by Alice Evans, perinatal pharmacist
I work as part of a multidisciplinary perinatal mental health team three days a week whilst the other two days are spent with the pharmacy mental health team based at Glangwili hospital, West Wales. As a perinatal pharmacist, I support women on medication during the perinatal period, which includes pre-conception and up to one year postpartum. Women are referred to me when they are considering starting a medication, for advice on current medicines or for a medication review. I also advise other healthcare professionals on the most appropriate medication to use during the perinatal period. The rest of my time is spent writing documentation/guidelines on the use of medication during this period.
Starting a new role during a pandemic
When I first began my role in August, I had no idea how prevalent perinatal mental health was and how it could affect both men and women. Around 1 in 5 women develop a mental illness during pregnancy or within the first year after birth and if left untreated, women can continue to experience symptoms, sometimes for many years after the birth of the child.
Unfortunately, some women are often reluctant to seek help during the perinatal period. There is still a stigma regarding the perception that they should be a “perfect parent” but many women that I speak to suffer with depression and/or anxiety. Recently, I’ve met a few mothers who developed postpartum psychosis after giving birth. I had never heard of this condition before starting my job and I had no idea of how severe it is. What surprised was that it can happen to women without any previous mental health issues, which is why we need to raise more awareness on these issues.
This job is completely different to what I was used to as a ward-based pharmacist and working in perinatal mental health has been a massive learning curve for me. It took a while to get used to the ‘office style job’ and because of COVID-19, most consultations are done over the phone so it can be difficult to build a relationship with patients. I am hoping to do more face-to-face consultations in the near future. I was grateful for the RPS guidance on remote consultations to support this new way of working.
Dealing with new trends in mental health
The perinatal team noticed a trend of women being referred to the team with a decline in mental health after stopping their psychotropic medication. It came to light that these women were told to stop their medication by the GP because they were pregnant. They had no information on the risks versus benefits and some stated they had no option but to stop taking their medication. Some women who were breastfeeding were told to “pump and dump” to prevent the baby receiving any drug from the breastmilk.
It quickly became clear that more needed to be done to discuss medication at pre-conception or at the early stages of pregnancy. As a result, I’ve completed a psychotropic prescribing tool that contains information on the use of antidepressants and antipsychotics during pregnancy and breastfeeding. The tool uses the format of a traffic light system with the medication with the most evidence of safety coloured in green and the medication with the least evidence of safety coloured in red. We made sure that the tool was easily accessible to all practitioners within Hywel Dda Health Board. We believe that this tool will help GPs discuss all the options with these women and show them that in some cases keeping them on an antidepressant/antipsychotic is the best option.
Going forward
My aim in this role is to continue building strong relationships with other primary care professionals, by continuing to work with prescribers on the appropriate use of medication during pregnancy and breastfeeding. I would also like to increase collaboration between my team and community pharmacists, who are ideally placed with often already have a good relationship with the patients, allowing them to identify any red flags. By ensuring community teams know they can access our team and resources to help them counsel these women and signpost them to the most appropriate places.
The RPS is carrying out important work to help you with your mental health and wellbeing. Read our resources via our workforce wellbeing page and on the role of pharmacists in mental health care.