Short term SSRI use

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Anon

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Time to decide between 3rd Class Medical renewal and Basic Med. I prefer 3rd Class but don't need it. I am having trouble finding a Basic Med provider.

Most of you know me. I lost an immediate family member 18 months ago. A few months after, I was prescribed Lexapro. I took 10mg for 5 months and stopped 1 year ago. Diagnosis code was Adjustment Disorder with Anxiety.

No other history of psych issues or meds.

The psych nurse who prescribed the meds is no longer at the counseling practice. However I still have the same PCP.

If I get my PCP to sign a letter stating the above, will that be enough to get issuance on the spot?
 
I hope she was a Nurse Practitioner (and in one of the 21 states that allow them to prescribe). Nurses don't have prescribing rights in most places. Nurses can't sign off basic med under any circumstances. If your primary physician is OK with signing you off for basic med, you can do that.

A note from your PCP isn't going to mean diddly to an AME when you've been prescribed SSRIs. It needs to come from the treating physician. You need to go back to the practice and find out get someone there to provide you with a status report, hopefully a physician.

Frankly, this whole thing smells. What state are you in?
 
Prescription was by a Psychiatric Mental Health Nurse Practitioner (PMHNP). Board certified and licensed to diagnose and treat mental health conditions and prescribe medications.

PCP is a PA.

Dr Bruce: a while ago you posted a list of 8 (?) medical history criteria that needed to be met. You said that a letter addressing all these items would allow the AME to issue. Can you repost those items? Does the letter have to be signed by a psychiatrist or physician, even if none were involved in the treatment?
 
(1) formal diagnosis
(2) Doc has to name the stimulant to the need for Tx
(3) What was prescribed and start DATE.
(4) Date of discontinuation (Must be < 180 days)
(5) That there was no suicidality
(6) That to the doc's knowledge this was the ONE and ONLY episode in your life reuqiring psychiatry support.
(7) that he has seen you > 60 days after discontinuation and there are no symptoms remaining.
(8) That the simulant to the need for Tx is gone.

All eight components have to be there....MUST be signed by the phyiscian. PAs are not MDs. Psych mental health nurse practitioners are not MDs.

B
 
bbchien said:
(1) formal diagnosis
(2) Doc has to name the stimulant to the need for Tx
(3) What was prescribed and start DATE.
(4) Date of discontinuation (Must be < 180 days)
(5) That there was no suicidality
(6) That to the doc's knowledge this was the ONE and ONLY episode in your life reuqiring psychiatry support.
(7) that he has seen you > 60 days after discontinuation and there are no symptoms remaining.
(8) That the simulant to the need for Tx is gone.

All eight components have to be there....MUST be signed by the phyiscian. PAs are not MDs. Psych mental health nurse practitioners are not MDs.

B
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with all the subjectivity inherent in diagnosing psychiatric disorders it must be nerve wracking for an MD to represent to the FAA that a patient is stable
 
As a physician, I'd have no trouble covering these 8 points. Sounds worse than it is. 1 through 4 would be a summary restatement of known facts. 5-8 are medical opinion judgements based on known history and my interview with the patient. No real medicolegal liability incurred if I do my due diligence and render medical judgement accordingly. (assuming no/never suicidal and I don't think he has residual impairment/condition still present)

I think this would carry less liability than signing a basic med exam. Of course, there is the whole, "my PCP is a PA/RNP etc etc issue to navigate..."
 
I have a consultation today with a HIMS AME who also does Basic Med. He is a psychiatrist. If anyone can find a path forward, he will. I'm fine with basic med if renewing my class 3 is too hard given circumstances of the original prescription.
 
Just had consultation with AME. It's all sorted out.

Once I have been off the med for 2 years, he can issue a Class 3 without documentation. Before then, he would need to defer to FAA for an SI.

So I am going to get a Basic Med from him now. Next year when I hit 24 months, I will go back and get a Class 3.

Huge relief!
 
Anon said:
Time to decide between 3rd Class Medical renewal and Basic Med. I prefer 3rd Class but don't need it. I am having trouble finding a Basic Med provider.
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Anon said:
So I am going to get a Basic Med from him now. Next year when I hit 24 months, I will go back and get a Class 3.
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You don't need a 3rd class. Why in the world would you leave Basic Med and do Class 3? Why did you even see an AME and do a consultation?
 
WDD said:
You don't need a 3rd class. Why in the world would you leave Basic Med and do Class 3? Why did you even see an AME and do a consultation?
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1. Irrational preference for what I am used to.
2. Card fits in my wallet.
3. Just in case someone wants me to fly their P-51 or C-47. Latter is not unrealistic since my best friend owns a C-47.
4. Once the condition has been reported and a Class 3 issued, I don't have to worry about it again.
5. Consultation was a cheap and easy way to eliminate uncertainty.
6. The AME happened to be the only place I could find nearby that offered Basic Med.
 
My .02. Why even risk it? Even after the issuance, pretty sure I have read Doc B post that these cases get reviewed in OKC.

Flying the skytrain sure would be fun, but Basic Med and never look back, if it was me.
 
Anon said:
Latter is not unrealistic since my best friend owns a C-47.
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Yes, but is he likely to let you fly it solo? If he’s on board as PIC, you could still fly it on Basic Med.

(And I need to make some new friends.....)

In any case, you have two years to decide.
 
Learnin’ to fly… said:
My .02. Why even risk it? Even after the issuance, pretty sure I have read Doc B post that these cases get reviewed in OKC.

Flying the skytrain sure would be fun, but Basic Med and never look back, if it was me.
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Because I don't see it as a risk. The FAA policy is clear, and I will have a chance to review everything with the AME before doing it for record.

You do you.
 
Anon said:
Because I don't see it as a risk. The FAA policy is clear, and I will have a chance to review everything with the AME before doing it for record.

You do you.
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Yeah - looks like you have a good plan!

I’m an admitted chicken **** when it comes to losing my ability to do the high(er) risk activities that help keep me sane!
 
Got my Basic Med in place today.

The exam was done by a HIMS AME. He said come back next year when I have been off the SSRI for 24 months, and he will have no problem issuing me a 3rd Class on the spot. He said I did not need to bring any records or documents. He said the FAA might follow up later with a letter asking for a statement from me, or possibly my pharmacy record, but he said that would not affect my med cert status and was no big deal.

Pretty happy with the process so far. I had a horrible life event and I'm glad the FAA is reasonable about it.
 
Anon said:
Got my Basic Med in place today.

The exam was done by a HIMS AME. He said come back next year when I have been off the SSRI for 24 months, and he will have no problem issuing me a 3rd Class on the spot. He said I did not need to bring any records or documents. He said the FAA might follow up later with a letter asking for a statement from me, or possibly my pharmacy record, but he said that would not affect my med cert status and was no big deal.

Pretty happy with the process so far. I had a horrible life event and I'm glad the FAA is reasonable about it.
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Congrats on getting the BasicMed! Glad to hear the FAA is playing fair for once.
Quick question—since you saw a HIMS AME, what was the actual exam like? Did he grill you much on the past SSRI use or the 'life event,' or was it pretty much a standard physical?
Trying to gauge what to expect for my own go-around. Safe flying!
 
I had already laid out the key facts during the consultation. He asked no additional questions about the SSRI use, which surprised me. It was a standard physical, very quick. Eyes, ears, heart, lungs, reflexes, vision, and a few questions about lifestyle. I am very physically healthy for my age, zero history of illness, so I was an easy layup for him.

I pressed him for a comment on the SSRI because he was a psych. He said it was entirely understandable in those circumstances, he had no concerns, and neither would the FAA.

Fortunately I had done some research before getting the prescription. The tools provided by Dr Bruce helped me understand some key points that could complicate the process. Those were:

1. Code the diagnosis as Adjustment Disorder, not depression or anxiety.
2. Only one medication at a time.
3. No recurrence after stopping.

There is a lot of stupidity out there by people who want to inject their non-medical opinions on SSRI's into the discussion. Fortunately the FAA seems to be fairly objective about it.
 
Typical POA cycle on such topics:

1. Predictions of doom from those who haven't BTDT.
2. Good personal experience described.
3. Predictions of doom based on a different scenario.
4. Repeat.

I'm glad the real-world process is working out for you as it should.
 
Lindberg said:
Typical POA cycle on such topics:

1. Predictions of doom from those who haven't BTDT.
2. Good personal experience described.
3. Predictions of doom based on a different scenario.
4. Repeat.

I'm glad the real-world process is working out for you as it should.
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Five out of six players report no adverse effect of Russian Roulette. The sixth player was unavailable for comment.
 
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