ADOLESCENT DEPRESSION GUIDELINES
Beyond Blue recently commissioned Adelaide Health Technology Assessment (AHTA) to conduct systematic literature reviews to provide the evidence base for adolescent depression guidelines. The review aimed to identify risk and protective factors for depression, how depression can be prevented and treated, and how risk factors have an impact on outcomes in the population of adolescents and young adults.
It’s another vapid, useless and potentially dangerous report. It gives the nod to the medical industry to run amok with the preseciption pad. It trivializes the causes and treatments of depression.
The big recommendation:
‘For young people with moderate to severe major depressive disorder, SSRIs in combination with CBT/IPT are recommended. Close monitoring of possible side effects and suicidal ideation is important. A multidisciplinary team approach is likely to have advantages for individuals with complex and/or highly comorbid presentations.’
'Given the lack of evidence in young adults, it is strongly recommended that strategies to prevent major depressive disorder in this age group be a focus for continuing research.'
'Further work is required to match a specific target groups with a particular intervention; for example, young people with biological risk factors (eg chronic illness) may benefit from a psychological intervention while parent risk factors (eg parent death) or social factors (eg homelessness, poverty) may require systemic interventions.'
'Best practice in assessment occurs within the context of a health professional (code for doctor) experienced in dealing with adolescents and young adults, who has appropriate communication skills, is culturally competent and is able to gain the trust of the young person.'
'The first aim of assessment is to determine whether a depressive disorder is present and its level of severity. The assessment process includes:
• greeting the young person and establishing the parameters of the assessment;
• establishing rapport, often by taking an interest in the life of the young person beyond their current difficulties — this may also be an appropriate time to identify the individual’s strengths.'
'It should be noted that particularly in moderate to severe depression, concerns about the risk of increased suicidal ideation with SSRIs must be balanced against the risks of no treatment; data from observational studies indicates that while SSRIs may increase the risk of youth suicidality, they are likely to decrease the overall risk of youth suicide (see discussion in Dudley et al 2008). Observational studies have also found decreased suicidality with increased duration of antidepressant use (Simon et al 2006).'
Well there you go. Depression is caused by a lack of Zoloft! The risk of suicide is a dreadful;l side-effect. We need more research and further work.
The report outlines the adverse effects of SSRIs
What the report had to say about the role of exercise in the treatment of depression was just plain wrong.
'Based on current evidence, exercise cannot be recommended as an effective treatment for
depression in adolescents or young adults.'
The report made no reference to personal development, the stress placed on children and youth from school work.
It didn’t mention the existential vacuum, or the role of anger in depression. No mention of the effect of diet and poo-pooing of the role of physical activity.
No mention of activities that focus on group cohesion and support - like sport, drama, bands …
These people are right off the planet. If this is all they can come up with, there is no hope for Beyond Blue to make any significant impact on the treatment of depression in youth and adolescents.
And why not? Because the committee is drawn from the medical and pharmaceutical industries.
A/Prof Michael Baigent Beyond Blue Clinical Advisor
Dr Andrew Chanen Child and Adolescent Psychiatry
Ms Lesley Fraser Australian Guidance and Counselling Association
Dr Brian Graetz Beyond Blue Education and Early Childhood
A/Prof Noel Hayman Royal Australasian College of Physicians (RACP):
Professor Louise Newman RANZCP: Faculty of Child and Adolescent Psychiatry
Dr Nikunj Parikh (as of 31 August 2009) Royal Australian College of General Practitioners
Ms Bernadette Peirce blueVoices consumers
Dr Jenny Proimos RACP: Paediatrics and Child Health Division
A/Prof Leanne Rowe (until 17 June 2009) Royal Australian College of General Practitioners
Ms Thelma Smalley blueVoices carers
Professor Sue Spence Australian Psychological Society
Ms Kay Currie NHMRC National Institute of Clinical Studies
They're relying on selective evidence.
No one there from the personal development, teaching or fitness industries. One lonely member of a counselling organisation. Why you'd put someone from the College of General Practitioners on the committee beggars belief. These are the people who prescribe the drugs with the list of side effects as long as you arm.
The contractors who did the dreadful job on the literature review were Tracey Merlin and Skye Newton from Adelaide Health Technology Assessment. They reviewed the wrong literature. And don't you love medical speak; words like 'ideation', 'suicidality' and 'comorbid' - makes it sound more important! The spell-checker went nuts.
This is most depressing report, ineptly prepared by mesdames Merlin and Newton. Even the Kinghts of the Round Table could have done a better job. If it were a year 10 assignment you'd give it 2/10 for trying.
Even more depressiong is the fact that the Board of Beyong Blue accepted and published it. They're a laughing stock.
It does nothing to make the plight of depressed adolescents any better. It just gives doctors the nod to prescribe more drugs, regardless of the side effects, regardless of whether this is the best way to assist young people to start living the life they'd like to live. If they're hyperactive give them Ritalin. If they're depressed give them Zoloft and tell them they'll be alright.
It's not alright, depression is not caused by a lack of Zoloft. It's just another example of junk medicine in action.
Anyone who's depressed shouldn't be allowed within a mile of a surgery.
The sooner Beyond Blue wakes up to itself and divorces itself from the medical and pharmaceutical industries as primary referral options for people who are depressed the better. Putting its name to a report like this does the community a grave disservice.
On the track
No track today. Another full day at the AIS. Have to leave early and get home late.
In the meantime stay tuned, highly tuned and if you're depressed don't call Beyond Blue, they'll just tell you to go and see your doctor.