What is "Recurring" exactly?

[Guest1]

I have read about recurring mental illness in various forms that will all but mandate SSRI Pathway II, but my question is what is recurring? This is all referencing an initial course of psychotherapy.

Case A: Patient diagnosed with mild depression (first occurrence). Takes SSRI for 6 months. No depression symptoms on SSRI. Stops SSRI and symptoms return for 1 week. Seems like a cut and dry recurrence to me. But what if patient then starts therapy and maintains documented good mental health for the next 9 months? Is this resolved or recurring?

Case B: Patient diagnosed with mild depression (first occurrence). Takes SSRI for 1 week and feels terrible in every way. No relief of depression symptoms from meds. Patient stops SSRI and continues traditional therapy. In the course of therapy, the patient achieves 1-2 months of remission, has 2 days of depression symptoms, then has 6 months of remission and continues in life without symptoms for eternity. Is that lapse after 2 months considered a "Recurrence" or just part of the therapy process?

How is the determination made that the patient has resolved their depression, does a specific amount of time need to pass? How does the FAA pick a specific date in the course of initial therapy to start counting and look for a relapse? Be it depression, anxiety, or adjustment disorder.. the road to recovery and stability will be full of ups and down. 3 good days and then 3 bad days, 7 good day and 2 bad days, 2 good weeks and 1 bad day... you get the idea. It is not as easy as pointing to the calendar and saying that in Mar and May I had continuous symptoms and now on June 1, I will never had another bad day. Therapy doesn't progress like that.

The only definite thing I can see would be a psychologist/counselor/psychiatrist formally releasing the patient from therapy and then at a later time the patient re enters therapy.

Thoughts?

 

[AggieMike88]

Pinging Doctor’s Lou and Bruce for their input. @lbfjrmd @bbchien

i don’t think many of us non AMEs are qualified to answer

 

[flyingron]

As far as the FAA is concerned:

If it happens once it's "a history of."
If it happens twice it's a "reoccurence of."

 

[Guest1]

As far as the FAA is concerned:

If it happens once it's "a history of."
If it happens twice it's a "reoccurence of."

But at what point are you considered healed and any return of symptoms is then a recurrence. As I said, no one who is being honest goes from continuous symptoms straight to symptom free and in complete remission

 

[lbfjrmd]

any mental illness is thoroughly evaluated by the FAA

 

[bbchien]

Guest 1, you have the misapprehension that the clinical evidence of the illness is defined by when the person takes medication. That's only partly true. It depends on the clinical notes. Two episode of depression serious enough to require (1) First episode, talk therapy, (2) second episode with or without meds, is a recurrence.

Then there is relapse vs recurrence: I cannot teach psychiatry 301 on a web forum.

Guest 1, you will need a forensic psychiatry evaluation....

 

[Rushie]

OP: they’re not giving you a straight answer because there is none. It all depends on what is in your record.

Consider:

Case A: “When I stopped the SSRI, I had 1 week of Discontinuation Syndrome, then I was fine.”
Case B: “Talk therapy fixed my depression. I had 2 days of a bad mood at some point.”
In both cases: “I got counseling to resolve my feelings that daddy loved sister more than me,” or, “my marriage is on the rocks.”

OR

“I keep getting depressed. It came back for one week. Then it came back for two days. For a while I was on an antidepressant but now I seem to do fine as long as I am in therapy.”

See the difference? Technically, it’s not depression until it lasts for two weeks or more. What they write in your record is what matters, and that will be what your doctors and therapists interpret from what you interpret from your own symptoms, distorted a bit by what’s necessary to get your insurance to pay.

And so once you’ve gone down that road, as both docs here have said, the FAA will scrutinize it, even if cases A and B are two different people, they’ll want to do a close look in both cases.