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