Yet another SSRI question

Discussion in 'Medical Topics' started by newbie99, Dec 13, 2017.

  1. newbie99

    newbie99 Guest

    Everone's story is different, here's mine:

    About 18 years ago, at my wife's urging, I mentioned to my PCP that I was feeling irritable above what I thought was normal. PCP asked the usual questions about triggers (work stress) and what not and me not knowing any better, accepted the Rx for Celexa.

    Don't remember how long I took it, honestly. I never noticed a difference while on it (was told it was a low dose, but don't remember the mg). I stopped taking it, and instead focused on simply changing my attitude about the things I was getting upset about.

    About 10-11 years ago, the wife again urged me to go to the PCP and get back on the Celexa (work stress, again). Still not knowing any better, I had the PCP (a new one) write a new Rx for a low dose. Took it long enough to run out, but never renewed the prescription. Told the doctor I didn't think it was helping/making a difference--I just needed to learn to deal with bad situations like a big boy. She agreed, and that was that.

    Haven't taken it or any other AD since, but now that I'm in the beginnning stages of starting flight training, and learning about all the ways to get DQ'd, I'm nervous. I never have been one to keep copies of medical records, and honestly can't even remember the name of the doctors in question.

    If I disclose that I took the Celexa "once upon a time", I'm under the impression I have to prove when and why I'm no longer taking it, which is where my worry lies. I've switched doctors a couple times (two retired on me!), and since I haven't taken it in so long, I didn't even mention it to my current doctor.

    Am I worrying over nothing, or ....?
     
  2. Rushie

    Rushie Cleared for Takeoff

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    Wow, wow, SO GLAD you came here first before you apply for your medical. Is this correct? You have not applied yet. I wouldn't touch MedExpress with a 30 foot pole right now.

    Yes this will be a problem. Yes, you need to try to find your records. Bottom line, get with the right AME and sort it all out before sending anything in to the FAA. One of the "right" AMEs will be Dr. Bruce Chien. If you live anywhere near him, if it were me I would see him in person for something like this.

    I think it will be less of a problem if the first time you took it was less than two years, but the fact that you had a prescription filled a second time is an issue. The FAA views this as evidence of depression and indeed both these doctors probably coded your insurance for "depression" of one sort or another. Those records exist somewhere unless this was so very long ago (pre-dates computers) and I don't even think Celexa has been around that long. (Well 18 years yeah maybe still paper records..) If you cannot remember the doctor or he is retired and unavailable, try to get the record from your insurance company. Maybe you can get past copies of your "explanation of benefits". What you need to try to find are the diagnosis codes. The more of this you can pull together before seeing an AME the better.

    You might also get pharmacy records and at least find out exactly how long you took it. Dig through your checkbook register and see if you can find the names of the doctors.

    If you truly are depressed, the only way you can fly is on the SSRI protocol which means you would have to get back on an SSRI. But it sounds to me like either you don't have depression at all, or if you do that drug at that dosage was ineffective. I fear that the only way through this is to answer that question which unfortunately means psychiatric testing. Dr. Chien or others may correct me if I'm wrong, if there is any way to make this go away without testing??

    Hindsight is 20/20 and too late for you but the lesson here as I see it: if a spouse is unhappy with YOUR mood, take that to mean instead, she is unhappy about something in your interaction (it is she who is perceiving your mood), and the right approach to that is marriage counseling. Marriage counseling is the only psychotherapy allowed by the FAA without a closer look. Not saying there is anything wrong with your marriage but pilots can take this route without certification risk and if you truly are depressed the therapist can guide you toward proper testing and treatment. But pilots jumping straight to getting SSRIs from a PCP like you did is like stepping into a minefield.

    Probably your wife is accurately perceiving when you are under stress and I think you figured out how to handle life stress without pills but convincing the FAA of this is another matter. You do need expert AME help with this one. You must be CERTAIN your application will lead to issue before you let it go "live". (That means pushing the submit button.) If you cannot be certain of that then you might want to leave it alone and go sport pilot. What you do not want to happen is to get a denial.

    Whatever you do, don't start filling out the online application and then give the confirmation number to an AME, even if you tell them you don't want it to go live. What you need first is a consult with an AME, not a certification visit.
     
  3. newbie99

    newbie99 Guest

    I'm glad too, that I came here first.
    No, absolutely HAVE NOT submitted anything. I'm still in the "I've always wanted to learn to fly" stage.

    Definitely not depressed, and you are right: we did the counseling thing. Didn't want to get into that, but yeah that's where I learned how my stress was affecting my family, etc. and ways to deal with it.
     
  4. lbfjrmd

    lbfjrmd Pre-takeoff checklist

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    so i am a HIMS-AME and do not completely share the above ... other than to agree Dr. B is very good. Other than not telling the whole truth ... you will end up successful. The FAA will likely want a psychiatric opinion. I do not see in hidden pitfalls for you! good luck.
     
  5. Rushie

    Rushie Cleared for Takeoff

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    That's good news! Obviously you know better than I do, so you don't think the whole thousands of dollars evaluation will be required but maybe just a consult with a psychiatrist?

    PS edit: and to the OP, I don't know this AME as well as I know Dr. Bruce but I think you'd do fine with him too.
     
  6. newbie99

    newbie99 Guest

    Well, if nothing else, I feel more confident now than a few hours ago! Guess we'll see if that is short-lived, lol.

    I will try and find an AME around here that will do a consult first, without paperwork. I've got no issue with going to a psychiatrist for an evaluation. I just hate to spend a boat load of money for a "NO". Heck, even a "YES" because in my mind, it's not an issue.

    Thanks!
     
  7. Rushie

    Rushie Cleared for Takeoff

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    I know just how you feel. That sounds like a good plan, when you call to make the appointment just tell them that's what you want to do. If you have any doubts or questions about what happens come back here, these two doctors (lbfjrmd and Dr. Chien) will know what to do and are lots better than some of the AMEs we hear about on this forum, plus all the other pilots who've been through this. I myself took an SSRI years ago and had to jump through a couple extra hoops but got certified in the end.
     
  8. lbfjrmd

    lbfjrmd Pre-takeoff checklist

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    yes ... if the shrink clears him i think it will be 'good to go'. whether they want any shrink or a faa shrink is only question.
     
  9. iflyvfr

    iflyvfr Cleared for Takeoff

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    Be aware that shrinks do not participate in the health insurance system; you pay them cash. That shouldn't change anything, but it was something I quickly learned. I too had some life/work stress that my PCP "Dr. Feel Good" helpfully tried to fix with some Lexapro. Your story sounds quite similar to my own - I let Dr. Chien guide me through it. Lots of paperwork but in the end it all worked out fine. The great thing about Bruce is he won't let you give him the code until he knows with great certainty whether you will be issued. It takes all the guesswork out of dealing with a standard AME who is otherwise clueless about the more difficult cases and who will defer you without a second thought. Good luck.
     
  10. bbchien

    bbchien Touchdown! Greaser!

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    The key will be an FAA credentialled psychiatrist to opine after seeing you, and reviewing your records, that these were “reactive” situations and that there is not an underlying propensity to depression/anxiety. But I would not make a move without it.

    See the alternative explanation would be that you have a chronic, mild recurring dysthymia which predicts future relapse again. Then the only way to win certification is on the SSRI protocol, to be monitored frequently snd repetitively...and that is time and funds intensive.

    I can hear the FAA’s Dr. Giovanetti’s voice now.....

    So Dr. Fowler and I differ on the approach. I would gather the records and do the necessary eval. first. He eeould do the ex, defer to the FAA, and await instruction. I would get the necessary evaluation FIRST, preserving the ability to NOT do an exam that might end in denial.

    Having personally experienced a “board of review”, why would one go forth without wverything in the bag?

    But no matter how you cut it, you will need the HIMS Psychiatry evaluation and every bit of record you can get...

    Dr. Bruce
     
  11. newbie99

    newbie99 Guest

    Ugh. While I certainly appreciate your input, my confidence was absolutely short-lived! So, if I understand what you are saying is that my first step would be to meet with the HIMS Psychiatrist? Then, take those results to a regular HME?

    My wife is more confident than I am at this point; she thinks getting records won't be a big deal. Hopefully she's right!
     
  12. lbfjrmd

    lbfjrmd Pre-takeoff checklist

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    i always wait for a HIMS to be authorized by the FAA (the only way it can be). Many time i expect a case to go HIMS ... then hear from FAA that they only need 'this or that'. But that is not to say that experienced HIMS AME's have to dot every i and cross every t. We high volume HIMS-AME's all have own bag of tricks, special phone # etc.
     
  13. Rushie

    Rushie Cleared for Takeoff

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    If I am understanding the two different approaches here and the OP's confusion. Dr. Bruce does not want to send it in until it's completely sewn up, without any chance of denial and a formal HIMS psyche "pass" would achieve that. But Dr. Fowler would send in what records you have, a lesser visit with a regular shrink, and feel pretty confident the FAA will eventually pass you, even if they ask for more this and that, and it might all be accomplished with less expense and hassle.

    Both are "right" in their own way. I did it the second way, the AME sent the application in, the FAA responded saying they wanted a personal statement from me, but didn't even require another psychiatric evaluation (aside from the one I'd already sent in, not a HIMS). I sent in my statement and got certified.

    But that was before I ever went onto these forums, I knew nothing about sport pilot or denials. If I had known, I probably would have done it Dr. Bruce's way, because I'm kind of a perfectionist and it would have really bothered me to have gotten a denial and then not be able to fly sport pilot.

    So it's up to OP how you want to do it. If you are extremely risk averse, I'd go with Bruce's way. If you can take a small chance you might be denied, do it the other way, send in the basics and wait for the FAA to ask for more.