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I think the guidelines are very well named they're actually for clinicians but also carers
and people who might be suffering from depression. They are actually guidelines, they are a little
bit unusual in that they are based on scientific evidence. So, it's not the opinion of a series
of experts, it's actually a rigorous scientific process that says that if you look at the
international literature on depression, this is the best advice we can give you for getting
better. And again it's on, based mainly on randomised control trials which is a very
rigorous scientific way of showing the difference between two different types of treatment.
So, the guidelines for depression, they're divided into two major age areas. So, one
is 13 to 18 years of age and the other is 19 to 25 years of age. The division is actually
pragmatic, 13 to 18 is about high school. So, we think that anyone treating a high school
individual or a high school student or a parent of a high school student should read those
ones.
The other ones are about young adults 19 to 24, 25. Again, they face different issues,
they might be going into higher education or university, or they might be going into
their first job. So, what the current scientific literature says on the best possible treatment
for depression for those two age groups.
One of the reasons we did these guidelines is because there have been some controversies
in the area and the controversies are clinical conundrums if you like that make it very difficult
for the individual or the parent, or the carer to understand what's the best evidence and
what's the best practice. I suppose the two ones that really come to mind, the first is,
'Does antidepressant medication actually make some people have suicidal thinking or suicidal
behaviour?' Related to that is the issue of 'Whether antidepressant medication in some
people actually leads to completed suicide?', and this is a major conundrum.
The second conundrum is the age when antidepressant medication, using a psychotropic drug that
affects the brain, how a young person can use those safely and get benefit? So, just
going back to the first one, these guidelines I think give very clear advice about emerging
suicidal behaviour. We were able to access the American Federal Drug Administration database
on this. It had over a 100,000 people and about 16,000 youth, and it clearly shows that
there is a doubling of emergent suicidal thinking if you are taking antidepressant medications
specifically they're called SSRIs, Selective Serotonin Re-uptake Inhibitors.
Now, some people might say, a doubling that's an extremely scary number. The fact is that
the doubling is from the rate of a sugar tablet, a placebo of 2% to 4%. Now, this is really
important because although it's a doubling, it's the doubling from a very small base rate
to another small number 4%, 96% of all of those people taking antidepressants don't
have emergent suicidal thoughts or behaviour.
The second thing is, in all the clinical trails that have been published and our access to
unpublished trials and the Americans have been very good at getting data from an unpublished
trials, not one person has actually completed suicide on these tablets. So, again we are
making, we think reasonably firm recommendations of these medications don't actually cause
suicidal, don't cause completed suicide.
Getting back to the second point I have made, 'what is the youngest age that you can use
antidepressants?' We would be recommending and the guidelines detail this that if all
of the antidepressant medications there is only one that has evidence in adolescents
and that's Fluoxetine, and that's a scientific name and it's known by various trade names,
and again the guidelines are clear about what those trade names are. But people could feel
very safe about one of the tablets, Fluoxetine is safe down to the age of 13 and this is
a new finding for Australia.
I think people might be interested about how these guidelines were developed and the scientific
process around that. And we certainly aspired to be the most rigorous way that we could
look at the data possible. And we followed very closely the NHMRC, the National Health
and Medical Research Council of Australia guidelines in how to do a very formal and
rigorous review.
What you do is you decide upon a search term. So, the search term might be 'the treatment
of depression'. And then you have parameters around that so the parameters might be in
13 to 18-year-olds. It came up with 57,000 articles, which is a huge body of literature.
This number 57,000 decreased because we subdivided into two age groups as I have already mentioned
13 to 18 and 19 to 25. And we further divided into three questions. One question was risk
factors for depression. We think we need to know about risk factors because parents or
individuals or clinicians might be able to decrease risk factors or indeed schools might
be able to decrease risk factors.
The second question was about prevention and there's three types of prevention, universal
prevention that affects everybody; selective prevention that targets people in the high
risk groups; targeted prevention that targets people who have depressive symptoms, not a
depressive disorder yet. And the last group was treatment. All the treatment studies,
in the world, that looked at depression. When you read the full guidelines you find that
we found many many different types of treatment; we found many drug treatments, we found different
types of psychotherapy like interpersonal psychotherapy or cognitive behaviour therapy.
But also, we found a range of other things like light therapy, relaxation therapy, exercise,
all sorts of interesting things. And these are all described in the practice guidelines.