My SSRI Special Issuance

C

Cogscreamer

Guest
I wanted to share my story of a difficult SI in the hopes that it will give others some insight and perhaps courage to not take 'no' for an answer.

I had been diagnosed with mild depression during my senior year of high school 25 years ago. The psychiatrist I had been sent to put me on Zoloft (Sertraline), which I guess helped. I stayed on it via my family doctor for the years afterwards, not really giving it much thought, and never realized the difficulty it would cause in working towards a PPL someday.

When I decided to pursue flying a few years ago, I first earned my sport pilot license instead of going for private, knowing that the SSRI could be an issue. However, a used Cessna 150 is a lot cheaper than pretty much any LSA that doesn't look like an overgrown ultralight.

So, it was time to reach out to the legendary Dr. Bruce. I had done my research and knew what I was in for: Dr. Bruce does not suffer fools gladly. His workload is immense - there are hundreds (thousands?) of airmen he is currently working with, so you have better have your stuff squared away so as not to burden his time. He will deliver results, but only if you do your part and follow his instructions.

With that in mind, I filled out the contact form on aeromedicaldoc.com with a brief summary of my quandary and soon got a response, indicating that he'd be willing to take me on and pursue my case further. He requested a pittance of a check paid to him to start a file (this kills me - I think I have paid less to Dr. Bruce in all of this than to any of the other medical professionals during this process).

He noted immediately that there were two paths available - on-medication or off-medication, and certainly off-medication was the far easier path. I was already on the very lowest dosage available, so in Dec. 2015 and Feb. 2016 I visited my general practitioner to have it noted in my records that I was discontinuing the SSRI and was then off of it for over 60 days. 2 months later, I visited a HIMS psychiatrist for evaluation. I then visited Dr. Bruce in May of 2016 for an exam and submission for the third class medical.

Dr. Bruce had warned that the only possible kicker that the FAA could come back with might be a diagnosis of 'dysthymia', which I had never even heard of at that point. However, in October of 2016 I received a letter via certified mail informing me that "...you do not meet the medical standard as prescribed in Title 14 of the Code of Federal Regulations (CFR), Section 67. Blah blah blah..."

I was devastated, as the denial meant I couldn't fly as a sport pilot, much less advance to private. I contacted Dr. Bruce right away, and he requested my "FAA Blue Ribbon Medical Record" to determine the cause of the denial. Because I had in the past tried discontinuing the medication on my own on a few occasions, but then would start taking it again a few months later when feeling slightly anxious, the FAA determined that this constituted dysthymia, and would not allow me to certify off-medication. This is hopefully the single biggest contribution I can make to those considering the SSRI certification path - do not do on-again, off-again with the medication, as the FAA will then determine that you need the SSRI, and not the much more likely (IMHO) conclusion that after 20 years on the stuff, you forget that having a little anxiety from time to time is just part of existing as a human being. Very hard lesson learned.

Dr. Bruce told me that my options were to (a) go back on Sertraline and endure the much more onerous 'on-medication' SSRI path, or (b) discontinue seeking a third class medical. Dr. Bruce was not going to coach me into one direction or the other, which impressed me - the decision on which path I wanted to pursue was truly my own. But I had "tasted flight" as the quote goes, and was willing to meet any requirement needed of me to continue flying. I told him that I would like to pursue the third class medical "on-medication" - I had absolutely nothing to lose, since it had already been taken away from me.

Step 1 was to get back onto the SSRI. However, this needed to be done under the guidance of a "board certified psychiatrist" (BCP). So I visited my general practitioner once more for a referral. This was an aggravating process, as everyone wants to shuttle you to a "therapist", and getting a proper BCP is a daunting task when you're not actually depressive. I finally got an appointment on Nov. 2016 with just such a BCP, with whom I outlined the entire situation, and my need to go back onto the SSRI. "25mg? That's usually for kids." "Maybe you shouldn't be flying at all." Gee, thanks for the support, doc! Fortunately, I didn't require much of them - just to be a "board certified psychiatrist" who could issue prescriptions and offer a "reasonable level of care".

Step 2 was to continue taking the pills for 6 months. Easy enough - after all, this dosage was "usually for kids".

Step 3 was meeting with the HIMS psychiatrist again. Fortunately, this person was supportive, understanding, and very pleasant to work with. Dr. Bruce informed me later that this individual was former military, like himself. I'm not sure if that's what made the difference, but when it comes to aeromedical issues, I would happily chose a retired military practitioner - they really have their stuff together.

Step 4 was the biggie, just 3 weeks later - the full neurological evaluation/screening, including the dreaded Cogscreen-AE. I was in fear of this day, and had been doing a few months of Lumosity beforehand just to try to prepare myself. The morning started out with all sorts of exams and tests - puzzles, memory challenges, response inhibition testing... I couldn't help but think of "The Right Stuff" the entire time. Finally the Cogscreen-AE machine was ready, which I detailed here: https://www.pilotsofamerica.com/community/threads/cogscreen.108790/#post-2495798

After that harrowing ordeal, we broke for lunch. Upon return, the staff were all smiles, and said that my Cogscreen-AE results were excellent, that I didn't have to endure any more testing, and the results of the morning tests weren't even needed. Oh, and since I had written out a check to cover the full gamut of testing, the total cost is much less, so here's your old check back and just write us a new one for about 60% of that. What a relief!

Step 5 (Jul. 2017) was optional, but Dr. Bruce suggested that I make one last visit with the HIMS psychiatrist in order to bolster my application. Hey, I was willing to put any cherry on top that I could. And as mentioned, the HIMS psychiatrist was someone I liked and respected, and I knew that they had my best interests in mind. Done.

Step 6 was to meet with Dr. Bruce once again (Aug. 2017) for another exam, just with much more paperwork behind it this time (I also had to compose a personal statement to submit, and I managed to get a note from my employer stating that I was a good, stable employee). There was a sizable stack of papers sent to the FAA afterwards. After that, the hardest part began - waiting. Call OKC after a certain day to see if they have the file in the system and 'express interest', then call again on non-consecutive business days until you get the magic words "we'll flag your file".

Step 7 was to continue meeting with the BCP every 3 months in the meantime (FAA only requires 6 month intervals, but this particular BCP works on a 3-month cycle), while calling OKC semi-regularly for status. By November 2017 I was informed that my case had been forwarded to the Federal Air Surgeon's office in Washington. By February of 2018 it was still in Washington, and I was given a contact there. Many messages and inquiries were left in the months afterwards, but finally in May 2018, the airman inquiry site for my name had changed status, and a week or so later I received a call from the Washington contact informing me that "there was something in the mail that I was looking forward to". Sure enough, a few days later, there it was - my third class SI!

Of course, Dr. Bruce had already sent me a scan of my SI by the time I got the letter! The only pressing issue that needed to be addressed right away was for the BCP to write a letter stating that he would inform the FAA immediately upon any change in my condition. Beyond that, though, there was nothing more needed, and Dr. Bruce instucted me to "enjoy the air!" I hardly needed any encouragement on that.

Now that the SI was issued, there were still requirements that had to be met. I still had to meet with the BCP every 3 months, meet with Dr. Bruce every 6 months, and undergo another Cogscreen-AE every 24 months as the major requirements of keeping my SI. While I did in fact visit the BCP right after Oshkosh, and then Dr. Bruce the very next day, Dr. Bruce cautioned against such a close scheduling, as the BCP needed to issue him a clinical report first. I managed to pull it off, yet Dr. Bruce voiced his displeasure - he knows the lead times that are standard in his profession, and rightfully chastised me for running things so close to the wire. Dr. Bruce knows his field, and I do not - even though it worked out, I knew I probably should have held off for a week. LISTEN TO DR. BRUCE.

That was early August, and Dr. Bruce was able to issue an extension of my SI for 6 months. He had strongly suggested to me last year that I take advantage of BasicMed, which I will most certainly do. I'll still need to see my "board certified psychiatrist" regularly for BasicMed, but it's only a minor inconvenience. So in a few months I'll contact my general practitioner and provide them with the BasicMed checklist, to continue on that path for the rest of my aviation life (unless something better comes along).

Thanks, Dr. Bruce - one more over the fence.
 
Congrats!!!

And thanks for sharing your experience!
 
Awesome, and congrats!

I used Dr Bruce myself, although for a couple issues that didn't require nearly as much hoop-jumping as yours, and was so glad I did.

Now, as he said.... go fly! :)
 
That's great news. My application is in process. Is been over a year since started gathering med records, taking COG screen, etc. Dr Bruce is a huge help.

While I have been waiting I've been busy working on my IFR training in the hopes I'll be ready for my test shortly after getting by medical. Of course some additional cross country time and solo work will be helpful but since my brother is a CFII it helps. Hopefully by years end I'll have some good news.


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I had to edit it out of the original post to fit under the 10,000 character limit, but I wanted to give a really big 'thank you' to the fine people on this forum, and voice my appreciation for the ability to talk about some very private/personal subjects in an anonymous manner. Knowing that other people were struggling with similar situations, yet still making progress towards getting their SIs really helped. It's easy to feel alone in this process, and sometimes I'd just check in on this forum to see how other people were doing with wait times, or what wisdom the AME members were dispensing. This is about the closest thing to a support group available, and gave me a few rays of hope when I needed them.

But hey, even Bob Hoover fought tooth and nail for his SI and finally prevailed - I can't imagine better inspiration!
 
Because I had in the past tried discontinuing the medication on my own on a few occasions, but then would start taking it again a few months later when feeling slightly anxious, the FAA determined that this constituted dysthymia, and would not allow me to certify off-medication. This is hopefully the single biggest contribution I can make to those considering the SSRI certification path - do not do on-again, off-again with the medication, as the FAA will then determine that you need the SSRI, and not the much more likely (IMHO) conclusion that after 20 years on the stuff, you forget that having a little anxiety from time to time is just part of existing as a human being. Very hard lesson learned.

^^^^ THIS. After 20 years on the stuff, you might have "discontinuation syndrome" which can be confused with an underlying psychiatric diagnosis. I think the industry downplays this problem. These drugs permanently change your brain's neurotransmitters. UGH. So sorry you had to go through the long route, but so glad you are in! Enjoy!
 
^^^^ THIS. After 20 years on the stuff, you might have "discontinuation syndrome" which can be confused with an underlying psychiatric diagnosis. I think the industry downplays this problem. These drugs permanently change your brain's neurotransmitters. UGH. So sorry you had to go through the long route, but so glad you are in! Enjoy!
Or worse. I saw the effects on someone close to me.

And then there's this: https://www.washingtonpost.com/outl...ory.html?noredirect=on&utm_term=.dd843bb7efce

Medicine needs to be disrupted and reinvented.
 
In many many ways, especially the "business of medicine"
Yep. May as well disrupt the "business of war" and the "business of law enforcement" and perhaps a few other things while we are at it.
I knew airline pilots that were on Prozac a couple of decades ago, and simply lied on their medical app. As a friend said to me, would you rather have them fly while depressed?
 
Or worse. I saw the effects on someone close to me.

And then there's this: https://www.washingtonpost.com/outl...ory.html?noredirect=on&utm_term=.dd843bb7efce

Medicine needs to be disrupted and reinvented.

Scary article! I have been thinking about this very subject as we are facing long term care decisions. I had been aware that they do that (drug patients for staff convenience) and also the reverse, staff will steal the patient's pain meds or other drugs. But the efforts to fight this, stiff fines, will only drive up the cost which will drive up LTC insurance cost and make it even more unaffordable.

I think the problem is even bigger. We are keeping ourselves alive too long, without quality of life.
 
op can you clarify for the audience, so the process took about two years? You couldn’t fly for how long? And how much coin did you drop in the process and how much coin do you drop yearly??
I think those numbers would be helpful for future inquiries!!!
 
op can you clarify for the audience, so the process took about two years? You couldn’t fly for how long? And how much coin did you drop in the process and how much coin do you drop yearly??
I think those numbers would be helpful for future inquiries!!!

Happy to oblige! Yes, the process took about 2.5 years in total (and I was unable to fly for right around 17 months, given time from denial to SI issuance), but that's including the 'false start' of trying to certify off-medication. If someone was already on an approved SSRI (stably for 6+ months) and wished to certify on-medication, and was already being seen/prescribed by a "board certified psychiatrist", they could receive a special issuance in just under a year based on the timeline I experienced. Of course, that's as a "non-revenue airman", as Dr. Bruce says - were I requiring a second or first class medical as part of being a commercial pilot, I'm assuming that timeline can be compressed slightly, but only Dr. Bruce could advise further.

It was bad enough for me as an applicant what with the Germanwings 9525 crash freshly on the FAA's mind, but honestly, with the stolen Q400 crash last weekend, I wonder if fresh applicants will have an even tougher time. Given the attitudes towards mental health, it makes me feel like a bit of a pariah - when others were surprised by my having to slog through a difficult SI and exclaimed "How come? You look like a perfectly healthy guy!" I simply said that it was because of a medication I take, and I didn't elaborate further. Honestly, it seems like the DUI/possession applicants have easier runs at obtaining a medical (I could very well be wrong), and my experience has certainly colored my opinion of dealing with the FAA. I know Dr. Bruce insists on full disclosure and truthfulness (which I certainly provided, and was perfectly honest when dealing with him and all other doctors), but if someone in a similar situation to mine asked me if they should slog through the SSRI application path with an unknown outcome, or if they should simply "lie via omission", I'd have a difficult time telling them that the former is truly the best route. It felt like an incredibly burdensome barrier for someone who just wanted to follow their dreams. In fairness to the FAA, however, it wasn't until 2010 that a medical was even possible to get for someone on an SSRI, so progress is at least being made (and we have Dr. Bruce in particular to thank for that). Thus endeth my rant...

How much did this cost me? What, are you trying to provoke anxiety/depression?!? ;) I can't find all my old check copies, but this breakdown is probably pretty close:
$180 - Dr. Bruce starts my file late 2015
$151.31 - general practitioner late 2015
$600 - HIMS psychiatrist april 2016
$180 - Dr. Bruce visit may 2016
....and then I got the denial. So, just under one AMU for certifying off-medication, had that been successful. But, it wasn't, so I proceeded onward with:

$158.58 - general practitioner late 2016
$130 - Board certified psychiatrist late 2016
$90 - Board certified psychiatrist late 2016
$90 - Board certified psychiatrist early 2017
$90 - Board certified psychiatrist may 2017
$280 - HIMS psychiatrist june 2017
$750 - Cogscreen-AE test (as noted in the first post, I did well enough on Cogscreen that the additional gauntlet of cognitive testing wasn't needed - the day would have cost me $1375 if my Cogscreen scores weren't sufficient on their own, and I thusly required the additional test results to prove acceptable cognitive function)
$144 - HIMS psychiatrist july 2017 (this was the optional 'cherry on top' visit)
$90 - Board certified psychiatrist aug 2017
$300 - Dr. Bruce visit aug 2017 (Dr. Bruce was running a special deal that week - "buck a pound" for paperwork submitted to the FAA. I'm kidding of course - it would have been closer to $500 if he had such an offer ;))
$90 - Board certified psychiatrist nov 2017
$90 - Board certified psychiatrist jan 2018
$90 - Board certified psychiatrist apr 2018
...and then I got the SI. So... [types numbers into calculator, shields eyes from result...] Around 2.4 AMU. Which honestly is not bad - Dr. Bruce had cautioned me that this would not be cheap, and said to expect around 4 AMU for the process, and that's the number I would give to anyone asking how much they should expect to spend. I managed to do it cheaper, but the costs can vary quite a bit based on where in the US you are, as well as other factors (I noted that the FAA only requires a 6 month visitation cycle with the board certified psychiatrist, but mine insists on 3 months).

The big question is, was it worth it? This took years (while being grounded), thousands of dollars, lots of stress, loads of aggravation, all simply to prove to a government agency that I am "fit to fly". But when I line up my little airplane on the end of 4000 feet of arrow straight asphalt under a clear blue sky, firewall the throttle, hit Vr and pull back to see the entire earth fall away from me... Yeah, it was worth it. Every. Single. Penny.
 
Happy to oblige! Yes, the process took about 2.5 years in total (and I was unable to fly for right around 17 months, given time from denial to SI issuance), but that's including the 'false start' of trying to certify off-medication. If someone was already on an approved SSRI (stably for 6+ months) and wished to certify on-medication, and was already being seen/prescribed by a "board certified psychiatrist", they could receive a special issuance in just under a year based on the timeline I experienced. Of course, that's as a "non-revenue airman", as Dr. Bruce says - were I requiring a second or first class medical as part of being a commercial pilot, I'm assuming that timeline can be compressed slightly, but only Dr. Bruce could advise further.

It was bad enough for me as an applicant what with the Germanwings 9525 crash freshly on the FAA's mind, but honestly, with the stolen Q400 crash last weekend, I wonder if fresh applicants will have an even tougher time. Given the attitudes towards mental health, it makes me feel like a bit of a pariah - when others were surprised by my having to slog through a difficult SI and exclaimed "How come? You look like a perfectly healthy guy!" I simply said that it was because of a medication I take, and I didn't elaborate further. Honestly, it seems like the DUI/possession applicants have easier runs at obtaining a medical (I could very well be wrong), and my experience has certainly colored my opinion of dealing with the FAA. I know Dr. Bruce insists on full disclosure and truthfulness (which I certainly provided, and was perfectly honest when dealing with him and all other doctors), but if someone in a similar situation to mine asked me if they should slog through the SSRI application path with an unknown outcome, or if they should simply "lie via omission", I'd have a difficult time telling them that the former is truly the best route. It felt like an incredibly burdensome barrier for someone who just wanted to follow their dreams. In fairness to the FAA, however, it wasn't until 2010 that a medical was even possible to get for someone on an SSRI, so progress is at least being made (and we have Dr. Bruce in particular to thank for that). Thus endeth my rant...

How much did this cost me? What, are you trying to provoke anxiety/depression?!? ;) I can't find all my old check copies, but this breakdown is probably pretty close:
$180 - Dr. Bruce starts my file late 2015
$151.31 - general practitioner late 2015
$600 - HIMS psychiatrist april 2016
$180 - Dr. Bruce visit may 2016
....and then I got the denial. So, just under one AMU for certifying off-medication, had that been successful. But, it wasn't, so I proceeded onward with:

$158.58 - general practitioner late 2016
$130 - Board certified psychiatrist late 2016
$90 - Board certified psychiatrist late 2016
$90 - Board certified psychiatrist early 2017
$90 - Board certified psychiatrist may 2017
$280 - HIMS psychiatrist june 2017
$750 - Cogscreen-AE test (as noted in the first post, I did well enough on Cogscreen that the additional gauntlet of cognitive testing wasn't needed - the day would have cost me $1375 if my Cogscreen scores weren't sufficient on their own, and I thusly required the additional test results to prove acceptable cognitive function)
$144 - HIMS psychiatrist july 2017 (this was the optional 'cherry on top' visit)
$90 - Board certified psychiatrist aug 2017
$300 - Dr. Bruce visit aug 2017 (Dr. Bruce was running a special deal that week - "buck a pound" for paperwork submitted to the FAA. I'm kidding of course - it would have been closer to $500 if he had such an offer ;))
$90 - Board certified psychiatrist nov 2017
$90 - Board certified psychiatrist jan 2018
$90 - Board certified psychiatrist apr 2018
...and then I got the SI. So... [types numbers into calculator, shields eyes from result...] Around 2.4 AMU. Which honestly is not bad - Dr. Bruce had cautioned me that this would not be cheap, and said to expect around 4 AMU for the process, and that's the number I would give to anyone asking how much they should expect to spend. I managed to do it cheaper, but the costs can vary quite a bit based on where in the US you are, as well as other factors (I noted that the FAA only requires a 6 month visitation cycle with the board certified psychiatrist, but mine insists on 3 months).

The big question is, was it worth it? This took years (while being grounded), thousands of dollars, lots of stress, loads of aggravation, all simply to prove to a government agency that I am "fit to fly". But when I line up my little airplane on the end of 4000 feet of arrow straight asphalt under a clear blue sky, firewall the throttle, hit Vr and pull back to see the entire earth fall away from me... Yeah, it was worth it. Every. Single. Penny.
Love that last paragraph. That’s what ppl need to read if they are questioning if it’s worth it. Great job.
bTW. I see “AMU” all over the place and searched for the meaning. I’m relatively new here. What’s that mean? I assume some sort of financial equivalent. Like in my field we use reimbursment by RVU’s -relative value unit.
 
For comparison I am into it for a bit over $4000 and about 15 months. Getting a board certified psychiatrist was a huge problem since no one was taking new patients. Submitted my app in May and because of backlog I may not get an answer much before end of year. Frustrating because I have no issues and have been on med for almost 17 years. Far too many others just don't disclose and go on their merry way.


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Do you have to remain on the meds as Basic Med?

Why do you “have” to continue seeing the psych on basic med? Actual requirement or best practice?
 
For comparison I am into it for a bit over $4000 and about 15 months. Getting a board certified psychiatrist was a huge problem since no one was taking new patients. Submitted my app in May and because of backlog I may not get an answer much before end of year. Frustrating because I have no issues and have been on med for almost 17 years. Far too many others just don't disclose and go on their merry way.

I hear you, man - the first board certified psychiatrist's office I was referred to tried to shuttle me off to one of their therapists, and the BCP wasn't taking new patients anyhow. The second one took a bit of wrangling to get in to see, and once I was in with them, I had to do a great deal of explaining of my situation and precisely what I needed them for - they do not understand aviation, much less the very complex requirements of the SSRI Pathway II... It takes a lot of self-discipline to refrain from responding to their questions with "because the FAA says so" (though perhaps that would have saved a bit of time).

And I agree - it feels really unfair to play 100% by the rules, disclose _everything_ on your medical application, then be punished for it with months/years of waiting, thousands of dollars in expenses, perhaps even a straight-up denial... when someone who simply 'failed to disclose' would launch right to the head of the line. But you'll have a clean conscience when you're done, not have to worry about the FAA somehow finding out, and hopefully karmic retribution will smile upon you for your tribulations.

The wait is really crushing, especially since there is nothing you can do at that point - prior to that, I always had some next 'checkpoint' I could look forward to - next meeting with the BCP, next meeting with the HIMS psych... There was always a task that I had to complete, but after sending off the big mail packet to OKC, it's nothing but calling in occasionally to check for status, which won't change for many months. Around 8 months in, I started to get a little stir-crazy, and dropped Dr. Bruce a line (I hate to bug the guy, but I was wondering if my application might have been lost somewhere) to see if he had any insider information - he told me that the current backlog was immense, and he had 3 other patients who had been waiting even longer than me. So, it had to be getting close, and my very first indication that 'something was up' was when I checked https://amsrvs.registry.faa.gov/airmeninquiry/Main.aspx for my name, and it showed "Medical Class: Third" instead of something more nebulous.

So in the meantime, keep studying, get an hour of dual time in your logbook every so often, attend meetings of your local EAA chapter, find somebody who could use a hand building a kitplane... Heck, find a local glider club and try your hand at soaring - I had decided that I was going to run down every possible avenue available in trying to obtain a third class medical, and if there was no hope, I'd get a private glider license and see about building a Xenos. "You can't take the sky from me."
 
Benflyguy: I'm working on instrument rating so I fly every week. May as well get dual time in working on approaches, etc. since CFII is my brother it helps. He also does Angel Flights so it's another opportunity to learn the IFR ropes. I am missing getting up on my own though.


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Do you have to remain on the meds as Basic Med?

Why do you “have” to continue seeing the psych on basic med? Actual requirement or best practice?

Yes, I need to remain on the meds for BasicMed and need to keep seeing the board certified psychiatrist. Why? Because Dr. Bruce said so! :)

I'm sure that's an actual requirement of some sort, but I didn't press the question further with him (maybe he or one of the other senior AMEs can elaborate). I trust Dr. Bruce well enough that if he knew of an easier path, he would have suggested it, however. At any rate, I know (or at least, am pretty sure) that remaining on the meds and continuing to visit the board certified psychiatrist leaves open the possibility of returning to a third class SI in the future (yet it would require the HIMS/Cogscreen-AE dance once more). I don't forsee that happening, to be honest (unless I won the lottery and decided that an L-39 is what would bring me true happiness). But it's reassuring to know that I'm not locking myself out of anything.
 
Yes, I need to remain on the meds for BasicMed and need to keep seeing the board certified psychiatrist. Why? Because Dr. Bruce said so! :)

I'm sure that's an actual requirement of some sort, but I didn't press the question further with him (maybe he or one of the other senior AMEs can elaborate). I trust Dr. Bruce well enough that if he knew of an easier path, he would have suggested it, however. At any rate, I know (or at least, am pretty sure) that remaining on the meds and continuing to visit the board certified psychiatrist leaves open the possibility of returning to a third class SI in the future (yet it would require the HIMS/Cogscreen-AE dance once more). I don't forsee that happening, to be honest (unless I won the lottery and decided that an L-39 is what would bring me true happiness). But it's reassuring to know that I'm not locking myself out of anything.
Unless you have a more serious diagnosis than simple depression (in which case you probably wouldn't qualify for SSRI path 2), I'm pretty sure that under BasicMed, whether meds should be continued is between you and the prescribing physician, and, for purposes of whether you still qualify for BasicMed, the physician who signs you off, if that is different from the one who prescribed the meds. There is no specific requirement for an SI for simple depression, either one time or continuing, under BasicMed. If you've exhibit a "personality disorder sufficient to manifest in over acts", of course, that's a different story.

Of course, depending on your case, it might be an extremely good idea to continue on the meds and to keep seeing the board certified psychiatrist, lest you become subtly impaired to the point of being unsafe to be PIC, and thus no longer qualified to fly under BasicMed. ;)

If this is incorrect, I'd appreciate correction from Dr. Bruce. But I see nothing in the statute that contradicts this.
 
Unless you have a more serious diagnosis than simple depression (in which case you probably wouldn't qualify for SSRI path 2), I'm pretty sure that under BasicMed, whether meds should be continued is between you and the prescribing physician, and, for purposes of whether you still qualify for BasicMed, the physician who signs you off, if that is different from the one who prescribed the meds.

My guess is that since the FAA determined that on-again/off-again use of the SSRI constituted dysthymia, that this is what requires remaining on the SSRI in perpetuity (as far as being aeromedically 'fit' goes). At any rate, I'm not hurting myself by staying on the SSRI and continuing to visit the board certified psychiatrist when I go BasicMed (other than spending money that I'd rather put towards a tank of 100LL). I may consult with Dr. Bruce once I go BasicMed to better understand the 'why'.
 
My guess is that since the FAA determined that on-again/off-again use of the SSRI constituted dysthymia, that this is what requires remaining on the SSRI in perpetuity (as far as being aeromedically 'fit' goes). At any rate, I'm not hurting myself by staying on the SSRI and continuing to visit the board certified psychiatrist when I go BasicMed (other than spending money that I'd rather put towards a tank of 100LL). I may consult with Dr. Bruce once I go BasicMed to better understand the 'why'.
Yes, I totally agree that if you and your physicians agree that you should stay on the SSRI then that is what you should do. That sounds like Dr. Bruce is saying that they are necessary for you, as you say, to remain "aeromedically fit" to fly. BasicMed does require you to self-ground if you know of a condition that would render you unable to safely pilot an aircraft. But at least with the BasicMed option, you can avoid the massive paperwork and repetitive testing needed to maintain an SI... unless of course you decide to return to the 3rd class world.

Actually, I think I misread your post to say that you would need to maintain the SI as well as stay on the SSRI even if you went BasicMed, which is why I brought up the SI. Apologies for that. But for anyone else: unless you are starting out, or for some other reason need the initial 3rd class, I'm pretty sure that there is no need to go the SSRI path 2 route in order to keep flying with medicated simple depression if BasicMed would fit your needs. You can go BasicMed, provided you can find a physician to do the exam and sign you off with the meds you are on and provided you are not taking one of the prohibited meds, and just let your 3rd class expire.

Again, if that's wrong, I'd appreciate a correction from someone in the know, like Dr. Bruce.
 
Unless you have a more serious diagnosis than simple depression (in which case you probably wouldn't qualify for SSRI path 2), I'm pretty sure that under BasicMed, whether meds should be continued is between you and the prescribing physician, and, for purposes of whether you still qualify for BasicMed, the physician who signs you off, if that is different from the one who prescribed the meds. There is no specific requirement for an SI for simple depression, either one time or continuing, under BasicMed. If you've exhibit a "personality disorder sufficient to manifest in over acts", of course, that's a different story.

Of course, depending on your case, it might be an extremely good idea to continue on the meds and to keep seeing the board certified psychiatrist, lest you become subtly impaired to the point of being unsafe to be PIC, and thus no longer qualified to fly under BasicMed. ;)

If this is incorrect, I'd appreciate correction from Dr. Bruce. But I see nothing in the statute that contradicts this.

My layman’s understanding is that the Basic Med checklist points the physician to a reference site that includes the FAAs list of “prohibited from flight” drugs.

SSRIs are on that list, so even if you have a 3rd class and then later take an SSRI, the med bounces you out of Basic Med even if the diagnosis doesn’t.

Any AMEs or Drs that can confirm that understanding?
 
Thanks for taking the time to share your experience.

I'm currently working with Dr.Bruce on a somewhat similar case. I'm hoping to follow decision path 1, but it may be recommended that I go 2. My plan was to quit training and find a new career path if it was recommended I take path 2. Seeing your story makes me a little less pessimistic about path 2. Though I would be seeking a 1st class medical and I still don't know how that would influence a potential employer some day.
 
Honest question. Is the concern the depressed state of the pilot could result in him harming himself and others?

Or the side effects of the meds impair your ability to operate an aircraft?
 
Honest question. Is the concern the depressed state of the pilot could result in him harming himself and others?

Or the side effects of the meds impair your ability to operate an aircraft?
My guess....

A depression episode is definitely a concern (review the GermanWings incident)

And medications could possess a sedative effect.
 
My understanding is if you use one of the meds (regardless of diagnosis) you've got to follow the rigorous path unless it was short term and then you can demonstrate you are off and have been off it. As much as I find this regulations overly restrictive for GA pilots we can all imagine the news coverage when a GA accident occurs and the reports include evidence pilot was on an anti-depressant. OMG - the hew and cry of outrage and how could this person have a license? Blah blah blah. So in the end the FAA puts up a very rigorous approval path so they can say with a straight face - and good conscience - that they did all they could to eliminate dangerous people from flying. Again, I believe there should be some tweaks to the process for the average GA pilot.


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My layman’s understanding is that the Basic Med checklist points the physician to a reference site that includes the FAAs list of “prohibited from flight” drugs.

SSRIs are on that list, so even if you have a 3rd class and then later take an SSRI, the med bounces you out of Basic Med even if the diagnosis doesn’t.

Any AMEs or Drs that can confirm that understanding?

This question? I'm not an AME so don't know the answer to this one. Bruce or Dr. Lou?
 
This question? I'm not an AME so don't know the answer to this one. Bruce or Dr. Lou?
My layman’s understanding is that the Basic Med checklist points the physician to a reference site that includes the FAAs list of “prohibited from flight” drugs.

SSRIs are on that list, so even if you have a 3rd class and then later take an SSRI, the med bounces you out of Basic Med even if the diagnosis doesn’t.

Any AMEs or Drs that can confirm that understanding?

i agree!
 
Azure, The original legislation calls out illness (which can impair reality testing, the definition if psychosis) needs “under the care of a state licensed specialist”....that would be a psychiatrist.
 
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Azure, The original legislation calls outentsl illness (which can impair reality testing, the definition if psychosis) needs “under the care of a state licensed specialist”....that would be a psychiatrist.
Bruce, I have no idea what that one word was supposed to be and it seems to be critical to what you're saying. :confused:

Are you saying that simple depression is classified by the FAA as psychosis because it CAN impair reality testing?

It sounds from what Dr. Lou said that the meds are considered no-fly without path 2 and the SI, so it sounds like path 2 is closed off and I stand corrected on that. So what about path 1, hypothetically speaking? Can someone with a dx of simple depression NOT treated by medication go BasicMed without an initial SI?
 
I believe Dr Bruce was going for “the original legislation calls out mental illness...” but that’s only a guess
 
Ok. @bbchien @lbfjrmd

Let's say you had your last 3rd class in 2008.

In 2017 you went on an SSRI for depression and anxiety for 1 year and then are off for 60 days and don't intend to go back on.

Can you go basic Med as long as you are off the meds?
 
Ok. @bbchien @lbfjrmd

Let's say you had your last 3rd class in 2008.

In 2017 you went on an SSRI for depression and anxiety for 1 year and then are off for 60 days and don't intend to go back on.

Can you go basic Med as long as you are off the meds?
Yes, Terry. As you basically continued to function and work during the whole period, there's no question as to "psychosis" in the original legislation. Your PCP can sign you off.
:)
Azure said:
Bruce, I have no idea what that one word was supposed to be and it seems to be critical to what you're saying. :confused:
...the above is to your question.
 
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