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SPECIAL ISSUANCE for ANTIDEPRESSANTS

Discussion in 'Ask A Flight Surgeon' started by My Flight Surgeon, Apr 2, 2010.

  1. My Flight Surgeon

    My Flight Surgeon Sr. Aviation Medical Examiner Staff Member

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    Here is the information guys.

    The FAA is limiting consideration of special-issuance medical certificates to these four
    medications. Increasingly accepted and prevalently used, these four antidepressants may be used
    safely in appropriate cases with proper oversight and have fewer side effects than previous
    generations of antidepressants. While the focus of this policy statement is on individuals being
    treated for depression, the FAA realizes that these four medications may be used to treat
    conditions other than depression. It should be noted, therefore, that, in all instances, the FAA
    will continue to consider applicants and make determinations on a case-by-case basis under the
    special-issuance process just as it always has.
    In addition to treating psychiatrists, AMEs who have specialized training under a
    program called the Human Intervention and Motivation Study (HIMS) also will assist the FAA
    by making recommendations about certification cases to be considered under this new policy.
    The HIMS program is a safety-critical aviation program established nearly 40 years ago. The
    program, developed specifically for commercial pilots, was designed as an alcohol and drug
    assistance program to coordinate the identification, assessment, treatment, and medical certification
    of pilots in need of help. Under HIMS, pilots who successfully meet rigorous FAA protocols may
    be returned to duty in accordance with 14 CFR 67.401. The FAA will apply the basic HIMS
    evaluation and monitoring approach to this new policy and HIMS AMEs will participate in a
    specialized training program tailored to evaluating and monitoring applicants who wish to be
    considered under this new policy.

    CONSIDERATION FOR SPECIAL ISSUANCE OF A MEDICAL CERTIFICATE
    WITH REGARD TO DEPRESSION TREATED WITH MEDICATION
    This protocol applies to considerations for special-issuance medical certification for airmen requesting first-, second-, and
    third-class special-issuance medical certificates, for the exercise of privilege under 14 CFR Parts 121,135, or 91, who are
    being treated with certain antidepressant medications.
    Criteria to be Considered:
    Diagnoses:
    Mild to moderate depressive disorders, such as
    1. Major Depressive Disorder (mild to moderate) either single episode or
    recurrent episode
    2. Dysthymic Disorder
    3. Adjustment disorder with depressed mood
    Pharmacologic Agents Considered:
    (single-agent use only)
    1. Fluoxetine (Prozac);
    2. Sertraline (Zoloft);
    3. Citalopram (Celexa); or
    4. Escitalopram (Lexapro)
    Specifically Unacceptable diagnoses and or symptoms:
    1. Psychosis
    2. Suicidal ideation
    3. History of electro convulsive therapy (ECT)
    4. Treatment with multiple antidepressant medications concurrently
    5. History of multi-agent drug protocol use (prior use of other
    psychiatric drugs in conjunction with antidepressant medications)
    Psychiatric status:
    1. All symptoms of the psychiatric condition for which treatment is
    indicated must be ameliorated by the single medication and the condition
    must be stable with no change in or exacerbation of symptoms for 12
    months prior to certification;
    2. Airman must be on a stable dosage of medication for a minimum of
    12 months prior to certification; and
    3. Airman must have no aeromedically significant side effects of
    prescribed medication.
    Required Reports and Consultations:
    (initial consideration)
    1. A consultation status report (and follow-up reports as required) from a treating psychiatrist
    attesting to and describing the applicant’s diagnosis, length and course of treatment,
    dosage of the antidepressant medication taken, and presence of any side effects from the
    antidepressant the applicant takes or has taken in the past;
    2. A written statement prepared by the applicant describing his or her history of
    antidepressant usage and mental health status;
    3. A report of the results of neurocognitive psychological tests with provision of the raw
    test data: including, but not limited to:
    COGSCREEN AE, Trails A/B; Stroop Test;
    CCPT, PASSAT, Wisconsin Card Sorting Test;
    4. An evaluation and a written report from a HIMS-trained AME who has reviewed items
    1., 2., and 3. above and who makes a recommendation for a special-issuance medical
    certificate; and
    5. Any additional information the Federal Air Surgeon may require to make a determination.
    Issued in Washington, DC, on March 26, 2010. .
     
  2. pppatacki

    pppatacki New Member

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    Doc,

    A couple questions that you amy or may not know yet.

    1. They don't specifically list other conditions beyond depression, although as you mentioned these medications do treat other conditions such as OCD. Are they saying that they will consider other conditions?

    2. What would all those tests costs and where would someone be able to get them all done?
     
  3. Chance

    Chance Well-Known Member

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  4. flyer47362

    flyer47362 New Member

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    This is great news, however, is a diagnosis of depression still disqualifying even if no psychotropics are used? There are plenty of people with mild depression/anxiety who respond very well to counseling/talk therapy without the need for medications.

    Is that still a DQ in this case??
     
  5. 400A

    400A New Member

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    Short answers, the depression diagnosis may ground you for a bit, but the drugs, used to be the big no no.

    The biggest key, if it is true, is getting your docs to send letter after letter to OKC stating there is no reason for you not to be flying (for the non drug therapy).
     
  6. maxshuty

    maxshuty Well-Known Member

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    What I dont quite understand is that this is all great news but I had one heck of a hard time getting my medical certificate before because of a previous history of being on antidepressants even though I was "clinically cured" and on no medication, it still took me forever to get the dang Medical... will this change now for people ? Will historical stuff be less of an impact?
     
  7. My Flight Surgeon

    My Flight Surgeon Sr. Aviation Medical Examiner Staff Member

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    From what I know so far, the only diagnoses they will consider are
    1. Major Depressive Disorder (mild to moderate) either single episode or
    recurrent episode
    2. Dysthymic Disorder
    3. Adjustment disorder with depressed mood

    Only HIMS certified AME's can process these SI's. There are about 100 of them in the country.

    I would estimate the cost to be $3000 to $4000 but al of the guidelines are not yet out to those of us who are HIMS AME's so we will have to wait to come up with more solid numbers. The Neuropsychological teting will be the expensive part of this.
     
  8. My Flight Surgeon

    My Flight Surgeon Sr. Aviation Medical Examiner Staff Member

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    That decision is based on individual circumstances.
     
  9. My Flight Surgeon

    My Flight Surgeon Sr. Aviation Medical Examiner Staff Member

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    No, medical history is still critical. It is always decided on an individual basis.
     
  10. SpiraMirabilis

    SpiraMirabilis Possible Subversive

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    I remember hearing that they were looking to approve 5 medications... just out of curiousity do you know which one they dropped and why?
     
  11. My Flight Surgeon

    My Flight Surgeon Sr. Aviation Medical Examiner Staff Member

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    No I do not.
     
  12. GoRideABike

    GoRideABike New Member

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    Since it appears that only those using SSRIs for depression can take advantage of this for the time being, what are your thoughts on those taking them for other conditions, such as OCD, eventually being able to get an SI? (I know you can't predict the future, I'm just asking more to see if it seems to even be a possibility at this point)
     
  13. My Flight Surgeon

    My Flight Surgeon Sr. Aviation Medical Examiner Staff Member

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    Maybe in 5 years after they get a track record on this. Who knows.
     
  14. panam

    panam New Member

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    Great news. Hey doc, how about cases that are a mix of depression and anxiety. They always seem to come hand in hand. From what I understand it is depression only, how about anxiety? These 4 meds also work on pacients with anxiety .

    I read that the FAA will not consider patients that had multi agent drug protocol use. Does that mean if a patient was EVER on 2 anti depressants at the same time they wont be considered? lets say a patient that took zoloft and had to use clonazepam until Zoloft kicked in. the faa considers that multi drug use?

    Thank you so much for your time!
     
  15. My Flight Surgeon

    My Flight Surgeon Sr. Aviation Medical Examiner Staff Member

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    That is what I understand but I am waiting for the formal guidance from the FAA. I am sure this will be discussed at the Aerospace Medical Association meeting in May so I will know a lot more after that.
     
  16. My Flight Surgeon

    My Flight Surgeon Sr. Aviation Medical Examiner Staff Member

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  17. fftoto

    fftoto Well-Known Member

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    Hey Doc, thanks for all the info. Do you know what the 6 month amenesty clause is about? It sounds like we can fly while on the meds but you need to report the issue on your next medical with in 6 months. Also the above link did not seem to work, it stated PDF not available.
     
  18. My Flight Surgeon

    My Flight Surgeon Sr. Aviation Medical Examiner Staff Member

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    The 6 month amnesty clause is as follows:

    SUMMARY: This notice announces a limited program to forgo enforcement action for persons who disclose before September 30, 2010, previous falsification on applications for airman medical certification regarding the use of antidepressant medication, the underlying condition for which the
    antidepressant was prescribed, and visits to health professionals in connection with the antidepressant use or underlying condition.

    If you are taking antidepressants, you must self-ground IAW 14 CFR 61.53. The amnesty just states they will not seek prosecution for falsification of your prior 8500-8 applications for medical certificate.

    If you fall into this, are clinically stable for more than 12 months, you will probably get a Special Issuance in about 6 weeks after completing the required evaluations.
     
  19. mogstaar

    mogstaar New Member

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    I would like to know more about why ANY past use of multiple anditdepressants is automatically disqualifying, rather than considered on an individual basis. In my case, I was temporarily prescribed a second med, trazodone, to be taken at night to help with insomnia. But that was years ago and I haven't had sleep problems since. I don't understand the rationale. :confused:
     
  20. My Flight Surgeon

    My Flight Surgeon Sr. Aviation Medical Examiner Staff Member

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    Ask the Federal Air Surgeon.
     

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