Depression is a difficult disorder to combat, but it gets twice as hard when you’re a parent. Not only do you have to care for yourself, but you also have to care for your kids.
This can be especially hard for new moms, who have to juggle medication and breast feedings — and prevent the risks that come from combining the two. You’re likely here ahead of (or just after) the birth of your child, wondering if there is a danger to combining Lexapro® and breastfeeding?
Being an expecting mom is stressful enough without remembering that the second the baby’s born, you’re a mom with mom-level responsibilities. Most moms will say without hesitation that their child’s health is the most important thing on their minds, but what about your own health?
It’s an important question to consider in this situation because the danger of Lexapro and breastfeeding is part of a larger conversation about what’s best for the baby and for you.
If you’re trying to decide whether to avoid breastfeeding while on Lexapro or other antidepressants, it’s important to understand the risks.
Before we dive into the hard stuff, it’s important to understand a couple of things about Lexapro, or escitalopram, in its generic form.Escitalopram is a selective serotonin reuptake inhibitor, or SSRI.
SSRIs help your brain better balance its levels of serotonin. 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.
The question of whether you can breastfeed on Lexapro or other psychotropic medicines is a complicated one, in part because there are two considerations to make when deciding.
The first, as you likely suspect, is the safety of the baby, who can indeed absorb the medication through human milk.
The second, as you should know, is your own safety (or the safety of the mother) and her mental health if she stops taking this medication.
Lexapro might indeed increase the risk of adverse effects for an infant, but the relative danger of those effects versus the danger of a mother no longer taking an essential medication is difficult to weigh hypothetically.
To put it more simply, some mothers and their babies may be better served in the postpartum period by the mother staying on the medication, based on our current knowledge of the risks of Lexapro to an infant.
Unfortunately, that’s because the information we have and the knowledge it has formed is very little.
We know a few things about Lexapro and the risk of infant exposure.
Lexapro can indeed pass through milk to the breastfed infant, but experts believe the levels of medication spread through exposure to breastmilk to be very low, based on the current studies.
It’s important for us to clarify that there are insufficient studies on breast milk exposure to psychotropic drugs.
The Food and Drug Administration (FDA) points to evidence of poor weight gain, sedation, restlessness, poor feeding and agitation in infants exposed to escitalopram through their mothers’ milk. The FDA suggests infants should be monitored closely if mothers elect to continue using escitalopram while breastfeeding.
Escitalopram carries a category C rating from the FDA, which means that while animal testing showed adverse effects, inadequate human trials exist at the moment, and the potential benefits may mean taking the drug anyway is better for some women’s circumstances. So how does this affect you?
For starters, it means that you and your healthcare provider will need to make a decision about what’s best for you. And if you choose to stay on escitalopram, there are some responsibilities you’ll have to your infant.
Experts do believe there are some things you should watch for with an infant if you do decide to breastfeed on Lexapro. These include developmental milestones, drowsiness, adequate feeding and appropriate weight gain based on birth weight.
There’s also the risk of a condition called galactorrhea (abnormal milk production) in breastfeeding women, non-breastfeeding women and men who take escitalopram.
There’s insufficient research to show significant risks (because there’s insufficient research overall), but experts still classify this medication as a “use cautiously” medication while breastfeeding because, well, we don’t know what the long-term effects might be.
Experts advise that you should tell your healthcare provider if you are pregnant or breastfeeding before taking Lexapro.
But stopping the medication without the guidance of a healthcare professional can lead to some potentially dangerous side effects. When you discontinue a medication, you can leave yourself in the position to experience some withdrawal symptoms.
Withdrawal symptoms of escitalopram might include mood changes, irritability, nausea, dizziness, headache, confusion, sweating, manic episodes, shaking, exhaustion, agitation and insomnia.
There are other risk factors that you’ll also want to talk over with your healthcare provider. The amount of your daily dose, the amount of breast milk you’re actually producing for consumption, and whether other drug interactions might pose combined risks. All of these factors contribute to your final recommendations.
If you have lingering questions about the safety of breastfeeding while on antidepressants, those questions are something you should bring to a healthcare professional. They’re uniquely qualified to help you with the decision-making process.
Psychotropic medications and mood disorders are a lot to handle, and when you have an infant in your hands, it can feel like there’s no room for the other stuff. That’s when it’s most important to seek help and support.
If you’re dealing with depression or struggling to make the right decision for your mental health needs and your baby’s safety, talk to someone.
Feeling overwhelmed by your depression? We have more mental health online resources, including information on ways to treat your depression and how to manage your stress better. And if you’re ready to talk to someone, our online therapy is here when you need it.
Kristin Hall is a board-certified Family Nurse Practitioner with decades of experience in clinical practice and leadership.
She has an extensive background in Family Medicine as both a front-line healthcare provider and clinical leader through her work as a primary care provider, retail health clinician and as Principal Investigator with the NIH.
Certified through the American Nurses Credentialing Center, she brings her expertise in Family Medicine into your home by helping people improve their health and actively participate in their own healthcare.
Kristin is a St. Louis native and earned her master’s degree in Nursing from St. Louis University, and is also a member of the American Academy of Nurse Practitioners. You can find Kristin on LinkedIn for more information.
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