“I accept that is something that goes against the argument that she was suicidal,” he said.
Mr Boyle asked if suicide was likely if there had been no triggering event.
“I’d suggest there could be some triggering events that we don’t know about, some triggering events that are internal, but I accept that knowing there is no triggering event … it is less likely,” he said.
Dr Schramm agreed a person making short and long-term plans would make one “less concerned” they would harm themselves.
“A decision may have occurred after such plans, long term or medium term, were made,” he said.
Mr Boyle asked about the likely suicide risk of a person who had been proactive in the past about seeking assistance from counsellors and doctors.
“In general I would accept Allison seemed to be someone who put her hand up when she wasn’t coping and sought help,” he said.
Dr Schramm agreed symptoms of depression could become worse during pregnancy.
He agreed doctors could increase an anti-depressant dose in order to control mood swings around menstruation.
Dr Schramm said he did not know when Ms Baden-Clay was last actively depressed.
“The records show one of her most recent attendances on her GP at the Kenmore clinic, which was sometime in March, indicated she was complaining of mood swings,” he said.
He said he noticed a note in Ms Baden-Clay’s session with Carmel Ritchie in which she spoke of feeling “not good enough”.
In re-examination by barrister Michael Byrne, Dr Schramm said it was not his belief the increase of sertraline dosage would be likely to have caused suicidal ideation.
“You would normally expect that increased risk when someone first starts on that medication,” he said.
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