Another SSRI case

[kwv108]

All,
I'm sure you get this question all the time so I apologize for beating the topic to death. I am currently a student pilot and I love flying, but I have what seems to be a major issue. I am currently on Paroxetine Hydrochloride (Paxil) for depression and mild PTSD. On my last deployment there were some unfortunate events that took place which I received treatment for when I got out of the Marine Corps. I had trouble sleeping, adjusting to my new civilian life was somewhat difficult, and the VA doc put me on Paxil to help with that. I have been on it since then fairly steady with no major events or complaints. It did not occur to me when making the decision to realize my dream of flying that it would be such an issue. I contacted an AME and she advised me to consider SSRI path 1. I have since contacted my doctor and we have established a plan of coming off the medication. I really would like for this to work as it is something I've always wanted to do, but never had the chance until now. It seems based on my research online that the SSRI is an obstacle that is all but impossible to overcome. I went into detail about this with the AME and she said she would need to do some further research. Has anyone seen a case where this was successful? It is unfortunate, but I realize now I really should have dealt with everything on my own as it was really a temporary issue. Any information or advice would be appreciated. Thanks!

 

[bbchien]

First of all, thank you for your service.

Well, "It depends". Most folks including some PCPs don't understand that all anxiety/depression is NOT the same. To do Decision path 1 successfully, and get certified, the agency has to be pretty sure you don't have dysthymia, chronic resistant depression or any of a number of "come and go" situation which cycle often and aren't as stable. Think "Andreas Lubitz" and you'll get it.

So if you have been on the med for a LONG time, ( >5 years) the presumption is AGAINST you. The agency is NOT interested in certifying anyone who is going to relapse- and if you have been on meds for 5 years the probability that you will relapse in 4 years is about 50%.

If you are young and have been on it for a lot of your adult life, that's another problem.

Ten years- you can forget about it. that has the character of "I'm throwing my pills away and I am well"....which is a tough sell.

If you have been on then off then on....that's disease that has relapsed (oversimplified) and decision path 1 is NOT going to work for you.

So the first question is, what does the VAH psychiatrist (not the psychologist) think about chronicity of your situation.
Second, is, is the PTSD resolved. Is EVERY symptom on your award letter resolved and documented by the psychologist?

 

[kwv108]

First, thank you very much for your quick response. The information and insight is very much appreciated. As far as age goes I am 29 years old, and I have been on Paxil consistently since January 2014. I didn't get much from the conversation with my VA psychiatrist other than his opinion that due to my stability up to this point that coming down off the medicine under observation is a reasonable approach. He didn't really go into any further detail, and started the step down that we discussed. He brought me down from 30mg to 20mg. I see him in a progressive set of appointments as follow ups to ensure everything is going well. In reading the other forums I have seen various lengths of time that are required to be off with no issue as well as an evaluation by the treating psychiatrist. I do not experience the symptoms of the PTSD that I did at that time, but it is not yet documented unless the regular 6 month check-ups with the psychiatrist would count. About a year and a half ago the psychologist that I was seeing moved to another location, and it was determined that since I was doing alright for that length of time that I did not necessarily need to see one. I will definitely bring that up to my psychiatrist, and I will ask him his opinion regarding my symptoms during my follow up visits. I seem to be at the very beginning of a long process for approval so I don't have much information other than what I have found through my own research, and what you have given me now. This seems like a good start, and I know the process is there for a reason. I just would like to give myself every opportunity to make this happen, and if it doesn't just accept it and move forward with something else. Thanks again! You provide quite a lot of great information as I can see from this post and others. It is great that you take the time out of your day to provide people like me and idea of what we are facing Have a great evening!