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SPECIAL ISSUANCE for ANTIDEPRESSANTS

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

  1. L B Fowler Jr MD

    L B Fowler Jr MD senior ame/hims CVW-11 Flt Surgeon CVA-66 (1980)

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    Tough decision . . . attend to your health 1st! At least now pilots can be treated for depression and return to flying. If it is necessary to go the HIMS/SI route, the SI will likely be with you as long you take the approved antidepressants.
     
  2. My Flight Surgeon

    My Flight Surgeon Sr. Aviation Medical Examiner Staff Member

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    If you are on antidepressants, you must be stable on the dose for at least a year before a Special issuance is granted. If you have a Special Issuance for depression and stop the antidepressants, I suspect the FA will ask for routine status reports for several years, i.e., the Special Issuance will probably remain in effect for another 5 years or so. If you are on short-term, less than 6 months, antidepressants, you must be off for 3 months before you can get a medical.
     
  3. My Flight Surgeon

    My Flight Surgeon Sr. Aviation Medical Examiner Staff Member

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    You self-groun under 61.53.
     
  4. L B Fowler Jr MD

    L B Fowler Jr MD senior ame/hims CVW-11 Flt Surgeon CVA-66 (1980)

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    the 4 depression meds approved by the FAA: Prozac, Zoloft, Celexa and Lexapro. If you have a HIMS/AME in your area or a company HIMS committee, they could be helpful in guiding you. The extra costs do not start to add up unless you will need the meds usuallly > 6 months when returning on the meds does require a SI and is by design a longer process.
     
  5. S1lverbullet

    S1lverbullet New Member

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    Hey doc, thanks for all of your time and the answers you have given so far. I have a couple questions...

    1) What percentage in the last year (roughly) of applications have been issued a medical certificate?

    2) What are the criteria that will get an application turned down?

    I have had depression my whole life. It runs in my family, and for a couple years during college it was worse than it normally is. Because of the loss of being able to play a college sport, I was put on a stronger medication (Lamictal) to cope. I do not need it anymore and will be switching back to a more mild antidepressant. I am currently gathering all of my medical records as far back as they go to see exactly what my diagnosis is and what the doctors wrote about my condition. Is there any way to tell by looking at the records if I have a good shot at getting a medical granted to me or not?

    I have been on all kinds of medications in the past. Some have worked and some have not. Do they take into account how many different medications I have tried as well as the strength of those medications and if they worked or not?

    I would really like to have some kind of idea what my chances are of getting a medical waiver before I start this process. I am going to a board certified psychiatrist this next week to get started on one of the four approved medications.

    Thank you in advance for your time and answer!
     
  6. My Flight Surgeon

    My Flight Surgeon Sr. Aviation Medical Examiner Staff Member

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    They have granted slightly less than half of the applications.
    We do not have enough experience yet to know what is the trigger for a denial.
    There is no way to tell. These records are reviewed by the Chief Psychiatrist at the Federal Air Surgeon's office in Washington.
    Good luck.
     
  7. S1lverbullet

    S1lverbullet New Member

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    If I elect to stop taking antidepressants and pursue some form of alternative to medication I am then required to be off of the medication for three months and stable with a doctors report correct? I have had people tell me that if I got off of the meds it is like I was never on them in the first place. Do I have a better chance of getting a medical if I go this route? I have been using medication for the past ten years but there have been situations that have made my depression worse and now those events have been gone for years. I feel like I should try to get off of them considering I really want to fly. Do you recommend this approach?
     
  8. My Flight Surgeon

    My Flight Surgeon Sr. Aviation Medical Examiner Staff Member

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    You are correct as far as being able to apply without having to wait a year. You still must report having seen the doctor for depression (Question 18m = see the thread on Form 8500-8 above) and explain what happened.

    You need ot do what is best for your health and not what you need to do to try to fly.
     
  9. S1lverbullet

    S1lverbullet New Member

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    Yes I will definitely keep my good health as a first priority. I am going to go off of my medication for a couple of months and see what happens and then make a decision.

    I will answer yes to seeing a doctor for depression. Does this mean that I need a written report from my doctor documenting my depression and how I discontinued the meds or is it more informal. I mean do they just ask me about it and I explain it verbally and that is that?

    If I elect to discontinue the medication and apply, will the AME treat genetic depression differently than situational depression?
     
  10. My Flight Surgeon

    My Flight Surgeon Sr. Aviation Medical Examiner Staff Member

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    Yes, you will need copies of your medical records.
     
  11. S1lverbullet

    S1lverbullet New Member

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    Thanks for your answers doctor.
     
  12. S1lverbullet

    S1lverbullet New Member

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    Am i allowed to go to a counselor instead of being on medication and fly at the same time or is that a no no also? I have responded very well to counseling without medication in the past and i feel lime a positive report from both a psychiatrist and a counselor would really help my chances. Thanks in advance doc.
     
  13. My Flight Surgeon

    My Flight Surgeon Sr. Aviation Medical Examiner Staff Member

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  14. S1lverbullet

    S1lverbullet New Member

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    I just received my past medical records from my new psychiatrist office. Turns out I was diagnosed with Bipolar II a couple years back. My wife who is a nurse practicioner and my current psychiatrist both do not think that I am bipolar because since certain negative situations have subsided in my life my mood has been stable. Is there any way I can challenge or change this diagnosis? Any way around it at all?
     
  15. powell99

    powell99 New Member

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    I was diagnosed nine years ago with depression and was put on Prozac. In 2005 I was turned down for a Student pilot medical. In 2006 I sucessfully got off anti depressants and now I'm interested in going for my Student pilot medical. I've asked around and I'm not exactly sure how to pursue next. Do I need a Special Issuance? (I've been told both yes and no). I haven't recieved any psychiatric care since 2007 and I've been symptom free of Depression in that time.

    I was under the impression (back in '05) that I just needed to be off of my medication for 90 days and get a note from my doctor, but the regulations concerning anti depressants has changed. Is this still the case? Thanks in advance!
     
  16. My Flight Surgeon

    My Flight Surgeon Sr. Aviation Medical Examiner Staff Member

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    Yes, especially since you are on Prozac. Read the first post in this thread for the specifics.
     
  17. exneophyte

    exneophyte Well-Known Member

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    Hi powell99,

    I just wanted to clarify, are you still on the Prozac? If not, how long have you been off of them? I trust what the doctor said, but reading your post I couldn't be sure if you were still taking the medication. I can't say for sure, but I think it changes what would be required of you to get a medical.
     
  18. powell99

    powell99 New Member

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    Ah, sorry, I've been off of Prozac since 2006. My mistake.
     
  19. exneophyte

    exneophyte Well-Known Member

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    Doesn't this change things a little doc if he isn't still taking it?
     
  20. My Flight Surgeon

    My Flight Surgeon Sr. Aviation Medical Examiner Staff Member

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    He still needs to report the depression in Item 18m. He will need medical records to indicate that he no longer requires antidepressants and is not taking any. The AME will need to see these to issue a medical certificate.
     

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