Lexapro and Breastfeeding: Is It Safe?

Depression and anxiety can be overwhelming, and they can feel even more intense when you’re a parent juggling your own needs with those of your family. This is especially true for new moms.

The good news is that there are treatment options. If you’re diagnosed with major depressive disorder (MDD) or generalized anxiety disorder (GAD), you may be prescribed an antidepressant medication — like escitalopram (Lexapro^®) — to help you manage your symptoms.

If you’re an expecting or new mom prescribed Lexapro, you might wonder if it’s safe to take while pregnant or breastfeeding.

Ultimately, the decision will depend on what’s best for both your health and your baby’s well-being. 

Some mothers may choose (or may need to) bottle feed with formula rather than breastfeed. This can certainly be an option for mothers on Lexapro who worry about the potential risk to the baby. 

Choosing to breastfeed versus going the formula route is already a pressure-filled decision for many mothers, some of whom don’t have the privilege to pick one or the other. "There can be a lot of pressure on new mothers to breastfeed their infants, but there's little evidence that it makes a significant difference in a baby's long-term health,” says Daniel Z. Lieberman, MD, SVP of mental health at Hims & Hers and clinical professor of psychiatry at George Washington University. “Depression and anxiety, on the other hand, are serious illnesses, and if they're not treated properly, they can interfere with mother-infant bonding early in life. That interference can have a much greater effect on the infant's development than replacing breast milk with baby formula."

Ahead, we’ll help you understand the potential risks and other important factors to weigh in your decision, whether you’re trying to decide if you should avoid breastfeeding while on Lexapro or if you’re wondering if you can breastfeed while continuing your medication.

Before we get into the details, it’s important to understand a couple of things about Lexapro or its generic form, escitalopram (we’ll be using them interchangeably in this guide).

Escitalopram is a selective serotonin reuptake inhibitor or SSRI. SSRIs help your brain better balance activity levels of serotonin, a mood-regulating hormone and neurotransmitter.

This antidepressant therapy can help with a variety of conditions, but it’s most often used to treat depressive disorder, the symptoms of depression, and generalized anxiety disorder. They’re also used to treat postpartum depression.

Because Lexapro is linked with improved mental health, it may also enhance a depressed or anxious mother's ability to care for and bond with her baby. 

In addition to Lexapro, there are other SSRIs, including:

• Citalopram (Celexa^®)

• Fluoxetine (Prozac^®)

• Paroxetine (Paxil^®)

• Sertraline (Zoloft^®)

The question of whether you can breastfeed on Lexapro or other psychotropic medications is complex because it involves two key considerations.

First, there's the safety of the baby, who can absorb the medication through the mother’s breast milk. Second, there’s the safety of the mother and her mental health if she stops taking the medication.

While Lexapro might increase the risk of adverse effects for an infant, it should be weighed against the potential harm of stopping a medication that’s crucial for the mother and her ability to provide the emotional support her child needs to grow in a healthy way, both physically and psychologically. Again, it’s not always a straightforward process.

A healthcare provider will likely also take the following into consideration:

• The developmental and health benefits of breastfeeding

• The mother’s health and need for Lexapro

• The potential side effects for the breastfed child

To put it more simply, many mothers and their babies will be better served in the postpartum period by the mother staying on the medication, based on current knowledge of the risks of Lexapro to an infant.

More research is needed to better understand the risks.

While more research is needed, we know a few things about using antidepressants like Lexapro and the risk of infant exposure.

Lexapro can pass through breast milk to the breastfed infant, but based on limited clinical trial data, researchers believe the concentrations in breast milk are very low.

The Food and Drug Administration (FDA) has noted two reports of decreased feeding, weight loss, and increased fatigue and sedation in infants exposed to escitalopram through breast milk. However, a direct causal relationship hasn’t been established. Still, the FDA recommends closely monitoring infants if mothers choose to continue using escitalopram while breastfeeding.

If you choose to stay on escitalopram while nursing — whether by breast or through pumping and bottle feeding — researchers advise you to monitor the following:

• Developmental milestones

• Levels of alertness and drowsiness

• Adequate feeding

• Appropriate weight gain based on birth weight

Also, escitalopram is rated as Category C by the FDA, meaning that while animal studies have shown adverse effects, there is insufficient data from human trials. For some women, the potential benefits of taking the medication will outweigh the risks.

In sum, there isn’t much research showing significant risks for using escitalopram while breastfeeding, suggesting that it might be safe. But experts still classify this medication as a “use cautiously” medication while breastfeeding because, well, they don’t have enough data to draw from.

Additionally, some research suggests that SSRIs, including escitalopram, might slightly increase the risk of higher prolactin levels and galactorrhea.

Prolactin is a hormone involved in milk production and lactation. Galactorrhea is a health condition wherein non-breastfeeding women and men who take escitalopram produce breast milk (or a milky discharge) unrelated to location or pregnancy.

So, what does this mean for you? Simply put, you and your healthcare provider should discuss and decide what’s best for your situation.

If you’re also wondering, “Can I take escitalopram while pregnant?”, the short answer is yes.

The longer answer is similar to the one given for questions about breastfeeding and escitalopram.

Whether or not you take the medication should be decided with careful consideration by you and a healthcare provider. There’s no one-size-fits-all solution, but knowing the risks and your own personal needs can help make the decision a little easier to navigate.

Is Escitalopram Safe for Pregnancy?

Lexapro is generally considered a safe SSRI to take while pregnant if you need it to help you function day to day.

That said, there might be some risk, as escitalopram is also a category C pregnancy medication. As mentioned, category C pregnancy medications are those that could pose risks to a fetus, but there isn’t enough research available to say with certainty one way or another. 

Again, the value they bring to the mother often outweighs the slight risk to the fetus. 

While Lexapro can be transferred into amniotic fluid via the placenta, the ultimate danger to the fetus remains unclear and is also dosage-dependent.

Does Lexapro Increase the Risk of Birth Defects or Misscairraige?

Keep in mind that pregnancy loss (miscarriage) and birth defects are risks in every pregnancy. Specifically, all pregnancies have a 3 to 5 percent chance of developing a birth defect. Rates of pregnancy loss vary, but some estimate that 10 to 20 percent of pregnancies end in miscarriage.

One study found that women who discontinued their use of SSRIs before they got pregnant had a similar chance of miscarrying in the first trimester to those who continued use. Both groups had a slightly higher risk of miscarriage within the first few months of pregnancy. 

Researchers determined that SSRIs shouldn’t be discontinued during pregnancy out of fear of miscarriage.

As far as birth defects go, a large study found no increased risk associated with Lexapro.

Not necessarily. Experts advise that you should tell your healthcare provider if you are pregnant or breastfeeding before taking or stopping Lexapro.

Keep in mind that stopping the medication without the guidance of a healthcare professional can lead to some potentially serious side effects, like withdrawal symptoms.

Withdrawal symptoms of escitalopram might include:

• Mood changes

• Irritability and agitation

• Nausea

• Dizziness

• Exhaustion or lethargy

If you decide you want to stop taking Lexapro, healthcare providers typically recommend tapering off it before eventually discontinuing use completely. Gradually tapering your dosage can help prevent withdrawal symptoms.

Before you make a choice, you may also want to discuss the following with your healthcare provider:

• Your daily dose

• The amount of breast milk you’re producing for consumption

• Whether other drug interactions might pose combined risks

If you have lingering questions about the safety of breastfeeding while on antidepressants, you should bring them to your healthcare provider or pediatrician. They’re uniquely qualified to help you with the decision-making process. 

In the meantime, here’s what to keep in mind about taking Lexapro while breastfeeding or pregnant:

• Lexapro is a common, safe, and effective treatment option for depression and generalized anxiety disorder. It improves mood by helping your brain optimize serotonin levels in the body and brain.

• A baby can absorb trace amounts of the medication through breast milk. This may slightly increase the risk of adverse effects for an infant, like slower weight gain. That doesn’t mean breastfeeding moms should stop taking Lexapro, as escitalopram breastfeeding risks are low. The relative danger of the potential adverse effects versus the danger of a mother no longer taking an essential medication should be carefully weighed by a healthcare provider. 

• Lexapro is generally considered a safe SSRI to take while pregnant if it helps you safely function day to day. There’s no one-size-fits-all answer.

• Don’t abruptly discontinue your antidepressants. Reach out to your doctor to discuss your options, including safely tapering off Lexapro to avoid withdrawal symptoms.

If you’re dealing with depression or struggling to make the right decision for your mental health needs and your baby’s safety, it’s important to reach out to a healthcare professional.

Feeling overwhelmed by your depression or anxiety? We provide access to online psychiatric resources.