• Depression is a common, serious and significant illness of youth.
• The most important cause of suicide is untreated depression
• Depression varies in severity from mild to very severe
• Different degrees of depression probably require different treatments
• There are a range of treatments for depression in young people, only one of which is medication. Several studies show Cognitive-Behavioural Therapy [CBT] is beneficial, and research is needed to evaluate other treatments.

• Assessment, diagnosis and effective treatment requires skilled medical and non-medical professionals and well resourced Child and Adolescent Mental Health Services [CAMHS].
• New Zealand currently has less than half the workforce and other resources needed to maintain even a minimum CAMHS
• Funding and improved resourcing are a priority issue for DHBs and others to consider.

Medication

• Research shows that SSRIs are helpful for other problems in young people, not only depression. Specifically they are very useful for Obsessive-Compulsive Disorder, and sometimes for other anxiety disorders.
• There is no evidence that prescribing SSRIs to young people increases suicide.
• As the number of prescriptions of SSRIs to youth in NZ has increased the rate of youth suicide in NZ has fallen.
• The increase in suicidal thinking described as a risk occurs in less than 2% of those taking the medication ~ that is a small problem.
• Studies show that SSRIs, particularly Fluoxetine help depression in adolescents. There is a degree of conflicting evidence, but the balance is significantly in favour of SSRIs being effective. There is a need for more well designed studies to confirm this.
• Depression in children is infrequent and studies of medication too few and mostly too poorly designed to reach any firm conclusions.
• Untreated depression carries a greater risk of suicide than appropriate prescribing of SSRIs
• We do not accept that using SSRIs in adolescence constitutes a risk which is remotely as great as severe depression itself and it would be unfortunate if the position taken by Medsafe were to result in the withholding of appropriate SSRI treatment
• The need for patients and caregivers to have proper information was and remains good practice, but reiteration of this is valuable.
• The need for specialist opinion before antidepressant medication is commenced is supported, but it would be unfortunate if the current shortage of a skilled workforce in NZ CAMHS were to cause a family doctor to withhold treatment for severe depression.