Approved SSRI - Xanax as Needed

Discussion in 'Medical Topics' started by Anonymous, Jun 19, 2017 at 7:27 PM.

  1. Anonymous

    Anonymous Guest

    Hello, I understand there are four SSRI's that are currently approved by the FAA. I have been on one of those approved SSRI's for much longer than the 12 months required. That said, I have always been prescribed Xanax to use on as needed basis. The prescription for 30 .5mg is usually filled only twice per year. I have never had any depression or mood disorder, rather prescribed for anxiety. I am curious under this situation if it would be an automatic decline. If there is a Medical Examiner who can answer this question, it would be greatly appreciated.
     
  2. murphey

    murphey Final Approach PoA Supporter

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    Contact Dr Bruce Chien

    aeromedicaldoc.com
     
  3. Skip Miller

    Skip Miller En-Route PoA Supporter

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    The reason Murphey wants you to contact Doc Chien is that he did the research, and wrote up the proposal that was eventually approved permitting the four SSRIs to be used without forfeiting your Medical. You want an honest and correct answer.... aeromedicaldoc.com.

    -Skip
     
  4. Rushie

    Rushie Pre-takeoff checklist

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    Xanax and anxiety will be problematic and the SSRI is for a very specific protocol. Please do contact Bruce Chien as the others advise. He will be able to tell you exactly what would be required if you would be able to get a medical.
     
  5. Anonymous

    Anonymous Guest

    I have gone on his website and submitted a form, but is there a way to contact him on this or someplace else?
     
  6. Matthew

    Matthew Touchdown! Greaser!

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    He sometimes shows up here. By posting here and on his site, you'll hear from him.
     
  7. Rushie

    Rushie Pre-takeoff checklist

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    If you are an AOPA member he is on their forum but if not he should respond to you through the website before too long. He doesn't frequent this one as often.
     
  8. flyingron

    flyingron Touchdown! Greaser! PoA Supporter

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    You can not fly with Xanax for any reason. It's sedating benzodiazepine. It's not an SSRI so it's not on the SSRI protocol.

    Anxiety IS a mood disorder.

    As others have pointed out, you need a frank conversation (pre examination) with a good AME about what your certification routes might be.

    If you can get away from the Xanax, you might be able to qualify for the SSRI protocol. The protocol allows use for things other than depression.
     
  9. EminiTrader

    EminiTrader Line Up and Wait

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    Yeah the xanax regardless of frequency is a grounding issue. As others have said - call Bruce and be 100 percent candid. You lie to him he spits you out and you will be on your own.
     
  10. steingar

    steingar Touchdown! Greaser!

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    If you've been prescribed Xanax "as needed" you should change doctors.
     
  11. azure

    azure Final Approach

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    Is this new? When the protocol first came out, I recall Bruce saying on a number of occasions that it was only for simple unipolar depression.
     
  12. steingar

    steingar Touchdown! Greaser!

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    Microamine uptake inhibitors are very effective at treating depressive disorders. They do little for anxiety and unhappiness, which unfortunately is what they're prescribed for most by doctors who don't understand them as well as they think they do. Moreover they can't be used "as needed", they don't work that way at all.
     
  13. flyingron

    flyingron Touchdown! Greaser! PoA Supporter

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    Yes, it has changed since the original protocol. New is a relative term.
     
  14. neilw2

    neilw2 Pre-takeoff checklist

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    What do you mean by this? Benzos are commonly prescribed as needed
     
  15. Rushie

    Rushie Pre-takeoff checklist

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    I don't want to speak for him but I think I know what he means and I agree with it for the most part. Benzos are a terrible way to treat chronic anxiety. Situational is different. You're undergoing chemo. Somebody murdered your wife and you need to get through the funeral (true story). But when doctors give it to someone with daily or very regular anxiety or panic attacks "as needed" can become too frequent, then tolerance develops etc. and it's like rebound congestion from taking decongestant too long, it just makes everything worse.
     
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  16. neilw2

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    I believe that most treatment guidelines recommend benzos as a second line treatment for chronic anxiety.

    The OP says he is taking SSRIs which is the recommended first line treatment. It is very common for a chronically depressed patient to have "spikes" or acute episodes where they may require a benzo like xanax for a short time- as needed.

    The OP already stated he only fills his Xanax once or twice a year so assuming he gets a 30 days supply he uses around #60 tabs/year. Seems to me that he is truly using them as needed and would be at very low risk of developing tolerance.

    My professional opinion is he is being managed appropriately and I can't see anything that the OP has described that would make me think otherwise.
     
  17. Rushie

    Rushie Pre-takeoff checklist

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    I agree with you too, as long as it remains that infrequent. I guess what I disagree with would be too liberally prescribing them to too many patients who end up using them daily especially if given by a general doctor without a proper psychological work up. And of course, without the doctor nor patient considering consequences to pilot medical certification.
     
  18. bbchien

    bbchien Final Approach

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    That is absolutely grounding because the SSRI protocol is for a SINGLE psych. med. And Xanax is not an SSRI. And prn use is NOT steady state.
     
    Last edited: Jun 20, 2017 at 9:44 PM
  19. iflyvfr

    iflyvfr Cleared for Takeoff PoA Supporter

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  20. steingar

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    Depression is an "abnormal" chemical state within the central nervous system. It turns out that microamine uptake inhibitors, which modulate the activity of the molecules that nerve cells use to talk to each other, can ameliorate this "abnormal" condition in the many of the chronically depressed.
    You aren't depressed because you lost your job, your dog died, your wife left you or any of the other stuff that happens in a Country and Western song. You are unhappy. The biochemical processes that cause unhappiness are distinct from those that cause depression. Hence micro amine uptake inhibitors are useless for treating it. The only drug I've ever seen that works on unhappiness is alcohol, though personal I think a loyal dog is better.
    You aren't depressed because your job is in danger, or your spawn is misbehaving or your neighbors are dangerous. You might be anxious or afraid, and again monoamine uptake inhibitors are useless to treat this.
    Lastly, these drugs treat chronic conditions. They simply don't work "as needed". They are one of the most overprescribed medications, and meta analysis has suggested they work no better than placebos because of this misuse. I suspect that they work very well indeed to treat what their target disorder.
     
  21. Rushie

    Rushie Pre-takeoff checklist

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    By "microamine uptake inhibitor" are you talking about Xanax or SSRI (SNRI etc)s? Or both? Because you are mentioning depression and anxiety. I was under the impression that "as needed" does not work for an antidepressant but it certainly does for a benzo.

    If you are talking about the Xanax you are saying the reverse of what I am saying. Benzos taken daily are not good for treating chronic anxiety in the long run but they sure do remove anxiety and fear for a one time use. This is why they give you one prior to a procedure. So it seems to me "as needed" is effective and appropriate as long as the as needed is very infrequent.

    But antidepressants on the other hand need to be taken daily and build in your system to be effective in treating depression. I'll go along with your distinction between unhappiness and depression and agree if you are on a SSRI and then your dog dies it won't stop the unhappiness. You claim alcohol is the only drug that can do that, but I thought alcohol had some of the same neurotransmitter effects as Benzos (GABA maybe?)
     
  22. flyingron

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    I don't think Steingar means microamine, he monoamine (which includes serotonin and norepinephrin). Microamines refer to certain of the amines fond only in trace amounts. While a MAO or SSRI may affect those as well, it's sort of outside our discussion.

    I don't think there was any argument about benzos for acute conditions (one event use). Chronic conditions even taken PRN is not a good use for it.

    But chronic or acute, PRN or taken readily, Xanax as I stated and Bruce confirmed is RIGHT OUT for flying.

    The posters SSRI use doesn't seem to be PRN. As I stated, he needs to have a frank conversation with a good AME about what his certification paths might be. Getting off the Benzos and qualifying for the SSRI protocol provided he can do that with no adverse psychological effects would be a possibility.