SSRI continue or stop?

[david77]

Wondering if anyone could provide me with some advice.

I am currently on SSRI (escitalopram). Been on same dose for >7 years. Prior to that, a depression episode about 7 years previous at uni which had me on sertraline for about 12 months. I have been intending to come off the SSRI as the conditions to which I reacted don't exist any more.

A couple of months ago I put in my application for 1st class. AME seemed pretty uncertain as to how to go about it all, however my intention (which she noted in the application) was to come off the meds and reapply for regular issuance (decision path I).

Some time later I get the demand letter from the FAA requiring the HIMS assessment, Psychiatrist report, COGscreen AE, etc. Basically it seems that even though their "process" seems to indicate that a SI is not required if you are off the meds for 60 days - they still require it!

Should I bother with trying to follow decision path I? The AME might be able to issue after the 60 days off meds - but would the FAA turn around and request the HIMS assessments anyway?

Note I am not asking for advice as to whether I should or should not continue SSRI use from a health perspective - asking only insofar as certification processes are concerned. I will be working with my own doc either way.

Any advice appreciated.

 

[murphey]

Forget the popcorn...I need something stronger...double chocolate shake, since I'll be flying in the morning (weather permitting).

I'm having a deja vu moment. Or is that Deja Thoris?

And don't depend on your local doctor unless he/she is an expert at SSRI/HIMS/all that stuff dealing with the FAA. As per your comment "AME seemed pretty uncertain as to how to go about it all" indicates you need specialized AME medical expertise.

Check out this thread:

https://www.pilotsofamerica.com/community/threads/first-medical.117228/#post-2688772

 

[bbchien]

David, the trouble is lack of insight and that does not bode well. You have recurrent disease, and you have had a recurrence. That means you have the underlying diasthesis to recur. You feel fine but don’t realize that your psychiatry track record sez you have the underlying relapsing substrate. It is not adequate to have recurrent disease, untreated and unmonitored, which is denied by the agency. It is a certification mistake in your situation to throw the pills away and declare “I am HEALED!!”. You feel fine but the underlying chronic portion remains. You have already demonstrated that just by the history that you recount.

There isn’t a board certified Psychiatrist on the planet, let alone a HIMS psychiatrist, who can ignore the history.

So your only option IS the SSRI protocol. NB if you have ever had suicidality in your record, any psych hospitalization, etc, or any period of dual antidepressives drug therapy, that these are “severity indicators” and FAA will not consider you for the SSRI pathway.

There is the possibility that you may have NO pathway to certification.....(original petitioner for the SSRI pathway).....

 

[PeterNSteinmetz]

As indicated by Dr. Chien, there will be some subtle questions here from the FAAs perspective. Best to get in touch with one of the senior HIMS AMEs (2 on the forum) to assess in detail the chances of success and proper procedure.

 

[david77]

David, the trouble is lack of insight and that does not bode well. You have recurrent disease, and you have had a recurrence. That means you have the underlying diasthesis to recur. You feel fine but don’t realize that your psychiatry track record sez you have the underlying relapsing substrate. It is not adequate to have recurrent disease, untreated and unmonitored, which is denied by the agency. It is a certification mistake in your situation to throw the pills away and declare “I am HEALED!!”. You feel fine but the underlying chronic portion remains. You have already demonstrated that just by the history that you recount.

There isn’t a board certified Psychiatrist on the planet, let alone a HIMS psychiatrist, who can ignore the history.

So your only option IS the SSRI protocol. NB if you have ever had suicidality in your record, any psych hospitalization, etc, or any period of dual antidepressives drug therapy, that these are “severity indicators” and FAA will not consider you for the SSRI pathway.

There is the possibility that you may have NO pathway to certification.....(original petitioner for the SSRI pathway).....

Thankyou for the response Dr Chien.

I understand the recurrence changes the ballgame completely which is why I mention it. I was considering coming off the meds in conjunction with monitoring from my local GP however as you say it has risks and am happy not to. Was just confused as to what the FAA regarded as acceptable. I am happy enough to consult with a HIMS AME if that is the way forward.

No history of the severe indicators that you mentioned.

 

[bbchien]

"light reading" for you.....NB they expect the caretaking physician to be a board certified psychiatrist.