Is Lexapro safe while breastfeeding?

What does the evidence say about Lexapro while breastfeeding?

1. Citalopram and escitalopram pass into breast milk in small amounts, and while a few case reports describe sleepiness or weight loss in an infant, most studies have not found harmful effects or differences in intellectual development in babies exposed through breast milk. 1
2. At a maternal dose of 20 mg daily, the relative infant dose works out to roughly 2.6 to 3.3% of the weight-adjusted maternal dose, a level LactMed states would not be expected to cause adverse effects in breastfed infants, especially once the infant is older than 2 months. 2
3. A follow-up study of breastfed infants exposed to escitalopram found development scores around 110% of typical, and a separate analysis found no significant difference in IQ scores at an average age of 4.9 years between breastfed children exposed to an SSRI after birth and those who weren't. 2
4. A consensus panel on medicating breastfeeding women for postpartum depression names escitalopram, alongside sertraline and paroxetine, among the safest SSRI options, each with a relative infant dose under 10% and very rare, mild reported side effects, while rating citalopram itself somewhat less favorably than its escitalopram component. 3
5. In children followed to age 5, postnatal SSRI therapy for maternal depression was not linked to a higher risk of developmental delay or behavioral problems, and managing the depression appeared to soften some of the negative associations between untreated postpartum depression and later child outcomes such as ADHD symptoms. 4

How Lexapro changes by nursing stage

• Early weeks. Early weeks of breastfeeding, often while adjusting a postpartum depression or anxiety care plan. Watch for excess sleepiness, poor feeding, or slow weight gain in your newborn, and mention any of those to their pediatrician.
• Established nursing. Once nursing is established, escitalopram remains one of the SSRIs a consensus panel rates among the safest for breastfeeding, alongside sertraline and paroxetine, each with a relative infant dose under 10%.
• Weaning. Later in breastfeeding or during weaning, the same low-level exposure pattern holds, and nothing in the evidence suggests a need to change course as feeds space out. Continuing a medication that's been working for you is generally preferred over switching.