Third Class Medical, current 5+ years on mirtazapine

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DontWannaSay

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I’ve had a depression diagnosis for over 5 years and have been taking mirtazapine for over 5 years, still on it and don’t plan to stop and am stable and healthy. Mirtazapine is not one on the conditional list, but it’s not on the “unacceptable” list, either (it’s a tetracyclic antidepressant; the closest thing on the unacceptable is tricyclic). I have in the past (many years ago) tried two other antidepressants that are on the approve list while my doctor and I tried to figure out what would work for me, but I’ve never done multiple concurrently. I have no history of suicide attempts.

I’m planning to find a good HIMS AME for a consultation, but before that:

- Does the fact that my medication is not on the conditionally accepted list mean automatic denial? It seems that way from SSRI Decision Path - I…
- If it’s automatic denial, is there any path forward for me for PPL or do I need to settle for Sport Pilot? I might be willing to explore a medication change, but not sure how that will be seen, plus if the change turns out inferior to my current medication, I have to prioritize switching back over flying.

Thanks in advance.
 
DontWannaSay said:
I’ve had a depression diagnosis for over 5 years and have been taking mirtazapine for over 5 years, still on it and don’t plan to stop and am stable and healthy. Mirtazapine is not one on the conditional list, but it’s not on the “unacceptable” list, either (it’s a tetracyclic antidepressant; the closest thing on the unacceptable is tricyclic). I have in the past (many years ago) tried two other antidepressants that are on the approve list while my doctor and I tried to figure out what would work for me, but I’ve never done multiple concurrently. I have no history of suicide attempts.

I’m planning to find a good HIMS AME for a consultation, but before that:

- Does the fact that my medication is not on the conditionally accepted list mean automatic denial? It seems that way from SSRI Decision Path - I…
- If it’s automatic denial, is there any path forward for me for PPL or do I need to settle for Sport Pilot? I might be willing to explore a medication change, but not sure how that will be seen, plus if the change turns out inferior to my current medication, I have to prioritize switching back over flying.

Thanks in advance.
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I don't know your ultimate goal in aviation, but if it's not to be a professional pilot then you have new options (and pretty decent ones, at that) which will not require an FAA medical. Those options will vanish if you apply for a medical and get denied, so tread cautiously. Don't apply unless you know it will ultimately be approved.
 
Don't wanna say: An airman must won a lawsuit (Solondz) that denial on mirtazepine was "capricious and arbitrary" and he was isused however of all the antidepressives, mirtazepine iw the one we pain docs use to induce sleep. You'd have to pass the FAA's neurocognitive profie and mirtazepine's profile for cognitive flexibilty is just....awful.

If you can pass the FAA's neurocognative eval, you may have to sue (as it currently stands). Personally, I don't think Remeron (Mirtazepine) is a good aviation choice.....

You will need to be under the care of a board certified psychiatrist.....(not a PA, APRN nor PCP for this one).
 
I agree with Bruce. Although not an AME, I am a long practicing general internist who has written a lot of antidepressants in my time. Sigh... Anyway, despite an airmen getting a partial victory with respect to mirtazapine, is generally felt to cause quite a bit of sedation and it's not at all clear that this will ever become an approved medication. Likely the FAA can indeed come up with a very good reason why mirtazapine isn't a safe choice for a pilot. Or, at least a slew of highly paid experts to say something along those lines. To simplify it, if you can't fly on Benadryl, you're not likely ever going to fly with Remeron.

If you pursue this as a class 3 or above, prepare for a very long, expensive road, and still a good risk of ultimate failure. While I won't tell you what you should do, if I were in the same situation, I would be content with an SP license. With the recent expansion of MOSAIC, the number of options will indeed improve significantly.
 
Thanks very much for the speedy responses, all. It’s very disappointing but good to know now before wasting time, money, and energy on it.
 
DontWannaSay said:
Thanks very much for the speedy responses, all. It’s very disappointing but good to know now before wasting time, money, and energy on it.
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Do you want to fly for fun, or fly for money? If it's for money, yes, it's disappointing. But if you want to fly for fun, you can. (At least legally; whether it's safe or wise is a decision for you and your treating physician, no FAA involvement.)
 
For fun. So not as bad as it could be. With MOSAIC, I can fly the same planes most PPL beginners would fly, but it’s a bummer I won’t be able to have more than one passenger, fly internationally, or fly at night.

I guess a follow-up, albeit a bit hypothetical: If I were to change medication to one that’s on the conditional approval list now, and then stay on that for 5(?) years and continue use beyond, assuming stable health, how might my odds change under current FAA policy for going for Third Class Medical 5 years from now?
 
DontWannaSay said:
but it’s a bummer I won’t be able to have more than one passenger, fly internationally, or fly at night.
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Realistically, that's how most of us fly most of the time anyway. It's not as limiting as you think. Also, SPs can fly in the Bahamas (and I'd bet some of the rest of the Carib wouldn't care). Besides, in a few years those limitations may loosen a bit. That's been the trend.

It's really not that bad at all, and there are lots of planes you can fly (even some early Bonanzas) now with a SP ticket.
 
If your healthcare were consistent with one of the meds on the list, you could apply in 3 months with some expectation of success (provided the neurocog came out okay). Trick is, you don't apply until you HAVE IT ALL.

B
 
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Maybe look at this in an upbeat way. It's only been within a fairly short period of time that people have been able to fly. And it's still true that only a very small percentage of the world has the resources and ability to do so at all. So get sport if you can, and reflect on all of the fortunate things that led to that. If you're finding 2 up for sport potentially limiting, that tells me there's a good chance you have family, friends or a significant other to fly with. So get one of those interested in flying, and get them to get their private pilot. That'll be more fun and safer for all. Whatever you do, make sure you're able and safe. Worst case there, you just fly with an instructor or other pilot along. Not that big of a deal. Best of luck! Oh, and remember that a lot of people find riding a motorcycle a lot of fun. Yet I don't think I've ever seen 3 people on one outside of a circus.
 
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