Antidepressants (SSRI's and others)

[My Flight Surgeon]

As I look through the old threads in the Aeromedical/Flight Physicals Forum, I found some confusion about the use of antidepressants I just want to clarify the FAA’s current position for all of you.

The use of a psychotropic drug is disqualifying for aeromedical certification purposes. This includes all sedatives, tranquilizers, antipsychotic drugs, antidepressant drugs (including SSRI's), analeptics (drugs used primarily for the control of seizures), anxiolytics (Xanax®, etc.), and hallucinogens (LSD, etc.). If an airman suffers or has suffered from bereavement or minor depression then the airman must submit all pertinent medical information and clinical status report (read this as a letter from the physician or therapist summarizing the problem and status) to the AME to be forwarded with his/her Form 8500-8 to the FAA. If the condition is stable, resolved, or has no associated disturbance of thought, no recurrent episodes, and; a). psychotropic medication(s) were used for less than 6 months and discontinued for at least 3 months or b). there was no use of psychotropic medication(s), the AME may issue the medical certificate. Any other condition regarding the use of psychotropic medications require FAA approval.

ANd for the final word, in the latest issue of the Federal Air Surgeon’s Medical Bulletin, Dr. Tilton, the Federal Air Surgeon, reiterates that SSRI’s and other antidepressants are disqualifying medications.

[Kristie]

Is that for all 3 medicals?

speaking of, can you explain the difference between the medical licenses?

[My Flight Surgeon]

Yes, this is for ALL classes of medical examination.

[My Flight Surgeon]

Kristie,

The differences between the medical classes is not that simple. The biggest differences are the vision requirements but there are others. I have included a link that compares the standards for all 3 classes of certificate.

http://www.faa.gov/about/office_org/...a/synopsis.doc

[Murdoughnut]

Sounds like a healthy policy - instead of seeking the treatment they need, pilot's are forced to go without medication for risk of losing their job. Smells like the FAA to me.

[My Flight Surgeon]

Thank you fro your comments. We don't all agree with every policy the FAA has but we chose to live by them when we elected to become pilots. Change can be made by either petitioning the FAA or through your eleceted representatives in the Congress.

This was one of a series of posts designed to educate and inform pilots about the medical standards of the FAA. Hopefully these will be educational and informative to many. If ther are specific topics you would like to see in the future, PM me.

[SkyHawg]

Is St. John's Wart considered a drug to the FAA?

[My Flight Surgeon]

St. John's Wart is an herbal supplement. As such it is not a drug by FDA standards. As far as I know, the FAA has not formally addressed the issue of St. John's Wart.

St. John's Wart does have some interactions with other medications such as Tagamet and erythromycin because of the metamobilc pathway it uses in the liver. One should check with their physicain if taking other medications and St. John's Wart.

[killbilly]

Originally Posted by My Flight Surgeon

If the condition is stable, resolved, or has no associated disturbance of thought, no recurrent episodes, and; a). psychotropic medication(s) were used for less than 6 months and discontinued for at least 3 months or b). there was no use of psychotropic medication(s), the AME may issue the medical certificate. Any other condition regarding the use of psychotropic medications require FAA approval.

Can you clarify this, please? The way this reads to me, if the applicant used the meds less than six months and has not been on them for at least three months, then you can go ahead and issue the certificate WITHOUT the supporting documentation from the recommending physician?

Just want to be really clear on this.

[My Flight Surgeon]

That is the way I read it too.

[kellwolf]

Is there any push in the medical community to have this policy changed? For example, my wife would love to get her license, but she takes Zoloft (and gets really moody/manic/depressed when she's not on it), so she can't get a medical. She could possibly get a sport pilot license, but that doesn't really interest her. It seems to me there would be a push now that there is medical history to back the theory that these patients perform better when they are taking the medications than without them. I'd rather have a stable pilot in the cockpit on meds than a manic/depressive that is afraid of losing their medical.

[My Flight Surgeon]

There is no formal push by organized medicine that I have heard of yet.

The best way to change policy is to do so politically.

[Murdoughnut]

Originally Posted by My Flight Surgeon

Thank you fro your comments. We don't all agree with every policy the FAA has but we chose to live by them when we elected to become pilots. Change can be made by either petitioning the FAA or through your eleceted representatives in the Congress.

This was one of a series of posts designed to educate and inform pilots about the medical standards of the FAA. Hopefully these will be educational and informative to many. If ther are specific topics you would like to see in the future, PM me.

Hopefully I didn't come off as being short - it's just that I've heard from a couple of AMEs that the FAA medical folks in OKC tend to a bit fascist when it comes to their policies.

[My Flight Surgeon]

Well, let's just say they are black and white. There is little gray except for some of the problems they consider for Special Issuance. Even these have very rigid protocols.

That said, when I started as am AME doing FAA exams 30+ years ago one could not take any medication and fly. They have become somewhat more reasonable but only after collecting LARGE amounts of data and following these folks for many years. So, things are better than they used to be and maybe someday there will be a loosening of the rules when it comes to SSRI's. The real problem with these drugs is that there is no blood test or MRI for depression and suicidal thoughts.

It is too bad that the SSRI's also work for other problems like smoking. It clouds the issue of which patients are depressed vs. smoking and depressed.

The issue with depression, from the FAA's standpoint, is that people with depression have a very difficult time concentrating thus leading to mistakes in a bust cockpit environment.

[TheShortOne]

but depressed people on SSRI's are (usually) much more even keel and a lot LESS depressed! Wouldn't it make more sense for them to allow someone on those medications rather than deny them and give the cockpit over to someone who is depressed and needs them? I'd feel safer with a depressed pilot on meds rather than a depressed pilot who won't get treated for fear of getting their medical revoked...

[My Flight Surgeon]

Good argument. Now you just need to convince the FAA.

[Van_Hoolio]

Originally Posted by Murdoughnut

Sounds like a healthy policy - instead of seeking the treatment they need, pilot's are forced to go without medication for risk of losing their job. Smells like the FAA to me.

The FAA would rather have pilots self-medicate with alcohol.


Mike

[SkiHigh2002]

Ok I'm going to say something that is somewhat crazy here...

Is depression something that afflicts primarily old white guys? No.

Need Viagra? The FAA says that's just fine as long as you wait six hours before you fly. [Insert joke here]

Having dealt with depression and anxiety on my own and having had to make the very difficult decision to not take medication because of my medical certificate I can say that this is a policy that needs to be looked at very closely by the FAA. It is my position that SSRI's and other anti-depressants are such a new set of medications that the FAA has yet to properly deal with them. Most of the people who admit problems with depression and anxiety are not the traditional set of airline pilots (older white guys...) and therefore the FAA has no real presssing concern in addressing the medication.

The thing I wonder about is how many pilots up there right now are on SSRI's or anti-depressants without reporting it to the FAA. It would be a very interesting and very anonymous study...

Please no replies that are like "I'm a pilot and I'm not old!"

[My Flight Surgeon]

There are pilots who take SSRI's (in spite of the prohibition). From 1990 to 2001 there were 4128 pilot deaths in civil aviation accidents. 61 (1.48%) of these had been taking an SSRI as determined by postmortem toxicology studies. Interesting data.

[aloft]

Originally Posted by My Flight Surgeon

61 (1.48%) of these had been taking an SSRI as determined by postmortem toxicology studies. Interesting data.

Unlikely to be a statistically significant percentage.

[SteveC]

Originally Posted by aloft

Unlikely to be a statistically significant percentage.

Maybe not statistically significant enough to draw hard and fast conclusions, but certainly a large enough percentage to raise some eyebrows and open the door to further questions.

[SkiHigh2002]

Originally Posted by My Flight Surgeon

There are pilots who take SSRI's (in spite of the prohibition). From 1990 to 2001 there were 4128 pilot deaths in civil aviation accidents. 61 (1.48%) of these had been taking an SSRI as determined by postmortem toxicology studies. Interesting data.

I would be interested to see if any of these deaths were attributed to the SSRI. For example, an engine failure and subsequent fatality crash has little correlation to taking an SSRI. I guess I am just not sure of the negative side-effects associated with flying while taking these medications.

[skydriverdc6]

Why do you think so many pilots hit the bottle, lol I bet if you looked at the data (which is probably hidden in a dark room behind bars) it would be interesting to see how many pilots were grounded for drinking on the job

[My Flight Surgeon]

Just FYI, the information distributed by the HIMS program indicates the incidence of alcoholism in pilots is the same as the general population.

If you don't know about HIMS, here is the link to their website http://www.himsprogram.com/index.php

[Doug Taylor]

That's a really good link. I should add that to the main website links when I update the site again.