Volume 193 - Issue 9
Guidelines for youth depression: time to incorporate new perspectives
Authors: Ian B Hickie and Patrick D McGorry
Med J Aust 2010; 193 (9): 557-558. || doi: 10.5694/j.1326-5377.2010.tb04054.x
Published online: 1 November 2010
Published online: 1 November 2010
In reply: Zimmerman correctly highlights the intrinsic limitations of applying the current “evidence base” for managing severe depression in young people. In part, our critique of the new guidelines1 stems from our shared concern about their real utility in clinical practice. As we have outlined elsewhere, we do not favour a simple “sequencing of treatments” model or recognise a clear separation between early phases of severe unipolar or bipolar depression.2 The real difficulty for clinicians is that young people presenting with severe depression are not only at high risk of immediate harm, but may also be on the path to a range of different psychiatric (and neurobiological) outcomes, including bipolar disorder, psychotic disorders and comorbid alcohol and substance misuse.2,3 Unfortunately, there are no clear clinical, neuropsychological or biomedical predictors of the relative risks of developing these adverse outcomes.2,3 Consequently, we have recommended the development of a broader clinical trials network that recognises this complexity and seeks to develop a more relevant evidence base in the future.4 For now, we need to continue to develop clinical service initiatives that not only engage young people but can provide the longitudinal and more specialised care that may be required for those who develop more complex disorders.5
References
- Hickie IB, McGorry PD. Guidelines for youth depression: time to incorporate new perspectives [editorial]. Med J Aust 2010; 193: 133-134.
- McGorry PD, Hickie IB, Yung AR, et al. Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions. Aust N Z J Psychiatry 2006; 40: 616-622. 0_i1095405
- Berk M, Conus P, Kapczinski F, et al. From neuroprogression to neuroprotection: implications for clinical care. Med J Aust 2010; 193 (4 Suppl): S36-S40. 0_i1095409
- McGorry PD, Yung AR, Pantelis C, Hickie IB. A clinical trials agenda for testing interventions in earlier stages of psychotic disorders. Med J Aust 2009; 190 (4 Suppl): S33-S36. 0_i1095411
- McGorry PD, Purcell R, Hickie IB, Jorm AF. Investing in youth mental health is a best buy [editorial]. Med J Aust 2007; 187 (7 Suppl): S5-S7. 0_pgfId-2200515
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