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Depression

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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 & 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 & 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

Disclaimer

The Clinical Practice Guideline is provided by way of guidance only and subject to the Clinical practice guidelines disclaimer