Depression

Guidance for medical examiners when assessing a patient for either a general topic or condition – Depression.

Definition

This guidance should be used for applicants treated with any of: 

  • Major depressive disorder
  • Adjustment disorder with depressed mood
  • Dysthymia.

Aeromedical implications

Effect of aviation on condition

  • Fatigue
  • Sleep deprivation
  • Time zone changes
  • Stressful events
  • Social isolation
  • Irregular access to medical care and surveillance
  • Remote locations

Effect of condition on aviation

  • Overt incapacitation
    • Suicidality
    • Psychosis of Major Depression
    • Comorbidities eg anxiety, substance use
  • Subtle incapacitation
    • Reduced concentration and memory
    • Impaired cognition.

Effect of treatment on aviation

  • Impaired cognition
  • Sedation
  • Nausea
  • Disequillibrium
  • Impaired sleep

Approach to medical certification

Based on the condition

  • Confirmed diagnosis
  • Exclusion of other diagnoses eg BPAD, Schizophrenia, OCD
  • Managed precipitants
  • Remission and euthymia (normal mood) for a minimum of 4 weeks without neurocognitive impairment

Based on treatment

  • Acceptable, stable and effective treatment without significant side effects

Stability

  • Sustained remission and euthymia (normal mood) without neurocognitive impairment
  • A recurrence and relapse prevention plan (e.g. CBT, Medication) commensurate with presentation, number of episodes and severity of disease (treatment duration dependant on number of episodes)

Risk assessment protocol - information required

New cases

Psychiatrist report.

  • Confirmed diagnosis of unipolar depression (DSM IV)
  • Clinical status
    • onset and precipitating events
    • past symptoms, including any of suicidal ideation, depression, mania, psychosis, or anxiety
    • current symptoms
    • compliance with medication and treatment
    • substance use
    • hospital, psychologist and other specialist assessments
    • progress - duration, relapses
    • social impact - family and work
  • Investigations conducted and assessment instruments used
  • Management
    • treatment - medication, psychologist etc.
    • side-effects
    • monitoring.

Renewal

  • Reconfirmed diagnosis of unipolar depression (DSM IV)
  • Current Clinical status
    • past symptoms, including any of suicidal ideation, depression, mania, psychosis, or anxiety
    • compliance with medication and treatment
    • substance use
    • hospital, psychologist and other specialist assessments
    • progress - duration, relapses
    • social impact - family and work
  • Investigations conducted (K10, Becks inventory, DASS etc.)
  • Management
    • treatment - medication, psychologist etc
    • side-effects
    • monitoring.

Indicative outcomes

  • In cases that are assessed as ‘low risk’ by CASA, treating doctor reports (GP or DAME) or Psychologist reports may be accepted in lieu of Psychiatrist report

Favourable

  • Requires confirmed diagnosis of unipolar depression with exclusion of other diagnoses
  • Mono-therapy
  • One of: Fluoxetine, Sertraline, Citalopram, Escitalopram, Venlafaxine (low-dose only), Desvenlafaxine

Unfavourable

  • Alternative diagnoses including BPAD, Schizophrenia, Psychotic disorders
  • Multi-drug therapy
  • Lithium, Anti-psychotics, Agomelatine, Quetiapine, Tricyclic antidepressants, Monoamine oxidase inhibitors

Pilot / controller information

  • Depression is one of the leading causes of disability worldwide
  • Well-managed depression is compatible with medical certification
  • Any relapse in depressive symptoms must be reported to the DAME
  • Any change to medication (starting, stopping or changing drugs or doses) must be notified to DAME and will require grounding for 2 - 4 weeks
  • Additional information may be required from family, treating doctors and flying colleagues

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Disclaimer

The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.

Last updated:
Online version available at: https://www.casa.gov.au//licences-and-certificates/medical-professionals/dames-clinical-practice-guidelines/depression
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