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View Full Version : SSRI and 3rd Class Medical


n27e
08-06-2018, 12:14 PM
I am not 100% sure if this is the correct forum but based on other posts, I figured I could get some assistance here.


If you're knowledgeable on the subject at hand, please, render your best advice. If you have nothing valuable or nice to say, I ask you refrain from replying otherwise you're just wasting both of our time.


Now to the question:


I am student pilot; in 2016, I was diagnosed with Generalized Anxiety Disorder. I opted to take medication because at the time, I did not know it would disqualify me as per the FAA.



I was prescribed an SSRI (Fluoxetine to be exact). During this period, I was dealing with high levels of stress at work and felt it was time to seek help. The medication surely helped and luckily for me, I did not experience ANY side-effects. From the moment I started the medication, I stopped flying because I wasn't sure if I could. I have not flown since. In 2017, I moved to WA and my 3rd Class medical was already expired. I made an appointment to see an AME and disclosed my medication. The FAA deferred my medical application as I was instructed (strongly via a lengthy legally worded letter which freaked me out a bit) that I was to see a HIMS doctor and complete all these tests.



I consulted a HIMS doctor and he advised me that the whole process could be expensive. I am also an AOPA member and their medical team pretty much told me to either pay the expenses or come off the medication. That or just simply give up. Other than that, the AOPA medical team wasn't very comforting or helpful besides that information which to me was pretty much useless as I already figured what they said. It was worth a try nonetheless.


Almost a year later and I am still clueless as to what I should do. It upsets me every time I see a plane fly over my house because my dream is grounded literally.


Had I known this would have happened, I would've thought about alternative options but I am not as experienced as many pilots are. I have almost 100 hours to include solo time I have paid for and it only took me this long because I am an active duty service member and had to deploy several times.



Keep in mind, I go through the military medical system and when I suggested to my PNP (Psychiatric Nurse Practitioner) that I wanted to try to come off the medication, she wasn't too fond of the idea (even though I have been on the medication for almost 2 years with no issues.


From what I was told by AOPA, hypothetically, if I came off the medication, the FAA would require documentation from an actual Psychiatrist and not a PNP as they do not hold enough weight to speak on my behalf.


My ultimate question is, where do I go from here?



Personally, at the time I sought help, I feel as if I took the easy way out by just asking for meds; not realizing the repercussions of it. I do believe that had I just waited, my situation would've gotten better and my stress levels would have decreased as I was in transition of a duty station plus had other personal issues going on that subsided months later after being diagnosed.



Has anyone else had this issue before? If so, what was your course of action and are you flying again?



My fear is I will never get to fly again, I don't have the money to pay for all these tests and to deal with the FAA but rest assured, I have accepted and dealt with numerous stressful challenges far greater than piloting an aircraft and made it through safely if not better than others with more experience.



What is your best advice?


rickair7777
08-06-2018, 12:44 PM
The bad news first: If you REALLY need to be on meds, then it will be an uphill and expense battle to get cleared to fly. This was not even allowed at all just a few years ago, and the FAA only recently made it possible. Unfortunately shortly after the policy change, that germanwings fruitcake murdered a planeload of people, which caused the FAA to take a round turn on mental health issues in general, and flying on meds in particular.

The good news: Generalized anxiety disorder is very common, and in a situational context is most often easy to resolve. Unless your life consists of constant, unavoidable high stress levels, odds are good that most folks can use the meds for a few months to stabilize themselves, and then manage their lifestyle better to avoid the anxiety spiral... just knowing that it can happen and how you got there is half the battle. Do some research on lifestyle and stress, and then get a second opinion if you think getting off meds would work for you.

Complication... being active duty, it's possible that the military medical system might be able to direct you take meds even if you get an outside opinion to the contrary. Might want to talk to a lawyer about that, you wouldn't want to go off meds and then get in trouble for doing it.

WhisperJet
08-06-2018, 12:44 PM
Can you work with someone to find ways to address your anxiety without medication? If you are going through life issues, maybe working with a counselor or life coach can help you through those and enable you to proceed without meds. Maybe lifestyle changes (diet, exercise, faith, meditation, hanging around positive people, new hobbies, etc etc)?

If you opt to stay on meds, and if flying is your dream, suck it up and pay the money. Look at it as the cost of doing business. It's better that you are in the best frame of mind (on or off meds) before you are at the controls anyway. You can do this. It's not impossible but you do have work to do.

Consider working with AMAS who is who ALPA contracts with for medical counsel.

Keep us posted. Good luck to you.


n27e
08-06-2018, 12:59 PM
Thanks for the replies,


I have though about just paying the money (whether it be through loans or whatever I can save up).



I don't really NEED to be on the meds, I remember my original doctor (an actually military psychiatrist) asked me what I wanted to do and I volunteered to try the medication. Horrible choice.



It's just that every medical professional I see, doesn't KNOW me and think I'm just another "freak show". I remember telling my PNP (before I knew she was only a PNP) that I wanted to get back into flying, I told her about the FAA regulations and she literally said to me "well, perhaps you should find another hobby". I left her office feeling extremely empty and lost. I really screwed myself over for doing the RIGHT thing.



I have no intentions of doing anything shady or illegal to fly again, I want to do this the right way.



So far, it's looking that I should just pay the money. I can't let this go, I don't want to be 85 years old some day and regret not doing what is necessary to live out my dream. I'm not asking to be an airline pilot, I just want to fly again for my own reasons. It's what I passionately enjoy.


Thanks to those who responded, I think I know the direction I need to take now. Thanks again!

n27e
08-06-2018, 01:25 PM
Can you work with someone to find ways to address your anxiety without medication? If you are going through life issues, maybe working with a counselor or life coach can help you through those and enable you to proceed without meds. Maybe lifestyle changes (diet, exercise, faith, meditation, hanging around positive people, new hobbies, etc etc)?

If you opt to stay on meds, and if flying is your dream, suck it up and pay the money. Look at it as the cost of doing business. It's better that you are in the best frame of mind (on or off meds) before you are at the controls anyway. You can do this. It's not impossible but you do have work to do.

Consider working with AMAS who is who ALPA contracts with for medical counsel.

Keep us posted. Good luck to you.


Sorry about the question but what exactly is AMAS and ALPA? I am not familiar with these terms, can you please educate me on this? I seriously do not know what they are.

Thanks!

n27e
08-06-2018, 01:31 PM
The bad news first: If you REALLY need to be on meds, then it will be an uphill and expense battle to get cleared to fly. This was not even allowed at all just a few years ago, and the FAA only recently made it possible. Unfortunately shortly after the policy change, that germanwings fruitcake murdered a planeload of people, which caused the FAA to take a round turn on mental health issues in general, and flying on meds in particular.

The good news: Generalized anxiety disorder is very common, and in a situational context is most often easy to resolve. Unless your life consists of constant, unavoidable high stress levels, odds are good that most folks can use the meds for a few months to stabilize themselves, and then manage their lifestyle better to avoid the anxiety spiral... just knowing that it can happen and how you got there is half the battle. Do some research on lifestyle and stress, and then get a second opinion if you think getting off meds would work for you.

Complication... being active duty, it's possible that the military medical system might be able to direct you take meds even if you get an outside opinion to the contrary. Might want to talk to a lawyer about that, you wouldn't want to go off meds and then get in trouble for doing it.


You are 100% correct about the complication. In fact, I have already verified what you have said with my prescribing military doctor (a civilian contractor so-to-speak). He mentioned to me that I CAN see an outside psychiatrist and follow through with their orders and recommendations. The only caveat to that is that I am REQUIRED to report it to the military. That is, doesn't mean the military would disregard it, they just wanted to be informed on what it is I am doing and whether or not my condition is within parameters to remain in military service.



I have less than 2 years remaining on my contract as I plan to leave the service with 9 years in. I did sign a document as Generalized Anxiety is a military dis-qualifier and I ran the risk of an administrative discharge. The agreement I made with the military was that provided I follow my doctors orders I would not be subject to discharge. I have followed ALL orders to the "T" but this is what is stopping me from flying.


Suppose when I get out of the Navy in less than 2 years, I seek outside treatment, would I have a better chance then?

Excargodog
08-06-2018, 02:35 PM
You are active duty???

Geez, guy, make use of your resources. Go find yourself a Navy flight surgeon and tell him/her your situation. If it's a base with a large flying mission, you'll likely have a senior flight surgeon who is board certified in Aerospace Medicine.

These guys are all sort of one big club, the USAF residency at Wright-Patterson, the Army/Navy residency at Pensacola, and afew civilian ones. These guys all know one another in a first name basis and generally the military guys wind up in the OKC FAA office and/or Federal Air Surgeon slot after they get their twenty years in.

Go find a military flight surgeon (Navy if that's your service) and explain what's going on. They pretty much LIKE people who like to fly, or they wouldn't have that job, and that's damn sure the case for the senior guys.

They can get everything you need done through military channels - if it indeed doable.

rickair7777
08-06-2018, 04:56 PM
Sorry about the question but what exactly is AMAS and ALPA? I am not familiar with these terms, can you please educate me on this? I seriously do not know what they are.

Thanks!

Airline Pilots Association (the union).

Aviation Medicine Advisory Service (consulting company). They're good, and you'll probably need them if you want to try to get a medical while taking meds. Not particularly cheap.

If you can get off the meds, you probably don't need to spend that money. Just wait some number of months post-meds, and then get a clean psych eval regarding the anxiety (your AME should be able to advise you on that).

n27e
08-07-2018, 09:01 AM
You are active duty???

Geez, guy, make use of your resources. Go find yourself a Navy flight surgeon and tell him/her your situation. If it's a base with a large flying mission, you'll likely have a senior flight surgeon who is board certified in Aerospace Medicine.

These guys are all sort of one big club, the USAF residency at Wright-Patterson, the Army/Navy residency at Pensacola, and afew civilian ones. These guys all know one another in a first name basis and generally the military guys wind up in the OKC FAA office and/or Federal Air Surgeon slot after they get their twenty years in.

Go find a military flight surgeon (Navy if that's your service) and explain what's going on. They pretty much LIKE people who like to fly, or they wouldn't have that job, and that's damn sure the case for the senior guys.

They can get everything you need done through military channels - if it indeed doable.


Yes, I am aware of my resources, very good point. In fact, that was the first thing I did. I talked to a Naval Flight Surgeon and told him what is going on, unfortunately this particular gentleman was advising me "off-record" so he couldn't do much other than what else I could try. The way the naval medical system works is you can't just call up a flight surgeon and set up an appointment. The use of a referral is required and that would have to be obtained via my PCM or this PNP who is essentially useless to me right now.



HOWEVER, you do raise some more good points and maybe I should dig deeper on this. According the flight surgeon I talked to, he said the odds of me being seen for this particular issue is pretty low for several reasons not even related to my issue but solely on the fact that I'm not a naval aviator and this is primarily for recreational purposes and not directly in the line of duty. He did say, it was possible, so it is worth a shot to try and push the visit.


Thanks for the response!

n27e
08-07-2018, 09:06 AM
Airline Pilots Association (the union).

Aviation Medicine Advisory Service (consulting company). They're good, and you'll probably need them if you want to try to get a medical while taking meds. Not particularly cheap.

If you can get off the meds, you probably don't need to spend that money. Just wait some number of months post-meds, and then get a clean psych eval regarding the anxiety (your AME should be able to advise you on that).


Curiosity, you mentioned that the AMAS is not particularly cheap? How much am I looking at spending via this route?



According the HIMS doctor I talked to months back, it almost sounded as if the most expensive part is getting the psychiatric evaluation.



The FAA also directed me to get and submit a Neuropsychologist report and cog screen-ae report. Cost on this particular testing and report was not mentioned by the HIMS. I'm going to assume this will cost hundreds if not thousands of dollars?


I am just collecting information and assessing my options, right it SEEMS to me that my best chance would be to safely come off the medication, wait the required time by the FAA and try again. The question is, will they still grant me a medical certificate. This was also mentioned to me by the AOPA that even if I do ANY of the above, there is still no guarantee that the FAA will find my case suitable and deem me fit for flight again.


I will definitely keep the forum posted on this matter.

rpatte1637
08-07-2018, 07:57 PM
I had a minor stroke a little over 2 years ago and the FAA has a 2 year mandatory wait. I was expecting to have to do a Cog Screen AE as part of my evaluation and everyone I spoke to in the Atlanta area was around $2500 and the testing take about 2 days to complete.

Excargodog
08-07-2018, 08:51 PM
According the HIMS doctor I talked to months back, it almost sounded as if the most expensive part is getting the psychiatric evaluation.



The FAA also directed me to get and submit a Neuropsychologist report and cog screen-ae report. Cost on this particular testing and report was not mentioned by the HIMS. I'm going to assume this will cost hundreds if not thousands of dollars?
.


Any military medical facility that routinely screens returning deployed troops for Traumatic Brain Injury - which is most of the major ones - ought to be able to do this for you.

JohnBurke
08-08-2018, 05:23 AM
Both AOPA and the AME (aviation medical examiner) who advised you regarding HIMS and your status, were correct.

Do not violate the terms of your military contract. If you do, it will trigger significant additional problems for you, if it leads to a medical discharge. Do what the military has directed you to do.

You have indicated that you do have a valid condition: this is the most important concern, above FAA medicals or other issues. We're talking about your health. If the medication is helping, then you need to recognize that this may be more important than other considerations, and if it has proven to control your anxiety and give you relief, then it really doesn't matter if you were ordered to take it or volunteered. It's what's in use to treat your condition and if it's working, that is what is important.

With regard to the FAA, it is not just the medication, but the underlying condition which the medication is used to treat. The FAA considers both on an individual basis. The use of psychotropic drugs and medications do come with conditions; they generally lead to deferrals, but with treatment and on a program of testing and observation, it is possible to get medical certification. Anything you do to complicate that will only make the process more expensive or difficult later. That can include being denied a FAA medical, or a military discharge for the condition. In the case of the latter, were you to vary from your military obligations and contract, would signal the FAA that your condition had already been determined disqualifying by the military; there's no reason to complicate the matter.

You can certainly speak to or attend a physician outside the military for consultation while maintaining your military treatment. While a flight surgeon may not be available to you within the military, aviation medical professionals outside the military are available to you, and there are AME's and programs that work to help people with special issuance, HIMS, etc, that will guide you through certification.

You've already been given the general information, several times it sounds like, and the AOPA representatives who explained the situation to you may not have told you what you want to hear, but appear to have given you correct data.

On a separate note, don't attempt to give up your medication to get a FAA medical, until you've got the professional guidance, treatment, and assistance to replace the medication with something else. If it's what's giving you the relief you need, focus on that: it's what's most important, regardless of how much you want to fly. Health first, everything else a distant second.

WhisperJet
08-08-2018, 06:09 AM
On a separate note, don't attempt to give up your medication to get a FAA medical, until you've got the professional guidance, treatment, and assistance to replace the medication with something else. If it's what's giving you the relief you need, focus on that: it's what's most important, regardless of how much you want to fly. Health first, everything else a distant second.



This is very sound wisdom. I highly suggest you heed JohnBurke's advice

n27e
08-14-2018, 02:38 PM
Both AOPA and the AME (aviation medical examiner) who advised you regarding HIMS and your status, were correct.

Do not violate the terms of your military contract. If you do, it will trigger significant additional problems for you, if it leads to a medical discharge. Do what the military has directed you to do.

You have indicated that you do have a valid condition: this is the most important concern, above FAA medicals or other issues. We're talking about your health. If the medication is helping, then you need to recognize that this may be more important than other considerations, and if it has proven to control your anxiety and give you relief, then it really doesn't matter if you were ordered to take it or volunteered. It's what's in use to treat your condition and if it's working, that is what is important.

With regard to the FAA, it is not just the medication, but the underlying condition which the medication is used to treat. The FAA considers both on an individual basis. The use of psychotropic drugs and medications do come with conditions; they generally lead to deferrals, but with treatment and on a program of testing and observation, it is possible to get medical certification. Anything you do to complicate that will only make the process more expensive or difficult later. That can include being denied a FAA medical, or a military discharge for the condition. In the case of the latter, were you to vary from your military obligations and contract, would signal the FAA that your condition had already been determined disqualifying by the military; there's no reason to complicate the matter.

You can certainly speak to or attend a physician outside the military for consultation while maintaining your military treatment. While a flight surgeon may not be available to you within the military, aviation medical professionals outside the military are available to you, and there are AME's and programs that work to help people with special issuance, HIMS, etc, that will guide you through certification.

You've already been given the general information, several times it sounds like, and the AOPA representatives who explained the situation to you may not have told you what you want to hear, but appear to have given you correct data.

On a separate note, don't attempt to give up your medication to get a FAA medical, until you've got the professional guidance, treatment, and assistance to replace the medication with something else. If it's what's giving you the relief you need, focus on that: it's what's most important, regardless of how much you want to fly. Health first, everything else a distant second.


Thanks for the reply.



I'm not sure if you understood exactly what I was trying to say here. I never said I was going to violate my military contract, in fact, you almost make it seem as if I am trying to weasel myself off the medication to fly again. Do not take this the wrong way but that is just how your reply came off to me.

In earlier posts, I did mention several key things: 1. Anxiety CAN disqualify a service member in the military (such as my case). However, the military knows this; since it is a stressful establishment they treat you and if treatment is successful you have no worries if your treatment fails then you will receive a medical discharge, the paper I signed basically said if I fail to obey doctor's orders then I will receive an administrative discharge. Completely different here. I'm not worried because it won't happen as I have no intentions on disobeying.



My contract ends in 20 months and again, I have zero intention of disobeying doctors orders (this includes stopping or altering my medication dose).



2. I clearly mention that I wanted to do this the right way and safe way. I only talked about coming off the medication through the proper channels and safely while under the supervision of my treating physician. I don't know where you came up with this whole idea that I was just going to stop taking meds and then try again.


As for the AOPA, they didn't tell me anything you didn't already just repeat back to me again. I am completely aware of what I can do, the problem is, how should I go about it. AOPA didn't tell me something I didn't want to hear as I already knew what it is they told me. Originally, when I went to see the AME, he deferred my application but felt very confident my case is so light and under control that I wouldn't have an issue getting my certificate back. What he didn't say was how much the cost was, I am trying to solve several problems here. I am trying to save on costs all while remaining safe and within parameters via the military and FAA.



Again, thanks for the reply and I don't mean to come off as impolite because I am not; the post just didn't seem very useful to me. I believe you may have misunderstood what it is I am trying to do.



You suggested at the end of your post to pretty much just give up because of a medical condition that is under control and has been for years. You might think that I'm not accepting that as an answer because I am not. If everyone gave up their dreams because of a medical condition, perhaps, society would not be where it is as every major breakthrough had to go through some kind of pitfall before it was successful. In my case, it's how I go about staying healthy, safe and legal to make it work.

n27e
08-14-2018, 02:40 PM
This is very sound wisdom. I highly suggest you heed JohnBurke's advice


Yes, good advice for someone who is careless. I have every intention on doing this legally and safely.

Minimums
08-17-2018, 06:47 PM
Has anyone ever heard of anyone ever getting approved for a 1st class while taking an SSRI? I know they've opened this up to ATC Specialists now as well but assuming it's still an uphill battle.

RadialGal
08-17-2018, 09:27 PM
Lighten Up Francis.

Also, perhaps learn some English? These folks are honest to God airline pilots and you are trying to school us? God gave you two ears and one mouth for a reason.

RadialGal

Excargodog
08-18-2018, 06:59 AM
Has anyone ever heard of anyone ever getting approved for a 1st class while taking an SSRI? I know they've opened this up to ATC Specialists now as well but assuming it's still an uphill battle.

An EXPENSIVE uphill battle:

https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/app_process/exam_tech/item47/amd/antidepressants/

https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/FAA_Certification_Aid_SSRI_Initial_Certification.p df


https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/ssrimedsspecs.pdf

https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/SSRI%20Follow%20Up%20Path.pdf

Pilotchute
08-18-2018, 02:01 PM
I did it recently. Took about 9 months.