Advice for SSRI (antidepressant) SI

rivets

rivets

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Rivets
Hi folks,

I just joined this forum and would like to ask about Special Issuance for antidepressant med use. I take a qualified SSRI med and have no side effects. This is going to be my first application for a medical certificate.

I have encountered one AME who encouraged me to lie to the FAA. I encountered another AME who wanted to extort $300 and my credit card number on the spot in order to even start talking to me about my "options".

I have taken the CogScreen-AE at one center, at the cost of $550, who turned out to be unable to write my report properly. I am considering retesting at another center, at the cost of $500, who claim (wrongly according to my HIMS AME) that all test results must be reported to the FAA and that I'm not allowed to retake the test.

I am an honest person and want to do the right thing at all times, but I recognize the FAA has set up a legal game and I do not want to run afoul of their rules. I do *not* want to fall into the Sport Pilot Catch-22.

If anyone has experiences or advice, I would greatly appreciate it. Best regards,

-- Rivets
 
Do NOT lie to the FAA. Doctor Bruce Chien is one of the authors of the SSRI special issuance plan. He's a regular here, if you wait a minute, he'll be by. I take it you've already done your research if you know you need an HIMS AME (and not some clown who ought to have his designation yanked by suggesting
you should falsify your application) and Cogscreen.
 
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Thank you for the admonition to NOT lie. I am not a good liar and I don't like lying, and I don't like having stuff hanging over me. :p I love airplanes but not at the risk of creating ways for people to get me in legal trouble.

I just want to find a clean way to get from where I am to either a knowledge that I will not pass, and therefore to not apply, or to submit a solid application.
 
One more question -- in that regard, is counseling with an LCSW reportable and dose it create problems? My inclination is that --

1. All encounters with psychiatrists are covered under my SSRI SI and I'm dealing with it;

2. Counseling with an LCSW was uneventful and tells the FAA nothing new; so

3. It should be harmless to "over-report" the LCSW counseling.

-- Rivets
 
Except for certain marital and job counseling, it is reportable. If you're already going to report the SSRI use, that aspect is a pretty much non brainier as you say. They know you have depression already.

I would suggest that you consult with Dr. Bruce, http://www.aeromedicaldoc.com (he has email there). He can give you a good read as to whether you will be able to get the issuance or not more than anybody else I think. You can chat with him all you want before committing yourself to an actual application.
 
If you want to see the FAA's protocol for medical certification with SSRI use (past or present), see here and follow the links therein. If you want to comply with that protocol, get hold of Bruce or someone like him (and I don't know anyone else like him). The one absolute certainty is that if the FAA catches you lying to them about this (and they have numerous ways to do that), your flying goose will be thoroughly cooked.
 
Thanks for the advice, Cap'n Ron.

I am mostly distressed and worried by (a) veiled encouragements to lie; (b) incomplete or inconsistent information on the part of AMEs and doctors; and (c) doctors who seem to be acting in a blatant, shameless effort to line their pockets rather than look after the best interests of their airman patients.

My current most pressing concern is the fact that the neuropsychologist says "I must report all CogScreen-AE results to the FAA and you may not retake the test!" versus the HIMS AME saying "You can retake the test without penalty". Conflicting information in the tense high-stakes legal game that is the FAA aeromedical process is not comforting.

Thanks again. I hope Bruce chimes in; if he doesn't I'll contact him directly.

-- Rivets
 
Oh Je_sus. Rivets, you's squandered $550 don't squander more. Where in the country are you- you need to go to a HIMS certified neuropsych so that when you are done and have spent all that coin, what you have will be useful to getting you certified.

Did your HIMS AME fail to point you to the reputable sources?

Here's the required protocol if you are going to certify ON medicine, it not only involves the HIMS Neuropsych but it also a HIMS forensic psychiatrist. See pg 13 of the Federal Register protocol; and the list of the requirements is in the "specs" attachment.

If you tell me where on the planet you are, I'll give you some names....
 

Attachments

  • Specs for NP Evals-SSRI Medications-2013-01.pdf
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  • SSRI.pdf
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Hi Dr Bruce --

Thanks so much for the reply. I live in the greater San Francisco Bay Area.

I am currently considering working with Dr Richard Andolsen, Healdsburg, CA as my HIMS AME. He has been quite helpful so far with _pro bono_ replies to my questions. I was also considering getting my CogScreen-AE done by Dr John Lang, San Francisco, CA, who has also been generous with his replies.

So what *is* the rule regarding administration of the CogScreen-AE: Can it be retaken without penalty, or not? And what sort of record does merely taking the test and having a neuropsychologist prepare a report generate, and what effect does that have?

Best regards,

-- Rivets
 
bbchien said:
... also a HIMS forensic psychiatrist.
Click to expand...

Interesting -- I haven't seen this in the text of the requirements anywhere. Is this something that they will ask for after I apply?

-- Rivets
 
It can be taken again but some of the data items will not be valid as it depends on your being naieve to it, to some extent.

I see what's happening. You are getting probono help so you don't get the whole skinny. Better hire that HIMS AME. But here's the list of psychiatrist and psychologist HIMS assets by state. These are the guys who can do it to FEDERAL SPEC, e.g, from whom the testing will be actually uesable.

I wrote the SSRI petition. You can bet they're going to demand the HIMS forensic psychiatrist evaluation....I see I left that attachment off, her's another go at it.

For the psychiatrist, you again, do NOT NEED the HIMS psych, but once again, if you use a guy who does not know what FAA wants, you simply lose. The reason you need this is to testify to the (1) underlying diagnosis, (2) stability of same on the single med, (3) and the affectual (mood) stuff that the psychologist isn't tooled up for.
 

Attachments

  • CA HIMS assets.pdf
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  • Specs for P&P Evals-2013-01.pdf
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bbchien said:
It can be taken again but some of the data items will not be valid as it depends on your being naieve to it, to some extent.
Click to expand...

Ok then. Let me explain.

I took the CogScreen-AE with a neuropsych who is based far away from me but who is listed on the set of HIMS assets you sent (thanks!). That was my $550 testing.

I scored with an LRPV between 0.15 and 0.18 (exact score redacted for anonymity). The neuropsych commented that my performance was satisfactory.

More recently, I contacted that neuropsych for a report. He claimed he needed to do the whole battery, and charge me an additional $2000. I noted that, for a favorable report, the new protocol is simply to do the CogScreen-AE and interview, skipping the extensive battery. He has thus far failed to reply.

bbchien said:
You can bet they're going to demand the HIMS forensic psychiatrist evaluation.
Click to expand...

Thanks. So that would include the person to whom I paid the $550. I hope I can convince him that he doesn't need to do the entire $2000 additional test battery.

bbchien said:
For the psychiatrist, you again, do NOT NEED the HIMS psych, but once again, if you use a guy who does not know what FAA wants, you simply lose.
Click to expand...

I see. So it's not enough to just use *my* psychiatrist? I figured I'd just follow the published protocol and have the treating psychiatrist write the report. Otherwise, one of the HIMS psychiatrists on the list you gave does not really know me. Or do I have to visit them? The idea is I go to the HIMS psychiatrist and give them all the records I can, they see me, then they sign off that I'm ok?

-- Rivets
 
rivets said:
Ok then. Let me explain.

I took the CogScreen-AE with a neuropsych who is based far away from me but who is listed on the set of HIMS assets you sent (thanks!). That was my $550 testing.

I scored with an LRPV between 0.15 and 0.18 (exact score redacted for anonymity). The neuropsych commented that my performance was satisfactory.

More recently, I contacted that neuropsych for a report. He claimed he needed to do the whole battery, and charge me an additional $2000. I noted that, for a favorable report, the new protocol is simply to do the CogScreen-AE and interview, skipping the extensive battery. He has thus far failed to reply.



Thanks. So that would include the person to whom I paid the $550. I hope I can convince him that he doesn't need to do the entire $2000 additional test battery.



I see. So it's not enough to just use *my* psychiatrist? I figured I'd just follow the published protocol and have the treating psychiatrist write the report. Otherwise, one of the HIMS psychiatrists on the list you gave does not really know me. Or do I have to visit them? The idea is I go to the HIMS psychiatrist and give them all the records I can, they see me, then they sign off that I'm ok?

-- Rivets
Click to expand...
I don't write so good or you don't read so good. Here's another spec sheet.

To quote form the previous post:

For the psychiatrist, you again, do NOT NEED the HIMS psych, but once again, if you use a guy who does not know what FAA wants, you simply lose. The reason you need this is to testify to the (1) underlying diagnosis, (2) stability of same on the single med, (3) and the affectual (mood) stuff that the psychologist isn't tooled up for.


See Bullet point #4 in this attachment.

So you can use your guy. But he/she may not get it right. Your call. WARNING: in such matters, going for the lowest cost always turns out the MOST expensive.
 

Attachments

  • SSRI.Specs.pdf
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bbchien said:
I don't write so good or you don't read so good.
Click to expand...

Thank you Dr Bruce! Apologies if I flaked out on that last part.

I have honestly been going at this for months and months. Literally. I'm ready to be done with paperwork and go flying.

Thanks again for the help!

-- Rivets
 
I think what Bruce is trying to say is that the FAA protocol does not say it must come from a HIMS neuropsych, but if you get someone else to do it, they probably won't know how to do it the way the FAA wants it done, and then things will become even harder to fix.

Did I get that right, Bruce?
 
Ron Levy said:
I think what Bruce is trying to say is that the FAA protocol does not say it must come from a HIMS neuropsych, but if you get someone else to do it, they probably won't know how to do it the way the FAA wants it done, and then things will become even harder to fix.

Did I get that right, Bruce?
Click to expand...

I'm not Bruce but I know Bruce - and you did.
 
Update on my situation --

* The $550 neuropsych turned out to be on Bruce's HIMS list and agreed to do my interview and report for an additional $300. Sounds reasonable, I guess.

* Thanks Bruce for the tip about a HIMS psychiatrist. I will find one from the list and contact them asap.

* I think I have a way forward right now.

* Thanks to everyone for the support, encouragement and advice.

-- Rivets
 
Here, by the way, are the latest cost estimates. So far, all my treating physicians have been able to supply reports at no additional cost.

$ 550 CogScreen-AE
$ 300 Neuropsychologist interview & report
$1200 Forensic psychiatrist interview & report
$ 250 HIMS AME visit
$ 250 HIMS AME report
--------------------------------------------------
$2550 Total

-- Rivets
 
Keep us posted on your progress,
I gave up tho by a year ago because it seemed impossible for me to g a special issuance on a SSRI.

Dr Bruce is and was infinitely helpful to me as well.
 
Progress so far (hi Bigevil!) --

* My AME, Dr Richard Andolsen of Healdsburg, CA, does not believe I need the testimony of a HIMS psychiatrist. I am willing to risk it because, given the background information I have, I know that all reports are going to be positive anyway.

* All doctors have sent their reports in except for the person who administered my CogScreen-AE, Dr Edgar Angelone, San Rafael, CA. If you remember, he did my CogScreen-AE for $550. He was not informed that the FAA changed their protocol to *not* require all the extra expensive testing. So he interviewed me for an additional $300 and will send in his report soon, I hope. He seems nice and competent and all has gone well.

Hoping for the best!

Bigevil -- what were your issues, exactly, that made you give up? (Though of course I'm glad for you that you gave up rather than be rejected, but still....)

Rivets
 
I've taken Zoloft with incredible success and no side effects for over 7 years. I originally went on it mainly for anxiety (also for slight OCD). Even with a impeccable bill of health and no issues from my medication it seems like a special issuance will be incredibly challenging to achieve.

I consulted with Dr Bruce but based on his advice and what I've read on countless posts, it seemed I'd have to spend almost as much as the PPL and even then possibly still be denied. As disappointing as it is, i have some naive hope that at some point in the coming years they'll update their requirements and perhaps by then the hobby will be in better shape all around for perspective pilots.
 
Hi Bigevil,

Sorry about your disappointing outcome. My AME (Dr Andolsen, see above) says he's shepherded 5 SSRI medicals through and is batting 5/5. I don't know where you live but from what you say, you should be the model of the person for whom the SSRI special issuance was designed. Well anyway -- best of luck!

Rivets
 
I'm in Socal, but would happily make a trek if I felt it could get me across the finish line.

Lets see how it goes with your process, if it turns out positively it'll give me confidence about hiring your doc!
 
Well if it works for you I'll grab a bunch of hours in my logbook heading up with a CFI !

Excited to see how it goes. Truth of the matter is that I'm still very much so not hopeful on my case. But would be thrilled to see a fellow SSRI flyer get in!
 
Thanks for asking!

The antidepressant thing seems in the bag, with $1000 of tests that the docs laugh and say is a "formality".

I also take a thyroid hormone replacement which my doctor is tweaking, and I need to be "stable on the medication" so I'm waiting till the dose is tweaked!

Cheers and happy skies,

Rivets
 
Only slightly off topic: Your flight physical is demanding and so is your life insurance medical underwriting.
*
Please keep duplicates of all your supporting documents. If you go to look for life insurance that covers aviation, it will be critical to finding what limited coverage there is available for such situations. Flooding an underwriter with validated, supporting documents may be the only way to secure coverage.
 
Hi All,

I take an SSRI : Prozac and I'm going through this song and dance with the FAA. I got my CogScreen done for $775 and the NeuroPsychiatrist said there were some areas that I scored low in and that it might require more testing. Personally, I think this is a scam, I mean, it's hard not to. I am treated for mild depression and have been for 18 months on this medication. I guess my question is: What are my options at this point? Before the Neuropsych submits my results I have asked that they call me. If I don't like what they have to say I may bite the bullet and go get someone else to do the test. Is that a possibility? I'm pretty set on becoming a pilot and I'm willing to do whatever it takes.

Dr. Chien, do you have any advice on the best way to go about this?

Thanks,

Seth
 
Dr. Chien, do you have any advice on the best way to go about this?
Click to expand...
To talk to Bruce you'll need to e-mail him, call him, or reach out to him on the AOPA forums. As far as I'm aware he no longer hangs out here.
 
rivets said:
The antidepressant thing seems in the bag, with $1000 of tests that the docs laugh and say is a "formality".
Rivets
Click to expand...

that's wonderful.
so did you get your student medical so you can solo?
 
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