Impact of pursuing special issuance for SSRI Path 2

[anonymous]

I have been medicated for anxiety more than once in the past and am currently medicated for anxiety with an SSRI (more than six months) and flying on Basic Med after disclosing the use to the physician signing off the Basic Med. In reading here, I see conflicting opinions about whether or not I'm actually legal flying on Basic Med without an SSRI special issuance.

Q1: If I talk to an AME who specializes in this, and they do not happen to agree that it is legal to fly on Basic Med without the special issuance, are they going to report me to the FAA for doing so?

Q2: If I did find an AME who was willing to work through SSRI Path 2 so that I could get a SI and then resume flying under Basic Med afterwards, how long would I likely be grounded during the process? (Assuming that SSRI Path 2 even available for anxiety, not depression?)

 

[bbchien]

The history you give is that of recurent anxiety. Path 1 is a 100% denial.
Path 2 takes 6 months under the care of a board certified psychiatrist, stable dose.
DQ-er include: past hx of pscyhosis or of dual psych med simultaneous use, use of hospital for psychiatry.

It takes FAA about 6 months after you have that and the evaluations together, to get to your case.

 

[anonymous]

The history you give is that of recurent anxiety. Path 1 is a 100% denial.
Path 2 takes 6 months under the care of a board certified psychiatrist, stable dose.
DQ-er include: past hx of pscyhosis or of dual psych med simultaneous use, use of hospital for psychiatry.

It takes FAA about 6 months after you have that and the evaluations together, to get to your case.

Great answer. However it answers neither of the questions posed. Fair enough if you don't want to answer question 1, but then that makes it a non-starter to even pursue this option.

But on question 2, is that "get the evaluations together, file, deferral, grounded as a result, then 6 months grounded while the FAA acts" or is that "file, deferral, grounded while getting the evaluations together and six months after that", or is that "you should be grounded already because I don't agree that flying on Basic Med is permitted and if you didn't ground I'd report you and you'd lose out forever", or something else?

 

[AKiss20]

Great answer. However it answers neither of the questions posed. Fair enough if you don't want to answer question 1, but then that makes it a non-starter to even pursue this option.

But on question 2, is that "get the evaluations together, file, deferral, grounded as a result, then 6 months grounded while the FAA acts" or is that "file, deferral, grounded while getting the evaluations together and six months after that", or is that "you should be grounded already because I don't agree that flying on Basic Med is permitted and if you didn't ground I'd report you and you'd lose out forever", or something else?

There seems to be quite a bit of disagreement between whether simple depression or anxiety + SSRIs precludes you from utilizing BasicMed and requires a SI, assuming you got on BasicMed legitimately (i.e. held a medical after the required date, never had a denial). If you search through this forum history on that question you will find several threads with people of some authority arguing back and forth with no clear resolution to the question. It seems to be one of these legal gray zones because BasicMed is not a FAA run program but rather an alternative to the FAA aeromedical process imposed by statute/congress. The FAA folks seem to say one thing (yes it does require the SI), the BasicMed folks seem to say another (depression/anxiety does not fall under one of the named, required SIs and the FAA guidance on medicine is not legally binding; this is between you and your doctor that signs the BasicMed form), and there is no clear, legal source that directly answers that question as far as I can tell. Perhaps I am wrong, but that is my takeaway from watching this forum for quite some time. Every time the topic comes up, the same arguments seem to happen with no further clarification, quite possibly because there may not be a clear cut, legal answer until some court case is forced to impose clarity.

To note, here is the language for required SIs (https://www.faa.gov/licenses_certificates/airmen_certification/basic_med/)

• A mental health disorder, limited to an established medical history or clinical diagnosis of—
  • A personality disorder that is severe enough to have repeatedly manifested itself by overt acts;
  • A psychosis, defined as a case in which an individual —
    • Has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis; or
    • May reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis;
  • A bipolar disorder; or
  • A substance dependence within the previous 2 years, as defined in §67.307(a)(4) of 14 Code of Federal Regulations

The last 3 bullets seem pretty clearly and rigorously defined. I personally have been trying to understand that first bullet, which seems to be pretty vaguely written. "Personality disorder" seems to be a relatively well defined psychological term [1], and I believe both depression and anxiety are considered "mood disorders" [2], but I am not a psychiatrist by any means so this is just what I have been able to ascertain as a layman. "repeatedly manifested itself by overt acts" is incredibly vague to me. Perhaps it has a strict definition within the psychiatric community, I have no idea (again not a psychiatrist), but as a layman scientist/engineer it seems incredibly vague. Any movement or expression could be described as "an overt act" so this seems to be a catch-all from a layman's perspective. If I had depression and cried twice because of it, has that "repeatedly manifested itself by overt acts"?

[1] https://www.psi.uba.ar/academica/ca...ica_tr_personalidad_psicosis/material/dsm.pdf

[2] https://www.ncbi.nlm.nih.gov/books/NBK572966/

 

[Rushie]

Not an AME so I could be wrong.

Question 1). We had an AME deny/defer because a guy had a tatoo in a recent thread, so yes, definitely possible that an AME you consult could turn you in to the FAA. But whether it is likely the average AME would do that I have no idea.

Are you legal under BasicMed now? Assuming you got your previous class whatever cleanly, these issues came up since, looking at the disqualifiers that AKiss listed, you come under none of them. Certainly not the last three, and simple anxiety is not a personality disorder, although it could be a feature of some PDs. I share AKiss’s thoughts about “overt acts” in any case. I’m thinking they mean violent acts or frankly antisocial or dysfunctional acts, not normal expressions of emotion. Crying would not qualify but a suicide attempt would.

Wait, that says “or”:

“A mental health disorder, limited to an established medical history or clinical diagnosis of— ”

So “a mental health disorder” would be anxiety, but “limited to an established medical history” - well you did not have an established medical history of the anxiety disorder when you went on BasicMed.

If you got a clean medical, went on BasicMed, then started an SSRI for anxiety, it seems technically you’re legal by my unqualified interpretation but I would not bank on the FAA agreeing with me.

 

[Lindberg]

Wait, that says “or”:

“A mental health disorder, limited to [(]an established medical history or clinical diagnosis[)] of— ”

"Established medical history" and "clinical diagnosis" both modify the following.

 

[Rushie]

"Established medical history" and "clinical diagnosis" both modify the following.

Ah! Thank you! It’s the location of the comma. I was reading it like the comma was after “history”. Changes the whole meaning. So that is indeed saying only those four listed are disqualifying.

Commas are important. Let’s eat, Grandma! vs Let’s eat Grandma!

 

[Lindberg]

Q1: If I talk to an AME who specializes in this, and they do not happen to agree that it is legal to fly on Basic Med without the special issuance, are they going to report me to the FAA for doing so?

There are apparently AMEs out there who would do this. Suggest you ask for names of reliable AMEs interested in keeping airmen in the air if you decide to go this route.

Q2: If I did find an AME who was willing to work through SSRI Path 2 so that I could get a SI and then resume flying under Basic Med afterwards, how long would I likely be grounded during the process? (Assuming that SSRI Path 2 even available for anxiety, not depression?)

If you have your ducks in a row in advance, Path 2 should result in deferal for FAA decision, not denial. So Basic Med would still be available in the interim.

 

[AKiss20]

I’m thinking they mean violent acts or frankly antisocial or dysfunctional acts, not normal expressions of emotion. Crying would not qualify but a suicide attempt would.

I would presume that is the intent as well, but afaik it is not defined anywhere.