Go through the SSRI process with my AME or apply for standard issuance?

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csmith422

Filing Flight Plan
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csmith422
For a brief explanation, previously I had followed SSRI pathway 2, with a decision to go on antidepressants. I was not on them but my AME and forensic physchiatrist both deemed that my case would look clinically better if I was on them, and reported stable. So I went on them, was successfully granted two special issuance medicals - both first class, which were both valid for six months. This was fine but spending the money that i was spending to have new reports done that often was not feasible for me, so I lost my medical simply by not reapplying within six month. Because of life changes and newfound stability for the past three years (two of which I was on the SSRI and reporting that to the FAA - one year was spent waiting in review) I have decided to discontinue the usage of them. Which I did 150 days ago, so my 60 days has well passed.

Basically what I am curious about if anyone can offer some input, the SSRI 1 pathway (SSRI Discontinuation) states that the airman may apply for a REGULAR issuance after that 60 day time is up. However, my AME advised that I would have to reapply for SI and be under that for 5 years, even with no meds. So he is having me get all new reports, two of them, both which cost $1000+. He says that he needs to submit a new report to the FAA containing all of the same stuff I had to do for the SI. My authorization letter that came with my special issuance just stated I need to ground myself if I changed doses, and notify my AME which was done.

Looking at the pathway, is all of this extra work even necessary or could I just do a new medxpress and call it good? It's in the weeds a bit and there's probably some fine print somewhere that says I can't but I don't understand why that would be the case. Reading through this quote, it seems like I may have to go the more complicated route but I just want to verify. I had one episode, less than 5 years in length, that was never mentioned as recurrent.

bbchien said:
No Eagle:
Practically speaking,
You can be eligible for path 1 only if you have had a single episode and it is less than 5 years’ duration (presumption of recurrence as you docs kept you on 5 years, for FEAR of recurrence) and nobody has called your course “recurrent”.

FAA sets you up for path 2 if you were on meds at time of you application.

But remember, FAA denies 100% of disease reasonably thought to be recurrent, untreated and unmonitored.

But if you have neither, you CAN do path 1. But the AME Can only issue you in the office, only under some very narrow circumstances. Yours Is not one of them. If you have been on for less than a year you may not even need a psychiatrist’s opinion….

The nonpsychiatrist PCP need to write all 7 items:

date of Rx, and what was used (presumes only a single med was used)
Diagnosis
He has to state the provocateur
Date of discontinuance
That there was no compromise of reality testing at any time in your course
That this was your one and only event IN YOU LIFE, to his knowledge
That he has seen you >60 days after discontinuation and that there are no symptoms left to treat.

He can’t miss a one.
As you will have been on a med within a year prior it is a special issuance. AME defers, the agency reviews and issues.
Click to expand...
 
Yes, it is. That's because what the ON SSRI path is for, is RECURRENT disease. "Recurrent disease unmonitored and untreated" is 100% denied. Why? because it has already recured or will again. So basically you apply path 2 and get denied.

You are either recurrent by virtue of > 5 years' history
Enough risk factors that the psychiatrists have named it "Recurrent".
or you actually have had a recurrence (off meds and then had to go back on).
(if this is untrue then someplace there has been a miscarraige).

The only way to "undo your diagnosis or history, woud be to go 10 years no meds no events and a successful life test well documented in between. Then you would go to the HIMS psychiatrist, who then has the authority to change your "recurrent diagnosis". Then and only then might you reapply with success off meds. However NB: The FAA will "belt and suspenders " you at that point and it'll be a special every year for 5 more years (15 years down the road) B4 you get released.

There is no inexpensive way out of this situation.
Why is that? If you have a reucrrence and there's a problem, guess who is "in the dock" (defendant)? FAA and the psychiatrist

B
 
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If I have supposed correctly, He needs to be on the teeniest dose of one of the approvable 7, to fly.
He could go off meds, grounded. Reapply after six months stable, wait six months for a dispostion....and get redenied (if he has a dignosis of "RECURRENT disease" either from his docs or from the FAA).

The teeny prophylactic dose changes the recurrency from an average of 6-8 years to about 20+ years.

Aviation, I remind candidates, is one of the HIGHEST UPFRONT costing professions of them all.
 
So if it was never stated that it was recurrent than I am safe from the FAAs position that I need meds? It could ALMOST be labeled adjustment disorder, which it was by my prescribing doctor, but looking through their paperwork it seems the criteria to get by that are very strict, and my treatment providers haven’t always said adjustment disorder. Hindsight is 20/20 because that is definitely a what it was.
My next question, in the past five years I’d say that the first two were the tail end of my symptoms, and I’ve been fine since that, and the first stint was the only one ever, which was what was reported by all of my treating providers. Does this exclude me from the “recurrent” category?
The only reason I can’t be labeled as adjustment disorder is it wasn’t diagnosed as that at first, and it lasted longer than the criteria allows.
Both my HIMS AME and my aviation forensics psych believe that path 1 is a viable path. I’ve got good recommendations from all of the doctors. I don’t mind an SI on pathway 1 if it’s viable. Now at this point because I’ve gone off the meds it looks like that was a mistake if I’ll end up back on path 2 anyways.

I only went on them in the first place because the forensic psych said I should. Now he’s the same one telling me I can be off. He’s gonna see me either way so more $$ for him.

The pathway layout that the FAA posts leaves a lot unsaid because the only thing it says is “after 60 days off medication airman may apply for regular issuance”

Thanks @bbchien as always for the input.
 
And because I’m off then more than likely I’d have to go through all the initial testing again? I had a cogscreen and all of that done once already.
 
But you haven't done the HIMS psychiatrist visit (whcih you'll need if the situation is a complex as it appears).

This sort of detailed information cannot be hacked out on as message board. You need to get good detailed, advice.
 
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