Escitalopram
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A Selective Serotonin Reuptake Inhibitor (SSRI) can be used during pregnancy if recommended by your doctor.
What are they?
SSRIs are a group of antidepressants. Individual SSRI medications include citalopram, escitalopram (Cipralex®, Enalto®), fluoxetine (Olena®), sertraline (Contulen®, Lustral®), and paroxetine. SSRIs are used to treat depression and anxiety, as well as other conditions, including obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and panic disorder.
Benefits
What are the benefits of taking an SSRI in pregnancy?
If an SSRI is working well, continuing treatment during pregnancy can help maintain your health, wellbeing, and quality of life. The benefits of continuing treatment in pregnancy are likely to outweigh the risks.
Risks
Are there any risks of taking an SSRI during pregnancy?
Although SSRI use in pregnancy might slightly increase the chance of some complications, the overall risk to you or your baby is low.
Some studies have suggested that taking an SSRI in early pregnancy may slightly increase the chance of heart defects in the baby, but most studies do not support this. If there is any increase in risk, it is small, and most women who take an SSRI during pregnancy have a baby with a normal heart.
The available information about miscarriage, stillbirth, premature birth, low birth weight, and childhood learning and behaviour does not prove that SSRI use in pregnancy affects these outcomes.
If you take an SSRI in later pregnancy, you will usually be advised to have a hospital delivery. This is because:
• SSRIs can sometimes cause short-term withdrawal symptoms in the newborn baby. Observation of your baby for a short while after birth may be needed.
• Rarely, SSRI use in pregnancy can cause a problem in the baby, where blood flow to the lungs is too high. This is called persistent pulmonary hypertension of the newborn (PPHN). The risk is low - around one in every 300 babies whose mother takes an SSRI may develop PPHN. As a precaution, your baby will be checked for breathing problems by a midwife or paediatrician.
• Women taking an SSRI in the month before delivery may have a slightly higher risk of post-partum haemorrhage (heavy bleeding after birth). A hospital delivery ensures that if this occurs, it can be treated quickly.
Alternatives
Are there any alternatives to taking an SSRI?
Possibly. Other types of medicines can be used to treat mental health conditions, but there is no good evidence that these are safer than an SSRI during pregnancy. There is also no suggestion that any one of the SSRIs is better to use in pregnancy than the others. The best option is usually the drug that works for you.
No treatment
What if I prefer not to take medicines during pregnancy?
It is very important that mental health conditions are properly treated to ensure your wellbeing during pregnancy and while caring for your baby. Stopping an SSRI might affect your mental health and can also cause withdrawal symptoms. Your doctor will only prescribe medicines when necessary and will be happy to discuss any concerns you may have.
Please do not stop taking your medication without first speaking to your GP or specialist.
Will I or my baby need extra monitoring?
As part of routine antenatal care in the UK, you will be invited for a detailed scan at around 20 weeks of pregnancy to check your baby’s development. No further scans to check for birth defects will be required. If you have taken an SSRI around the time of delivery, your baby may require extra monitoring to check for withdrawal symptoms.
Are there any risks to my baby if the father has taken an SSRI?
There is no evidence that an SSRI used by the father around the time of conception can harm the baby.
Who can I talk to if I have questions?
If you have any questions regarding the information in this leaflet, please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.