Depression with anxiety and childhood ADD

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jrm

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jrm
I have a dream of becoming a pilot and basically want to know what the best path forward is for getting medical clearance and how much I need to set aside money and time wise to complete the process. About three months ago I started lexapro 10 mg once a day and I had short term use of a benzo as needed(used less that 45 days 10 Valium tablets and 30 klonipin tablets). I also took a couple days off of work at this time. The medical record from the NP I saw and continue to see says the diagnosis is depression with anxiety. This was stress related and coinciding with the start of a new job. My understanding is I need to be stable on only the lexapro for at least 6 months but what else do I need to be aware of? I am also doing counseling what kinds of records do I need to gather when the time comes? I had a similar incident a year prior. No sucidal thoughts documented or experienced and no Phychiatrists.

Also, from second to fourth grade I was on Ritalin for ADD. I completed law school without any treatment for ADD so I think I have a strong history showing it is not an issue. It has never been brought up by a doctor since stopping the medicine. I am currently 31 for what that is worth.

Thanks for any help that can be provided.
 
I encourage you to use the search function in this forum for past topics related to both ADD diagnosis and the depression issues. Both have been discussed many many times.

Short version is that to gather up the required documentation that the FAA wants, this will be a significant money spend (thousands of dollars) and once all gathered, there is no guarantee it will be accepted and you will be granted the medical certificate.

Additionally, the doctors and psychiatrists examining you must be known to the FAA, and this group is very small. Hiring a very senior Aviation Medical Examiner (AME) who very thoroughly understands the FAA's needs and wants as a guide through the process is highly recommended. Again, not cheap, but will reduce risk of spending money on documentation that the FAA immediately rejects.

My very unqualified opinion is that your road with these two conditions will be long and very expensive. Your statement of "strong history showing it is not an issue" unfortunately doesn't work with the FAA. They look at an ADD/ADHD diagnosis as a lifetime condition that is disqualifying. Again, review the past topics for a better explanation as to why.


We have amongst our members two really senior AME's (Dr's Bruce and Lou) who frequently comment on medical certification questions raised on this board. Hopefully one or both will be by here soon to provide initial guidance.
 
Ok. Searching I see I will need to complete psych testing. I see a range of $2,500 to $5,000. Can that be narrowed any and how do I locate a provider? Will the AME recommend one? I see something about needing to score in the 85th percentile of airmen what's that all about? If it's only IQ does anyone know where you can find how airmen compare to the general population? I'm probably a 95th percentile kind of guy compared to the general population based on unofficial IQ test and the ASVAB. Do I need to seek out Dr. Chien or is this something an experienced AME could handle? From reading it seems my situation is less involved than others who have posted on each issue alone but what about the two combined.

I also see and understand that I should seek a consultation first and not apply for a medical.

What about advice on the order of things. Should I get the medical 100% sorted out before starting lessons or would it be advisable and ok to do both at the same time?

LSA is possible I suppose but I'm not a small man and would like to do some traveling with my wife and son.
 
You were given all these drugs by an NP? Or your family doctor as a child? So you've never been evaluated by a qualified psychiatrist? Do you really think you need an antidepressant or did you just go along with the NP's suggestion to get you through the rough patch? As a child, were you actually evaluated for ADHD or were you just too intelligent to endure the public school experience without being antsy? Have you ever had an IQ test?

You don't need to answer these questions on the board, but think them through from a new perspective. If in soul searching, you feel you truly have a chronic depression or ADHD, might want to save your money and go for some other hobby. But if you are unsure, and think you might have fallen for today's trend to over-diagnose and over-medicate, here's the most straightforward way to get to the bottom of this: Talk to Dr. Bruce Chien. He will point you in the right direction to get an actual complete psychiatric evaluation by the right qualified professional, and then guide you from there.

Do not under any circumstances apply for a medical, until you've done that and you know for certain what the outcome will be. You do not want to get a denial; that will ruin your chance for sport pilot.
 
Our messages crossed. No, don't start lessons. It will be a waste of money until you get this sorted out. If it were me, I'd go straight to Dr. Chien. Other AMEs might be as good but Bruce specializes in difficult cases. He's probably the most knowledgeable AME in the United States when it comes to stuff like this. Somewhere there's a link to his site.... give me a minute.
 
Thank you. I will do that. The ADD I do not believe was real; likely a lack of public school challenge. I made it all the way from fifth grade through law school with out any kind of treatment for ADD or ADHD. A pediatrician prescribed that no Psychologist. The depression is likely real and the SSRI seems to be quite helpful. It was definitely a rough patch that got me to seek help but things do seem to be at a new higher baseline since the new med. But no psychologist has been involved. I want to do this right I just hate that this is likely to add 25% or more to my license budget and doesn't even involve being near a plane. Are their any serious rumors of easing up this area in the next few years or is Basicmed the end of the line for the foreseeable future. Also is this a once and done type thing? Does anyone have any insight into the 6 month check ins if you are keeping the medical current? Is it a check the box type thing or a big ordeal?
 
jrm said:
Should I get the medical 100% sorted out before starting lessons
Click to expand...

Absolutely.... When the FAA send you a denial letter, you are 99% done for ever. There are a few cases where the denial is reversed, but very few. And once denied, this also removes the chance of flying Light Sport Aircraft.

So it is better to get the medical sorted before you spend thousands on training just to find out the FAA says "Denied".
 
jrm said:
Thank you. I will do that. The ADD I do not believe was real; likely a lack of public school challenge. I made it all the way from fifth grade through law school with out any kind of treatment for ADD or ADHD. A pediatrician prescribed that no Psychologist. The depression is likely real and the SSRI seems to be quite helpful. It was definitely a rough patch that got me to seek help but things do seem to be at a new higher baseline since the new med. But no psychologist has been involved. I want to do this right I just hate that this is likely to add 25% or more to my license budget and doesn't even involve being near a plane. Are their any serious rumors of easing up this area in the next few years or is Basicmed the end of the line for the foreseeable future. Also is this a once and done type thing? Does anyone have any insight into the 6 month check ins if you are keeping the medical current? Is it a check the box type thing or a big ordeal?
Click to expand...

All of these are questions for the Senior AME's with Difficult Case specializations such as Dr. Bruce Chien, not the unwashed and unqualified masses of the internet.

If you find one of his posts in this forum, use the email link in his signature to reach out to him.
 
AggieMike88 said:
I encourage you to use the search function in this forum for past topics related to both ADD diagnosis and the depression issues. Both have been discussed many many times.

Short version is that to gather up the required documentation that the FAA wants, this will be a significant money spend (thousands of dollars) and once all gathered, there is no guarantee it will be accepted and you will be granted the medical certificate.

Additionally, the doctors and psychiatrists examining you must be known to the FAA, and this group is very small. Hiring a very senior Aviation Medical Examiner (AME) who very thoroughly understands the FAA's needs and wants as a guide through the process is highly recommended. Again, not cheap, but will reduce risk of spending money on documentation that the FAA immediately rejects.

My very unqualified opinion is that your road with these two conditions will be long and very expensive. Your statement of "strong history showing it is not an issue" unfortunately doesn't work with the FAA. They look at an ADD/ADHD diagnosis as a lifetime condition that is disqualifying. Again, review the past topics for a better explanation as to why.


We have amongst our members two really senior AME's (Dr's Bruce and Lou) who frequently comment on medical certification questions raised on this board. Hopefully one or both will be by here soon to provide initial guidance.
Click to expand...
This should be a sticky.
 
A wiki or sticky with some detail by diagnosis or condition might be helpful but searching every thread for the needle in a haystack you are looking for on a nuanced field is less than helpful. I did a decent amount of searching before posting as public disclosure is not something I was desiring. I did even more after being unable to find the post annonimously button. If it is simply too complicated of a subject for newcomers to seek guidance on here a sticky to that effect might be appropriate. None of this is meant to be confrontational or aggressive although it might come across that way it really isn't. This is a foreign topic to me and likely complex to all. I was hoping for some first hand or expert advice on the matter as I simply do not know what I don't know and I felt some with experience could point me in the right direction. It seems like the right direction is to consult Dr. Chien which I will do. And I got the guidance I was looking for even if I was hoping there might be an easier, or more direct path.
 
It a knock on the OP but why does there seem to be so many people diagnosed with ADD and depression that want to become pilots. What is is about aviation that attracts a person with these diagnosis? Is it that too many people are now being diagnosed or is it that pilots are awesome and everyone wants to be us, or is it the attraction to process and procedures?
 
mulligan said:
It a knock on the OP but why does there seem to be so many people diagnosed with ADD and depression that want to become pilots. What is is about aviation that attracts a person with these diagnosis? Is it that too many people are now being diagnosed or is it that pilots are awesome and everyone wants to be us, or is it the attraction to process and procedures?
Click to expand...

Pilots are what, 6% of the general population of the US? I know we see ADD/ADHD questions on a regular basis here. I'm thinking it's more a result of the sheer numbers of diagnoses.

And for the OP: Good luck. It sounds like you have a couple of different issues to work out. FAA medical rules are in the process of changing right now. Hopefully there is a way that can work in your favor.
 
jrm said:
Should I get the medical 100% sorted out before starting lessons or would it be advisable and ok to do both at the same time?

LSA is possible I suppose but I'm not a small man and would like to do some traveling with my wife and son.
Click to expand...
You need to get the medical sorted out (tests done, results in) before you apply for a medical - fail and you are hosed. (get a consultation - not an FAA exam to kick things off)

If you want to start out on the LSA route while you wait for the results - sure, why not.
 
mulligan said:
It a knock on the OP but why does there seem to be so many people diagnosed with ADD and depression that want to become pilots. What is is about aviation that attracts a person with these diagnosis? Is it that too many people are now being diagnosed or is it that pilots are awesome and everyone wants to be us, or is it the attraction to process and procedures?
Click to expand...

As a pharmacist I'd venture to say you would be surprised how many people have ADD and depression and take meds for it. It was very eye opening working in the town I grew up in to see all the Mrs. Smith's I knew growing up getting their monthly med cocktail.

Most people you could never tell if you didn't know...
 
jrm said:
A wiki or sticky with some detail by diagnosis or condition might be helpful but searching every thread for the needle in a haystack you are looking for on a nuanced field is less than helpful. I did a decent amount of searching before posting as public disclosure is not something I was desiring. I did even more after being unable to find the post annonimously button. If it is simply too complicated of a subject for newcomers to seek guidance on here a sticky to that effect might be appropriate. None of this is meant to be confrontational or aggressive although it might come across that way it really isn't. This is a foreign topic to me and likely complex to all. I was hoping for some first hand or expert advice on the matter as I simply do not know what I don't know and I felt some with experience could point me in the right direction. It seems like the right direction is to consult Dr. Chien which I will do. And I got the guidance I was looking for even if I was hoping there might be an easier, or more direct path.
Click to expand...

Dr. Chien was involved in making the rules that allow a pilot with unipolar depression to fly while on an SSRI but they are followed closely. If all the testing shows you do not in fact have depression, and you stop the SSRI immediately, you could potentially go back to being a "regular" person but you had some isolated problems related to job change, stress, whatever, and you will squeak by. I'll share that this happened to me. I had a severe complication from a surgery that was treated inappropriately and I went into a deep depression. It took as long as 24 months to fix my physical problem and restore the use of my right arm. During part of that time I was treated for depression. I reported all this to the FAA. They asked for additional information, I supplied it, and when it was all said and done I was given a normal certification. The incident had come and gone and I was recovered.

So it is VERY IMPORTANT that you do not self diagnose, but follow Dr. Chien's instructions to get yourself properly evaluated. Based on what you've said here, the result could be anything from denial, to special issue, to regular certification, and there's no way to say at this point. Back when it happened to me I didn't know Dr. Chien, if I had to do it over, I'd have gone to him, I would have avoided the additional steps and delays.
 
neilw2 said:
As a pharmacist I'd venture to say you would be surprised how many people have ADD and depression and take meds for it. It was very eye opening working in the town I grew up in to see all the Mrs. Smith's I knew growing up getting their monthly med cocktail.

Most people you could never tell if you didn't know...
Click to expand...

How many who take meds really do have whatever it is? Or was it a diagnosis that the Mrs. Smiths, or someone else, talked the doc into making? I think that's where we are when schools are pressuring for ADHD diagnoses.
 
Matthew said:
How many who take meds really do have whatever it is? Or was it a diagnosis that the Mrs. Smiths, or someone else, talked the doc into making? I think that's where we are when schools are pressuring for ADHD diagnoses.
Click to expand...

I remember when I was in school (not long ago- 2008) they were still teaching that ADD/ADHD were UNDERdiagnosed, not over. I'm sure they are still teaching this.

However, I strongly agree with you, it very much a problem which has been a major contributor to the large proliferation of controlled medications on the streets of America today. I contend the public would be shocked to learned the sheer volume of these diagnoses and the (over)prescribing patterns of their treatments.
 
Other than Lou r
mulligan said:
It a knock on the OP but why does there seem to be so many people diagnosed with ADD and depression that want to become pilots. What is is about aviation that attracts a person with these diagnosis? Is it that too many people are now being diagnosed or is it that pilots are awesome and everyone wants to be us, or is it the attraction to process and procedures?
Click to expand...
Far too many physicians started diagnosing ADD and ADHD I'd guess in the late 70s-80s. That's about when the boomers started having kids and they and the doctors decided that teaching their offspring about discipline was too much trouble and that "better living thru modern chemistry" was the answer. It's just much easier than identifying the real problems. Yes, I'm a boomer and far too many of my friends' kids are examples of the over-diagnosis of ADD and ADHD. I'm sure if this had been popular in the 60s when I was growing up, my mother probably would have demanded the family doctor diagnose me as such.
 
JRM, you do not understand the diagnosis of ADD. It doesn't go away. It is a lifelong condition for which there is a waiver pathway (when severity is low), though it is never itself waived. Use the teeny link at my signature line to email me. I have shutoff email from this site due to certain abuse received over the years.....
 
I have zero qualifications to even guess about the medical questions here.

But, I see no reason to not start taking lessons if you want to experience learning to fly. You won't be able to solo without the medical, but personally, I would still find it worth the money to learn to fly and land a plane for real even if could never get my license. There are much more useless things to blow expendable income on.

A related thought, what if you decide you aren't any good at it and it's not that much fun? Why not make sure by taking a few classes before spending the time and money on resolving these complex issues?

Just one mans opinion.
 
Salty said:
I have zero qualifications to even guess about the medical questions here.

But, I see no reason to not start taking lessons if you want to experience learning to fly. You won't be able to solo without the medical, but personally, I would still find it worth the money to learn to fly and land a plane for real even if could never get my license. There are much more useless things to blow expendable income on.

A related thought, what if you decide you aren't any good at it and it's not that much fun? Why not make sure by taking a few classes before spending the time and money on resolving these complex issues?

Just one mans opinion.
Click to expand...
Those are good things for folks to consider. Goals and expectations vary greatly.
 
You can do a lot prior to solo: like complete the written. But I think it's wise to at least have an idea if you will be able to get that medical at all before you make the decision to spend lesson money only to find out it won't happen. Tough choices.
 
But I think it's wise to at least have an idea if you will be able to get that medical at all before you make the decision to spend lesson money only to find out it won't happen. Tough choices.[/QUOTE]
I'm thinking the same here.... At least have the "this is what it takes and what to expect" conversation with Dr. Bruce. Just like you don't ask a witness a question without knowing the answer, getting the correct details from Dr. Bruce is a whole lot better than making a decision based on the speculation from the uneducated masses on the interwebs.
 
I don't understand that attitude. Flight training for me was worth every penny just as an experience in itself. You guys act like it would be a waste of time if he couldn't get a medical, I can't understand that.
 
bbchien said:
JRM, you do not understand the diagnosis of ADD. It doesn't go away. It is a lifelong condition for which there is a waiver pathway (when severity is low), though it is never itself waived. Use the teeny link at my signature line to email me. I have shutoff email from this site due to certain abuse received over the years.....
Click to expand...

Dr. Bruce, just being curious, Is the waiver pathway different than having a diagnosis reversed or do the two mean the same thing?
 
Salty said:
I don't understand that attitude. Flight training for me was worth every penny just as an experience in itself. You guys act like it would be a waste of time if he couldn't get a medical, I can't understand that.
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It's going be hard for him to solo without that medical.

The ADD testing to get your medical is too cumbersome, the TOVA and PASAT are the only two that really measure your ability pay attention.

All the rest of the test have much more to do with your IQ.

As far as being in the top 85% of airmen, wouldn't the FAA have to have tested all airmen?
 
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midcap said:
It's going be hard for him to solo without that medical.
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I think @Salty's point is that soloing may be important to some, but not others. If you just want to go up with a CFI or some other pilot and learn about flying you don't need a medical.
 
Everskyward said:
I think @Salty's point is that soloing may be important to some, but not others. If you just want to go up with a CFI or some other pilot and learn about flying you don't need a medical.
Click to expand...

That's true....my CFI said if I never got my medical he would be more than happy to let me fly him around.:D
 
Salty said:
I don't understand that attitude. Flight training for me was worth every penny just as an experience in itself. You guys act like it would be a waste of time if he couldn't get a medical, I can't understand that.
Click to expand...
Not exactly what I was getting at. I think the OP needs to make that decision himself. He might want to base some of that decision on the likelihood of getting a medical. If he gets the "No way in hell" answer, he might decide differently than if he gets the "Maybe, but it's going to cost this much in time and money" answer.

Sure, he can always go on a lifetime of flying with a CFI aboard, but only the OP can decide if that's the path he wants to take.
 
paflyer said:
It's more like 0.2%. Even less for "actives" with a medical.
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You're right. I don't know where I came up with that number. I think close to 6% of pilots are women. Maybe that's why that number was stuck in my head.
 
Matthew said:
You're right. I don't know where I came up with that number. I think close to 6% of pilots are women. Maybe that's why that number was stuck in my head.
Click to expand...

That sounds reasonable, but surprised it's that high.

Statistically pilots (of all stripes) are only one out of 500. Pretty elite group.
 
midcap said:
Dr. Bruce, just being curious, Is the waiver pathway different than having a diagnosis reversed or do the two mean the same thing?
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ADD is one of a cognitive spectrum
Of disorders. The waiver path merely compares the candidates' performance to decile matched aviation peers in about 12 areas of function. A lot of these reports come out "Cognitive disorder unspecified" and then it becomes crucial in about six areas, that one outperforms 15% of his peers.

So basically ADD is not "one" disorder. And it is NOT about TOVA and PASAT alone.
 
bbchien said:
ADD is one of a cognitive spectrum
Of disorders. The waiver path merely compares the candidates' performance to decile matched aviation peers in about 12 areas of function. A lot of these reports come out "Cognitive disorder unspecified" and then it becomes crucial in about six areas, that one outperforms 15% of his peers.

So basically ADD is not "one" disorder. And it is NOT about TOVA and PASAT alone.
Click to expand...

thanks for clarifying that for me, it seems that you really have to have serious ADHD not to get a good enough score to get an approval.

I always wondered where the FAA got the peer group from, I assumed it's all the previous guys that went through the process, because I don't see current pilots volunteering for the battery of tests.
 
bbchien said:
ADD is one of a cognitive spectrum
Of disorders. The waiver path merely compares the candidates' performance to decile matched aviation peers in about 12 areas of function. A lot of these reports come out "Cognitive disorder unspecified" and then it becomes crucial in about six areas, that one outperforms 15% of his peers.

So basically ADD is not "one" disorder. And it is NOT about TOVA and PASAT alone.
Click to expand...
It sounds like it is no longer considered necessary to prove that the original ADD diagnosis was wrong, if the applicant is able to do well enough on the performance tests. Am I understanding that correctly?
 
Palmpilot said:
It sounds like it is no longer considered necessary to prove that the original ADD diagnosis was wrong, if the applicant is able to do well enough on the performance tests. Am I understanding that correctly?
Click to expand...
Current Policy reflects FAA's understanding that in the community, if Johnny isn't quite right, he gets pills. We have, really, only one hammer. "If it isn't right it must be a nail because I have a hammer." A lot of airmen think I only have to prove I don't have ADD. Well then the report comes back "unclassified cognitive disorder, weakness in 3 areas critical to aviation."

The airman rejoices that he doesn't have ADD, and then against my advice, decides to apply locally. He gets denied. Then only one of two things can be true:

He has a cognition deficit which renders him not able to be a pilot.
or
He is just too dumb to be a pilot.

I prefer the first. But I have been in this position before.

And to Midcap, yes the FAA psychology program has statistically validated norms, by decile. Since Bob hoover, they have been hard at work.
 
bbchien said:
Current Policy reflects FAA's understanding that in the community, if Johnny isn't quite right, he gets pills. We have, really, only one hammer. "If it isn't right it must be a nail because I have a hammer." A lot of airmen think I only have to prove I don't have ADD. Well then the report comes back "unclassified cognitive disorder, weakness in 3 areas critical to aviation."

The airman rejoices that he doesn't have ADD, and then against my advice, decides to apply locally. He gets denied. Then only one of two things can be true:

He has a cognition deficit which renders him not able to be a pilot.
or
He is just too dumb to be a pilot.

I prefer the first. But I have been in this position before.

And to Midcap, yes the FAA psychology program has statistically validated norms, by decile. Since Bob hoover, they have been hard at work.
Click to expand...


thanks Dr. BRuce
 
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