14-year old daughter - Psychiatrist wants to prescribe Lamictal

L

Loves his daughter

Guest
(Yes, I have reached out to our resident doctors here. But also looking for any discussion. I do see that similar issues have been discussed before, but I didn't see an actual answer to my question.)

I'm not looking for actual medical advice, rather I am looking for experience with how the FAA handles medication use. Really, I am hoping to avoid making a mistake that could affect my daughter for a long time to come.

My 14-year-old daughter was prescribed Prozac for depression. That didn't work. The psychiatrist is now looking to prescribe Lamictal, and suspects bipolar disorder, but hasn't settled on the diagnosis yet.

She does NOT seem to be interested in being a pilot at this point in her life. However, I don't want to shut that door unless it's necessary.

I know that if she's diagnosed bipolar, that's it - no FAA medical, forever.

I also know that Lamictal is disallowed.

My real question is, if she is NOT diagnosed bipolar, but IS prescribed Lamictal, will that cause a problem in the future even if she stops taking it?

Thanks.
 
Rgbeard said:
Here's where you find the short answer:

https://www.aopa.org/go-fly/medical-resources/search-faa-medication-database

The question has been asked before:

https://www.pilotsofamerica.com/community/threads/lamictal.81784/
Click to expand...

Thank you, I am aware of both of those. The first just says "disallowed" for this, but doesn't indicate if that means "permanently if you've ever taken it", or "just while taking it".

The thread you link I did read, but it doesn't seem to answer my question of the effects on your medical if you take it WITHOUT a diagnosis of bipolar.
 
There is no question on the Medxpress application that asks about medications you've been prescribed in the past. So if she's not taking it at the time she goes for a medical, she doesn't have to disclose it. But she will have to disclose whatever the diagnosis was that led to the prescription (which might lead to additional questions from the AME or FAA).
 
Loves his daughter said:
(Yes, I have reached out to our resident doctors here. But also looking for any discussion. I do see that similar issues have been discussed before, but I didn't see an actual answer to my question.)

I'm not looking for actual medical advice, rather I am looking for experience with how the FAA handles medication use. Really, I am hoping to avoid making a mistake that could affect my daughter for a long time to come.

My 14-year-old daughter was prescribed Prozac for depression. That didn't work. The psychiatrist is now looking to prescribe Lamictal, and suspects bipolar disorder, but hasn't settled on the diagnosis yet.

She does NOT seem to be interested in being a pilot at this point in her life. However, I don't want to shut that door unless it's necessary.

I know that if she's diagnosed bipolar, that's it - no FAA medical, forever.

I also know that Lamictal is disallowed.

My real question is, if she is NOT diagnosed bipolar, but IS prescribed Lamictal, will that cause a problem in the future even if she stops taking it?

Thanks.
Click to expand...

If he hasn’t prescribed anything yet you could take her to get a medical now, then she’d be eligible for basic med even if it’s 20 years down the road.
 
Health and mental health is very important. 14 is young to be dealing with these issues. I'm sorry for your issues, but I think as a dad, my first concern would be her health. Mental issues can be very debilitating for any person. If there is a way to prevent that debilitation I would be all for it. I think it's also important to think of these drugs and therapies as a miracle for people who truly need them. It's important that the patient view them as a helping force rather than a hindrance.

A second opinion on her mental health is probably important, having her worry about something she is not really interested in, aviation, is not important.

I pray that she leads a productive, happy life.
 
I think you shouldn't second guess your daughter's doctors, especially with a bunch of non-MD strangers on the internet. If her doctor thinks she needs the pills, she needs the pills. Bigger worry about kids that age then are they going to become pilots.
 
steingar said:
I think you shouldn't second guess your daughter's doctors, especially with a bunch of non-MD strangers on the internet. If her doctor thinks she needs the pills, she needs the pills. Bigger worry about kids that age then are they going to become pilots.
Click to expand...
I would call it due diligence. I've seen even good doctors make plenty of mistakes. I knew of one that misdiagnosed a ruptured appendix, almost killed the kid. I had two make bad calls with my then 16 yr old daughter. But fortunately, I am not overly influenced by titles and accreditations as some are.

I commend the OP for being a good concerned parent.
 
Morgan3820 said:
I would call it due diligence. I've seen even good doctors make plenty of mistakes.
Click to expand...

When a family member was young the school sent a note to the parents suggesting their child be put on Ritalin (methylphenidate) of some sort. They were told to go and pound sand. Perhaps they are still doing that ...
 
steingar said:
I think you shouldn't second guess your daughter's doctors, especially with a bunch of non-MD strangers on the internet. If her doctor thinks she needs the pills, she needs the pills. Bigger worry about kids that age then are they going to become pilots.
Click to expand...
Good news: He's not asking for medical advice.
 
PaulS said:
A second opinion on her mental health is probably important, having her worry about something she is not really interested in, aviation, is not important.
Click to expand...

YES, second opinion! Although it is not just aviation that can be affected, mental history can affect other things too such as certain jobs, security clearances, and firearms permits. Dad is right to be concerned about possible future impact.

If there is a real condition treat it, but make sure the diagnosis is correct. I know a girl who had severe mood problems and had been seeing a psychiatrist for a year or two, was being treated with psychoactive meds. Finally it occurred to them to check her hormones, turns out she has a physical condition where you excrete way too many adrenal hormones; she is now seeing an endocrinologist.

steingar said:
I think you shouldn't second guess your daughter's doctors, especially with a bunch of non-MD strangers on the internet. If her doctor thinks she needs the pills, she needs the pills. Bigger worry about kids that age then are they going to become pilots.
Click to expand...

Good Lord. Adolescent psychiatry is not settled science. Don’t necessarily believe the first shrink you see. I had a niece go through this. Varying doctors had varying opinions. And then there was the case I mentioned above, where the psychiatrist assumed mental disorder that turned out to be glandular.

Not saying OP’s daughter’s doctor is wrong, maybe they’ve already gotten second opinions and done a complete physical investigation. OP said he doesn’t want medical advice (that never stops any of us), he just wants to know the deal with the med and the FAA and he is right to ask about it. I can’t answer that, I’m waiting for Drs. Lou and Bruce.
 
steingar said:
I think you shouldn't second guess your daughter's doctors, especially with a bunch of non-MD strangers on the internet. If her doctor thinks she needs the pills, she needs the pills. Bigger worry about kids that age then are they going to become pilots.
Click to expand...
I think his daughter needs an advocate and parent. Its good to question these things to some level.
 
So sorry about your daughter.

I am the father of a 16 yo daughter that started down her path with depression when she was 14 as well. I know exactly where you're coming from because I was concerned about my daughter's future opportunities as well, whether it was flying, military, law enforcement or other vocations not accessible to those with mental health disorders.

My daughter attempted suicide last year and I can't articulate how foolish I felt and how inconsequential and meaningless my concerns were.

The Dr. is definitely right, health first. Lamictal is one of the drugs my daughter is taking and so far it is helping her. If Lamictal is beneficial for your daughter be thankful and don't look back!

Best wishes for you, your daughter and your family...
 
Loves his daughter said:
The psychiatrist is now looking to prescribe Lamictal, and suspects bipolar disorder, but hasn't settled on the diagnosis yet.
Click to expand...

This bugs me. It seems like he is guessing, then trying to use drugs to verify his guess. Oh, she is better with Lamictal? She must be bipolar. He guessed once before and was wrong. I’d challenge him on it before you fill that prescription or find someone better.

Loves his daughter said:
My real question is, if she is NOT diagnosed bipolar, but IS prescribed Lamictal, will that cause a problem in the future even if she stops taking it?
Click to expand...

I haven’t seen an answer to this. The problem would be that use of the drug indicates a condition and the only choices are epilepsy, bipolar, or a wrong diagnosis. Even if correct, she would never get the wrong diagnosis proven.

btw, prescribing a drug without a diagnosis? That seems weird.
 
bflynn said:
This bugs me. It seems like he is guessing, then trying to use drugs to verify his guess. Oh, she is better with Lamictal? She must be bipolar. He guessed once before and was wrong. I’d challenge him on it before you fill that prescription or find someone better.
Click to expand...

Have you had much experience with psychiatry? From my experience with family, it is often difficult to nail down MH diagnoses as many of the symptoms can be shared and most are subjective/shared by the patient as opposed to more objective forms of testing. It’s not unusual in my experience for multiple drugs and/or dosages to be tried to find the right fit for the patient. Just my second hand experience from quite a few friends and family.
 
Some, yes. When the doctor said he didn’t have a diagnosis yet, but he would figure out something, we stopped going to him. The next doctor identified a nutritional deficiency on the first visit.
 
Psychiatry is not like much of physical medicine where you can do a blood test and get a hard diagnosis. It’s very complex and sometimes not much more than a “best guess”. Many mental disorders first present around age 14 but that’s also when you have normal adolescent angst. The doctor can help discern whether it’s that or an actual disorder. To prescribe a drug you need to have some kind of diagnosis for the insurance company. But you need to observe the course over time and wait until adulthood to come to a final determination when it comes to mental disorders that share a lot of the same features.

However, you can’t wait several years to begin treatment when there is dysfunction and an impact on quality of life, especially if self harm or the threat of self harm is involved. When I said “don’t treat without a diagnosis and get a second opinion” I’m not saying it’s going to be possible to get it 100% right at this time, I’m saying do a thorough investigation, rule out physical issues as best you can, get some consensus among a couple of trusted professionals (or just one if you really trust him, he comes well recommended, and you’re comfortable with his conclusion. But personally I lean to two opinions when you’re talking about initiating psychoactive drug treatment in a child).

Weigh all the risks and benefits and then proceed, understanding that the first diagnosis at age 14 might not end up being right but that doesn’t mean the doctor was “wrong”. It means he has to put something down for the insurance and he believes the drug might treat the symptoms. There is nothing wrong with “try this and see if it works” when the patient is suffering and some immediate relief is required, just do a little due diligence if you have time (it’s not an emergency) but you can’t wait years to be absolutely certain.

But, like I said, OP may have already gone through this process and is okay beginning treatment. The issue is, whatever code is recorded is what the FAA will take as gospel and what you will need to disprove decades later. Any parent who is a pilot will be thinking of this even if the child hasn’t yet indicated an interest in aviation. I don’t blame OP for asking the question but I agree the health of his daughter comes first and wish them the best.
 
I can appreciate your concern for limiting or making difficult your daughter’s future. It’s good that you’re considering that. It’s not the medication, it’s the condition that’s going to be limiting.

Depending on how far along your family is in this struggle, your concern about limiting her future may pale in comparison to getting a proper handle on her struggles themselves.

Mental health in the US isn’t even a cobbled-together mess, it’s a mess in general not even loosely cobbled together. My guess based on your early concern is that you will be a great advocate for FIGHTING for proper care. YOU will need to coordinate EVERYTHING from the health care providers. Even if your daughter were an adult, that would still be the case. That’s also the case in a good year, but with the pandemic and health-care workers’ own mental health struggles, the system (I use that term loosely) is stretched thin.

I suggest you look up a local NAMI office. They have been a tremendous knowledge base, resource, and peer sounding board.

Best wishes.
 
steingar said:
I think you shouldn't second guess your daughter's doctors, especially with a bunch of non-MD strangers on the internet. If her doctor thinks she needs the pills, she needs the pills. Bigger worry about kids that age then are they going to become pilots.
Click to expand...

ALWAYS second guess doctors

https://www.hopkinsmedicine.org/new...rs_now_third_leading_cause_of_death_in_the_us

14 is pretty young to get her on drugs, I’d be looking at changing her lifestyle before medicating the kid. Getting a mental health diagnosis can be worse than a criminal record for more than just aviation.
 
bflynn said:
This bugs me. It seems like he is guessing, then trying to use drugs to verify his guess. Oh, she is better with Lamictal? She must be bipolar. He guessed once before and was wrong. I’d challenge him on it before you fill that prescription or find someone better.
Click to expand...


I have to point out that the doctor didn't say anything to you. All you know is what some guy on the internet has chosen to share in a very brief post. You don't know if that makes up all, part, or any of what the doctor actually said.

Find another doctor? Not sure what part of the country you're from, but psychiatrists who treat adolescents are exceedingly rare in most places. One reason is the immense amount of training it takes to do that work.

Jon
 
4CornerFlyer said:
I have to point out that the doctor didn't say anything to you. All you know is what some guy on the internet has chosen to share in a very brief post. You don't know if that makes up all, part, or any of what the doctor actually said.

Find another doctor? Not sure what part of the country you're from, but psychiatrists who treat adolescents are exceedingly rare in most places. One reason is the immense amount of training it takes to do that work.

Jon
Click to expand...

Enough of them that a whole generation got put on ADD pills :rolleyes:
 
4CornerFlyer said:
I have to point out that the doctor didn't say anything to you. All you know is what some guy on the internet has chosen to share in a very brief post. You don't know if that makes up all, part, or any of what the doctor actually said.
Click to expand...

Right. That why "it seems like..."
 
Loves his daughter said:
(Yes, I have reached out to our resident doctors here. But also looking for any discussion. I do see that similar issues have been discussed before, but I didn't see an actual answer to my question.)

I'm not looking for actual medical advice, rather I am looking for experience with how the FAA handles medication use. Really, I am hoping to avoid making a mistake that could affect my daughter for a long time to come.

My 14-year-old daughter was prescribed Prozac for depression. That didn't work. The psychiatrist is now looking to prescribe Lamictal, and suspects bipolar disorder, but hasn't settled on the diagnosis yet.

She does NOT seem to be interested in being a pilot at this point in her life. However, I don't want to shut that door unless it's necessary.

I know that if she's diagnosed bipolar, that's it - no FAA medical, forever.

I also know that Lamictal is disallowed.

My real question is, if she is NOT diagnosed bipolar, but IS prescribed Lamictal, will that cause a problem in the future even if she stops taking it?

Thanks.
Click to expand...

Your daughter is lucky to have such a concerned parent giving thought to the long term prospects of her situation.

I'm going to make some assumptions here and throw in my $.02. I suspect that the previous prescriptions of Prozac are coupled to a formal diagnosis of depression of some type. Those facts alone will give her some trouble with AMCD.

It's common for us to wish that our children will walk in our footsteps and carry on our "legacy". Maybe a bit of immortality by proxy. It's admirable that you want to keep that door open, but we should all be careful about projecting our values on others (including children). Most parents would go for certainties of health in the present over squashing potentially undesired dreams in the future.

Basically, deal with the risk that's in front of you and certain rather than the potentially never occurring risk in the future. If she truly is bipolar, and the rules state no bipolar pilots, then that card is dealt and it's better to make the best of a less than optimal hand.

I get the vibe that the psychiatrists uncertainty in the diagnosis is making you second guess the pharmaceutical intervention. I'm basing this on your statement that the psychiatrist wants to prescribe a psychoactive drug without a definitive diagnosis. If I were in your shoes I would share your concerns. My understanding of the process to diagnose bipolar (of which there are varying types) is that it's difficult because bipolar is a disorder of mood swings. That means clinicians are advised to make the diagnosis off clinical history rather than the state currently presented by the patient. The age of your daughter probably makes this more difficult as alternating moods and rapid emotional shifts is basically the definition of teenage years for many.

Her current psychiatrist may be spot on, or may be lacking. None of us can real opine about that. If I were in your shoes and I had reservations about the recommended pharmaceutical treatment I would probably pursue a 2nd opinion for a bipolar diagnosis. The key would be providing the 2nd clinician with all existing records, and a full understanding of your daughter's mood over time. Closing the door to a pilot certificate would be the least of my worries.

To put it in perspective, there are about 690k "pilots" (people holding certificates) in the U.S. That works out to about .2% of the US population. I know that a loss of flying for us in this small club seems like the ultimate crushing of dreams, but MANY people find away to live a happy fulfilled life without our "aviation use disorder". Best wishes for your daughter, and I hope this helps.
 
I think it's smart to double or triple check any diagnosis that suggests the use of behavior altering drugs, not just because of the FAA implications. To me it's pretty clear that the deck is stacked in favor of over prescribing, and has been for a long time.
 
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