When you’re pregnant, suddenly your health becomes a little more complicated. You have a passenger who’s counting on you to make good decisions for their sake, too.

But the decisions that you make might seem harder if you’re also coping with depression. You might start to second-guess yourself and whether you should take an antidepressant while you’re pregnant.

If you take an antidepressant like Lexapro, it’s useful to understand how the medicine may affect you and your growing baby. Here’s what you need to know.

Lexapro is the brand name for escitalopram, which is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI). Like other SSRIs, escitalopram works by increasing the activity of a chemical known as serotonin in your brain to help regulate your mood.

Lexapro is typically prescribed to people who have depression or generalized anxiety disorder (GAD). Most people who take Lexapro take 10 to 20 milligrams once per day.

Generally speaking, the first trimester is an anxious time for many pregnant women, since that’s when most miscarriages occur.

The tough reality is that taking any antidepressant at this delicate time may slightly raise your chances of having a miscarriage. Research from 2016 suggests that antidepressant use during the first trimester is associated with an increased risk of miscarriage.

However, you shouldn’t just stop taking your Lexapro cold turkey when you see that second line on your pregnancy test. Suddenly discontinuing the use of an SSRI has risks, too.

One large 2014 study found that women who took an SSRI during the early weeks of pregnancy had a similar increased risk of miscarriage to women who stopped taking an SSRI before their pregnancies.

If you discover that you’re unexpectedly pregnant and you’ve been taking Lexapro, put in a call to your doctor, so you can talk about the best way to proceed.

Fortunately, you probably don’t need to worry too much about Lexapro causing congenital abnormalities if you take it during your first trimester.

There doesn’t seem to be an association with an increased risk for what experts call “major malformations,” according to a 2012 study.

It’s also important to look at the possible downsides of taking an SSRI like Lexapro during the last part of your pregnancy.

Withdrawal

The use of SSRIs during the third trimester can increase the likelihood that your newborn baby will show some withdrawal signs from the medication. Experts like to call these discontinuation symptoms, and they can include:

  • respiratory distress
  • irritability
  • poor feeding

Adults often have discontinuation symptoms after they stop taking an antidepressant, especially if they don’t gradually taper down. If you can experience this, it makes sense that your baby might go through it, too.

Preterm birth and low birth weight

The National Alliance on Mental Illness cautions that there’s a possible risk of giving birth to your baby before they’re full term if you take Lexapro (or other types of antidepressants) during your second and third trimester.

Also, there’s some research that suggests an association between Lexapro and a greater likelihood for low birth weights.

Now that you’ve considered the potential risks of taking Lexapro while you’re pregnant, it’s time to think about what might happen if you stop taking Lexapro while you’re pregnant.

It’s not just medication that can be risky. Depression can be risky, too. A 2017 review of studies suggests that there is a very real risk to your baby if your depression goes untreated during your pregnancy. In fact, there can be both short-term and long-term effects.

You and your doctor have to weigh the potential risks of taking an antidepressant while you’re pregnant against the potential benefits.

For example, research shows that untreated maternal depression can raise your baby’s risk of being born prematurely and the risk of low birth weight.

That 2017 review also notes greater risk of premature death and admission to the neonatal intensive care unit. Your child might also be at risk for developing some behavioral, emotional, and cognitive problems later on during childhood.

There’s also evidence that forgoing treatment can put your own health at risk. Women who opt out of treatment for depression during pregnancy have a higher risk of developing postpartum depression after their babies are born.

And finally, studies have shown that untreated maternal depression makes it more likely that women will take on behaviors that may be harmful to their health, like smoking or misusing drugs.

Depression isn’t a shameful thing. It’s something that so many people deal with. Many, many pregnant women have gone through it — and come out the other side with a healthy baby — with the support of their doctors. Talk to your doctor about what’s best for you. They’re there to help.

Healthline

With the risks, even if they’re small, on your mind, you might be tempted to shelve your Lexapro for the duration of your pregnancy. But don’t just ditch your Lexapro and ask for a prescription for another antidepressant. Take a look at the risk profile for some other medications first.

Recent studies have looked at the most commonly prescribed SSRIs during pregnancy to see if there are connections between their use and problems like heart or neural tube abnormalities in the developing fetus.

The overall risk of damage to your growing baby is small, most studies have found. That doesn’t mean that there’s no risk, of course.

Generally speaking, sertraline (you may know it better as Zoloft) and escitalopram seem like reasonably safe options for use during pregnancy.

One large study concluded that sertraline seems to have the least amount of risk associated with it when used during first trimester. Lexapro looks pretty good, too, as the study didn’t find any links between the use of escitalopram and any of those birth defects, either.

The news isn’t so good for two other popular SSRIs, though. That same 2015 study also found links between the use of fluoxetine (Prozac) and paroxetine (Paxil) and an increase in certain congenital abnormalities.

But the researchers qualified their findings by noting that the absolute risk that a baby would develop those any developmental issues is still low, despite the increased risk. And there’s an important limitation to consider: The study was only analyzing pregnant women’s first-trimester use of these antidepressant medications.

It may be worth considering this, too: Eventually your pregnancy will end, and you’ll give birth. What effects could your Lexapro (or other SSRI) have on the big event?

For example, another large 2015 study found that mothers-to-be who took SSRIs during pregnancy were less likely to go into preterm labor or need a C-section than women who didn’t take an SSRI for their depression. However, their babies seemed to be more likely to develop a condition called neonatal maladaptation.

Babies with neonatal maladaptation might seem a bit jittery or agitated right after they’re born. Some babies may even be hypoglycemic, which can require intervention, to get their blood sugar levels back to where they need to be.

There are risks to consider with any decision you make. Still uncertain? Talk to your doctor about your fears and your worries. Ask questions. Talk about what the research says. Discuss your specific situation and your options.

You and your doctor may agree that it’s better for you to continue taking Lexapro to manage your depression while you’re pregnant. Or you may decide that it’s better to taper off your Lexapro.

It might be useful to discuss situations whether it’s possible to change course.

For example, you might choose to temporarily stop taking an antidepressant during your pregnancy after weighing all the risks. But later, you might feel that the benefits outweigh the risks. Your doctor can help you take the most appropriate steps.

If you’re asking yourself, “Well, now what do I do?” the answer is “It depends.” What’s right for you might be different than what’s right for someone else who’s pregnant.

Most experts will note that there’s not a 100 percent risk-free choice when it comes to taking an SSRI (or any medication) during pregnancy. Ultimately, it has to be your decision.

Your doctor can help you weigh the different factors and go over the risk factors and answer any questions. Then you can make an informed decision that’s right for you and your baby.

Hang in there. Depression is tough, but you’re tougher.