SSRI - Path 1

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No_Eagle_1355

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No_Eagle_1355
I’ve read through prior threads and I’m trying to gain some clarify, if such a thing exists. I also did a consultation with a HIMS AME but I think they may have given me some bad info.

I was on an approved SSRI (Lexapro) starting last summer while I was going through some mild social anxiety driven in large part to work-induced stress. This is the first and only time I’ve ever been on any SSRI mediation. I’m in the process of weening off under the supervision of the prescribing doctor. Assuming a successful discontinuation, I planned on filing for a 3rd class medical 90+ days after being off the medication.

During my consult, the HIMS AME walked me through Path 2 and said even though I fit the criteria for Path 1, they’ve never seen it work for anyone and I should prep for a psychiatrist eval and the other test (cog screen, I think).

I’m confused. I’ve read posts from others (including Dr. Bruce) and it looks like if my prescribing physician writes me a letter recapping my medication history and successful discontinuation, I can just bring that letter with me to my FAA medical and they should be able to issue a 3rd class medical on the spot (although it may be subject to a later deferral).

I understand it can be clear as mud when dealing with this. Anybody else have any insight or experience with an SSRI path 1?
 
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.
 
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Thanks, Dr. Bruce.

What does this mean? “That there was compromise of reality testing at any time in you course.”

Everything else seems kind of straight forward. The AME may issue right away if they conclude it fits a narrow set of circumstances or they defer and it’s that.
 
Dr. Bruce --

As to your statement -
As you will have been on a med within a year prior it is a special issuance. AME defers, the agency reviews and issues.[/QUOTE]

I am trying to figure out where the one (1) year requirement is in the regs... The way I was reading them, I could only find a 60 day requirement. I was looking at this link...https://www.faa.gov/about/office_or...am/ame/guide/media/SSRI Decision Path - I.pdf

I am sure you are correct, and the FAA's website is very difficult to navigate, just trying to get a better understanding.
 
That's a good point, Michael.

Decision Path 1 specifically says "...may apply for regular issuance." I'm not up to 5 posts yet so I can't include links in posts but if you google "Guide for Aviation Medical Examiners Decision Considerations - Aerospace Medical Dispositions Item 47. Psychiatric Conditions - Use of Antidepressant Medications", it takes you to the FAA website. There, the only reference to SSRIs and being off of them is SSRI Decision Path 1.

I agree with Michael that Dr. Bruce is probably correct, just looking to where or how the FAA addresses it.
 
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Michael T. Runyan said:
Dr. Bruce --

As to your statement -
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...

no_eagle-1355 said:
I am trying to figure out where the one (1) year requirement is in the regs... The way I was reading them, I could only find a 60 day requirement. I was looking at this link...https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/SSRI Decision Path - I.pdf

I am sure you are correct, and the FAA's website is very difficult to navigate, just trying to get a better understanding.
Click to expand...
That's administrative policy, which is not posted. Of course, anyone is free to believe anything desired - the results just aren't very good.
 
Thanks Dr. Bruce. I figured you had some inside baseball knowledge. Just wanted to make sure I wasn’t missing anything obvious on the FAA website.
 
If I were to pursue my 3rd class medical after I’ve been off of Lexapro for at least one year, does that make path 1 approval more attainable and less likely to be deferred?
 
No_Eagle_1355 said:
If I were to pursue my 3rd class medical after I’ve been off of Lexapro for at least one year, does that make path 1 approval more attainable and less likely to be deferred?
Click to expand...

Time alone isn’t the issue. Decision Path 1 is very vague and a bit conflicting with other guidance. It is a high priority re-write going on right now.

If you took SSRIs for less then 12 months, ideally less than 6, you don’t have recurrent or comorbid disease, it is possible to be issued without a deferment. But not many AMEs are fully up to speed on that as it isn’t formally written yet.
 
<6 month exposure, single med, only time in your life exposed to the single med, no suicidality…it has always been in the AMEs authority. But the audit rate is 100% and now that is in question as they are moving to require that as a special issuance…which would be a deferral….

there is a “adjustment disorder” sheet for that situation…..
 
bbchien said:
<6 month exposure, single med, only time in your life exposed to the single med, no suicidality…it has always been in the AMEs authority. But the audit rate is 100% and now that is in question as they are moving to require that as a special issuance…which would be a deferral….

there is a “adjustment disorder” sheet for that situation…..
Click to expand...
My son wants to start pilot school, but he was put on Lexapro a few months ago by just his PCP to help him sleep and deal with a very mild case of depression. He is doing amazing on it and we are confused if he needs to get off of it or what the process is. It is First time and only time he has ever had in any issues with sleeping/depression. Please direct me on what the next steps are. His goal is to become a chapter or commercial pilot. Thank you!
 
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