma, e.g.:
    • increased pressure in the eye
    • eye pain
    • blurred vision
  • symptoms of liver damage, e.g.:
    • abdominal pain
    • dark urine
    • clay-coloured stools
    • itching
    • loss of appetite
    • nausea and vomiting
    • yellow skin or eyes

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • seizure or convulsions
  • serotonin syndrome or neuroleptic malignant syndrome – signs include:
    • agitation
    • confusion
    • diarrhea
    • fever
    • overactive reflexes
    • poor coordination
    • restlessness
    • shivering
    • sweating
    • talking or acting with excitement you cannot control
    • trembling or shaking
    • twitching
  • symptoms of an abnormal rhythm such as heart palpitations, dizziness, or fainting
  • symptoms of a serious allergic reaction such as swelling of the face or throat, hives, or difficulty breathing
  • thoughts of suicide or hurting yourself
  • vomiting blood or presence of blood in the stool

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

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Dr. Oche Otorkpa PG Cert, MPH, PhD

Dr. Oche is a seasoned Public Health specialist who holds a post graduate certificate in Pharmacology and Therapeutics, an MPH, and a PhD both from Texila American University. He is a member of the International Society of Substance Use Professionals and a Fellow of the Royal Society for Public Health in the UK. He authored two books: "The Unseen Terrorist," published by AuthorHouse UK, and "The Night Before I Killed Addiction."
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