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We were able to make some guidelines about medications, in particular, the antidepressants,
which are most commonly used in this population. And the big question is, how safe are they
in pregnancy. And we're talking mostly now about the SSRI or the serotonin-acting drugs,
and they're used both for depression and anxiety disorders. So you can imagine they're common
at this time in the perinatal period and you're looking at the safety issues. Is it... How
safe is it for the developing foetus, as opposed to what if we don't treat mother and then
her stress and anxiety and depression impact somehow on the pregnancy or even further down
the track on the foetal and infant development? On the basis of the evidence, which is really
growing and improving year by year, and our expert panel to devise some fairly clear-cut
guidelines in that respect. So yes, we feel that we can relatively safely use the SSRI
class of drugs, about which we have a lot of knowledge now. And when I say that we mean
that we don't see that there is an increased risk of birth defects. Because that's what
everybody wants to know about, if I expose my baby in the first trimester, will it be
safe or not? And we think in the balance, there is nothing to say that it's not safe.
So that's encouraging.
The other aspect is if I expose my baby later in pregnancy, might it impact on the baby's
wellness, if you like, around the time of birth. And again, we're not finding that there
is any good evidence to suggest that it's not safe at this time. So that's also quite
encouraging. The body of evidence is less large yet, but it is... It's in a... It's
a positive finding so far in the balance. The third thing you're looking at in terms
of safety in pregnancy is, what if this somehow impacts on the development of the foetal brain
and further down the track when the baby... The little child's school whatever, we're
finding some issues there. Again, we have a body, only a small body here, but of encouraging
evidence to suggest that, that is not going to be an issue. So in respect to that class
of drugs, we can say quite a bit and that's good.
Regarding the psychological treatments in the perinatal period, we were able to make
some fairly clear recommendations because we've got that level of evidence. So we were
able to recommend cognitive behavioural therapy, interpersonal therapy, psychotherapy, quite
clearly beneficial, and we have the studies in that population to show that. I think the
important thing to keep in mind, if you're looking at after a mum, in this situation,
she's asking you as a health care provider for advice, the first thing you say is, "Well,
look, the main consideration is have a proper assessment." Go and have your full detailed
mental health assessment to actually make the diagnosis. And from there, you've then
got a choice and you can engage in psychological counselling, which might be all that's required
for the mild to moderate cases of depression and anxiety. Or if you've got a more severe
condition, then your psychiatrist or GP is likely to say, "Well, we need to consider
medication." It's not a black and white. If you decide... If the woman decides, with her
family, that maybe she doesn't want to go down the medication track, she can still have
ongoing support and therapy. The important... The keyword there is ongoing and ongoing monitoring.
So if things get worse, then it's continually re-evaluated as to the need for medication.
The two key things that need to exist before you can start to do the... To implement the
guidelines is to have adequate training and ongoing supervision and the adequate pathways
to care.
The guidelines were written in a very accessible fashion for health care professionals that
don't have special skills and they could also be read by a non-health care professional
with a reasonable understanding of mental health issues around this time. So we'd love
to see interested parties attending the public consultations, if they can, and we're organising
those in every capital city and some regional centres. We'd also like some written feedback
during the two-month consultation period. The guidelines are also very much targeted
at the whole of the Australian population so that they're for women who live and health
care professionals working in rural and remote areas, as well as those working with culturally
and linguistically diverse populations. And as we know, not all women are lucky enough
to live in metropolitan areas where one would hope these services would be available, so
one has to write it across the board.