Antidepressant during pregnancy: Psychiatrist’s perspective

In this episode of the Good GP, Dr Julia Rawlinson speaks with Dr Julia Feutrill, consultant psychiatrist at King Edward Memorial Hospital and co-director of the Elizabeth Clinic. They discuss the complexities of antidepressant use during pregnancy, providing GPs with practical advice for navigating these conversations.

Covering key assessment considerations, such as the severity of illness, history of hormonal sensitivity, trauma, and family psychiatric history. Dr Feutrill stresses the need to treat symptoms to remission rather than opting for subtherapeutic dosing, highlighting the low absolute risk of congenital malformations from antidepressant medications, especially compared to other modifiable risk factors.

Sertraline is identified as the antidepressant with the most robust safety data for pregnancy. Examining neonatal adaptation syndrome and outlines current understanding regarding dose adjustments during pregnancy. Guidance is provided on managing abrupt discontinuation and when GP referral to psychiatry is appropriate.

Dr Feutrill also draws attention to the growing recognition of hormonal sensitivity’s impact on mental health and encourages GPs to consider hormonal and neurobiological factors in their assessment and management.

Link & Resources:

• Mothersafe NSW - https://www.seslhd.health.nsw.gov.au/royal-hospital-for-women/services-clinics/directory/mothersafe
• TGA - Obstetric drug information services - https://www.tga.gov.au/resources/health-professional-information-and-resources/australian-categorisation-system-prescribing-medicines-pregnancy/prescribing-medicines-pregnancy-database/obstetric-drug-information-services
• Perinatal Mental Health Guidelines - https://www.cope.org.au/uploads/images/Health-professionals/COPE_2023_Perinatal_Mental_Health_Practice_Guideline.pdf

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