Greg Bright: Where are we with the treatment?

Gordon Parker: There are different types of depression … there are some that are purely biological and deserve medication as a priority. Some are a consequence of stress and would benefit from counselling and problem solving. And some are a reflection of personalities. So, we argue a ‘horses for courses’ model.

In regard to the medical approach, it hasn’t improved very much in the last 20 years, despite what the pharmaceutical companies would say. The newer antidepressants are not much more effective. And in fact for the melancholic depressants, they’re actually less affective… There’s been recent studies in America showing basically the atypical antipsychotic drugs, which are expensive, are actually not much more affective than the old ones.

We’ve done a lot better in destigmatising depression and mood disorders. We’ve done a lot better in getting people coming forward. We’ve got some richer approaches. Some drug combinations a bit better. Psychologists are a bit better trained. But it hasn’t improved anything like the rest of medicine.

Simon Swanson: We would say internally at CommInsure that early intervention has been an extraordinary success in the managing of some medical illness claims and income protection claims. So we’d say the awareness that Black Dog and Beyond Blue [programs] have brought to society are assisting the early intervention process.

Gordon Parker: Yes it’s wonderful when we get somebody who comes through at the age of 18. When I was working the specialist field, people would go to 50 or 60, coming through as ‘treatment resist’. If they come through at 18 and we can get the right treatment, you can actually change lives. That’s the advantage of destigmatisation. People are coming further earlier, comfortably.

And at Black Dog 60 per cent of young people coming through bring a partner or a parent. And I think that’s absolutely fantastic that they’re comfortable. Helen Hewett: Is there any behaviour that can be identified in people before the psychosis is there? Are there any trends?

Gordon Parker: Nothing really. You get some atypical presentation. Sometimes before a girl develops bi-polar disorder she’ll have anorexia nervosa. And sometimes before people develop depression they’ll be describing anxiety. But it’s not pristine. It’s not clear-cut.

Frequently what you do as a clinician is you try and find out what’s in the family. So if there’s schizophrenia in the family or there’s depression, then you’re thinking ‘well maybe’ and try to crystallise it. But the answer in broad terms is a negative.

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