Key Messages for Clinicians in Perinatal Mental Health by Professor Anne Buist
Prof Anne Buist is the Chair of Women’s Mental Health at the University of Melbourne. Anne has more than 30 years 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.
The one place we can get in really early is in antenatal care because pretty much every woman in Australia has antenatal care; so that’s the clear point of entry, and if not then, then early postnatal.
Bromocriptine which is given to stop lactation doesn’t affect many people but there is a very small percentage that it is going to make a lot worse, and it’s hard to know exactly which ones they are going to be. I’d be watching carefully for anyone that had a history of reacting to the pill, for instance, or any previous interventions.
There is more evidence that untreated depression is at risk to the baby than virtually any of the medications, with (in lactation) the exception of lithium and clozapine, and (in pregnancy) epilum and possibly to some degree lamotrigine; lithium has some risks, and I’d avoid clozapine there as well.
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.
- 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.