Key Messages for Clinicians in Perinatal Mental Health by Professor Anne Buist
Key Points
- Perinatal mental illness can affect the mother, infant and wider family, making early identification important, ideally from preconception or antenatal care onwards.
- A history of childhood trauma warrants particular attention, with supportive and attachment-focused approaches helping parents recognise and respond to their baby’s cues.
- Treatment decisions in postnatal depression should consider the risks of untreated illness alongside medication-related risks during pregnancy and breastfeeding.
- For women with a history of postpartum psychosis, close monitoring in subsequent pregnancies is important, with particular attention to protecting sleep in late pregnancy and the early postpartum period.
- Mother–infant care should extend beyond symptom management to include attachment, reflective functioning and practical support for the developing parent–baby relationship.
Prof Anne Buist shares practical insights from more than 30 years of clinical and research experience in perinatal psychiatry. This discussion explores early identification of maternal mental illness, childhood trauma, attachment, and the importance of supporting the relationship between parent and baby.
She discusses medication considerations during pregnancy and breastfeeding, protecting sleep in women at risk of postpartum psychosis, and helping parents understand their baby’s emotional needs. She also reflects on her assessment of Keli Lane, whose case featured in ABC’s Exposed, highlighting the complexity of psychiatric assessment in a legal context.
This recording reflects the evidence and service arrangements at the time; medication guidance should be considered alongside current recommendations.
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Prof Anne Buist is the Chair of Women’s Mental Health at the University of Melbourne. Anne has more than 30 years of clinical and research experience in perinatal psychiatry and works with the legal system in cases of abuse, kidnapping, infanticide, and murder. Her work has had direct implications for clinical care as well as assisting in advising government and health services to ensure good outcomes.
Author Quotes
Summary and slides
Professor Buist describes the types of materials that she would give to patients to guide them in responding to their babies’ cues.
Embarking on overall messages, she suggests that pre-conceptual preventative measures would give the best outcomes for women and their families. She reiterates that early identification and assertive management of perinatal depression are important and reminds the audience that perinatal depression is not just about the mother, but about the whole family.
Professor Buist concludes this segment by highlighting that new and exciting research in the perinatal depression field is ongoing, and states that helping mothers helps babies. She then invites the audience to take part in a Question and Answer session, where the following topics were raised:
- Whether medicating during pregnancy or lactation does more harm than good.
- Why there are differences in stress responses of babies with depressed and anxious mothers compared with those whose mothers were non-anxious but were exposed to a stressor during pregnancy.
- Whether or not there is a link between antidepressants and autism.
- Whether or not probiotics can treat depression.
- The attachment education is available to families.
- How attachment issues might lead to a higher incidence of ADHD.
- The effects of premature birth on attachment issues.
- What the predictors of perinatal depression are.
Take-Home Points
- Perinatal depression is common, can be serious, and impacts future generations.
- It is important to identify and treat perinatal depression as soon as possible.
- There is much promising ongoing research in the perinatal depression field.
- Valproate is to be avoided in women of childbearing age as it is associated with a high incidence of neural tube abnormalities.
- A recent systematic review and meta-analysis of lithium exposure in pregnancy stated:
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