Past depression history...chances?
 

Hey pilots,

So I was diagnosed with Major Moderate Depression in 2019 (I guess there's a major severe subtype), and it took awhile to get the right medication, which I found out is typical for depression... you have to find the Rx that works for you and the right dosage that works. My doctor started me on Wellbutrin, which is not on the FAAs approved list, but it didn't work for me anyway and I only took it for about 10 days before the doc switched me to Prozac (fluoxetine). That started to work but after 6 months it kind of pooped out, which again is common, and my doc switched me to Zoloft (sertraline). That did the trick and after a few months my mood adjusted fine. (Also, both Prozac and Zoloft are approved by FAA). I grounded myself and remained unemployed for about 3-1/2 years, but I was lucky and had financial resources. No suicide attempt, no DUI, no drugs either... I also started working out and had many sessions with a great clinical psychologist, who thinks I may be ready to ditch the anti-depressants after another month or so of observation.


So I'm wondering what happens if I apply for a FCM and NOT taking meds anymore. Do I still need to see a HIMS ame? I still have to disclose all my past doctor visits and meds taken previously, but does that still warrant an SI? Also will 3-1/2 years of unemployment and depression kill my chances at a regional, if I and my doc can prove to them I've made a full recovery? I have about 1470 TT, 100 MEL, 50 turbine, and come from 135 background. Plus 4 year degree.


Thanks to anyone who might be able to help.


r

Probably not. For past depression, you'll probably just need a statement from a shrink. You'll also need some period of time off meds (3-6 months or something like that IIRC).

If there was a diagnosed alcohol addiction somewhere in there, then I can't really answer how that would complicate things but it will be complicated.


I'm pretty sure it does not require an SI for *past* depression and med use, as long as you have a current clean bill of health, are expected to remain stable, and have met the waiting period off meds.


Regionals won't care at all. They don't do medical exams and won't ask anything about your health other than to see your 1C. They also won't care if it's an SI. The legal climate has changed, the airlines really can't get into your health business anymore, they just leave that up to the FAA. The worst they can do is give you an FAA 1C exam to verify that you meet the standards, but most majors won't even bother.

They may ask about the unemployment period, but you could simply say that you had some health issues which you wanted to focus on, and you were fortunate enough to be in the financial position to take time off. Then zip it, they can't ask for details about that. Also they literally cannot afford to turn anyone away who is qualified right now.

And definitely stick with exercise... both cardio and strength/functional are important but cardio is the biggy for mental well being. Shoot for 45-60 minutes most days of the week.

Also healthy diet and little to no booze.

https://i.ibb.co/mGT0tZ7/D5-B6210-A-...4997-A8759.jpg

You’ll need an SI.

Which is a primary reason people:

1. Don't seek treatment
2. Self-medicate
3. Fail to report

Thanks for the encouragement, I noticed you're a regular around here, is it ok to pm you? And you're absolutely right about the exercise... I'm finding out it's possibly THE most important keystone habit a person can develop.

None of which changes the reality that it will be required.

An AME will not be able to issue the medical; it will need to go to Oklahoma City, and requires a thorough evaluation by a health professional. While certain medications may be acceptable to the Administrator, the concern is ALWAYS the underlying condition for which the medication is prescribed. The medication itself represents a separate concern.

With most medications of concern, a period of 12 months away from the medication is required. In the case of certain medications allowed, as indicated by the original poster, a period of 12 months use, showing no adverse effects, is required. If the medication is ended, expect a similar time frame off the medication to establish a track record of effects and behavior without the meds.

This is an issue that you'll certainly want to navigate with assistance, from a qualified service with experience. It may be a lengthy process.

Flight experience, certification, and education/degree will have no bearing on the process, or outcome.

Where did you find that table? It's one I haven't come across yet. I've been reading through 67.401 and looking at the FAAs guide for AMEs though. There's also a SODA listed in 67.401, and if my condition is "static", I wonder if I'd be eligible for one of those. It really doesn't matter in the long run, since SI or not it shouldn't be a big hurdle to getting hired as rickair mentions. Might take the FAA 2-3 months to pick up a deferred 1C application, but if I do apply to the regionals I'm looking at least 6 months out so I can study up and get current, so that should be plenty of time to get the paperwork going. What I'm interested in is how much ADDITIONAL time, if any, it takes to grant an SI, vs a SODA, vs a regular approval if they're satisfied with me and my doc's paperwork. And if a HIMS Ame were required plus additional psych testing, what I might be looking at in additional costs. I bring up HIMS because the FAA puts depression in the same category of illnesses as substance dependence, and if I understand the regs right, pilots who fly while currently taking SSRIs have to see a HIMS Ame, even if they don't touch booze or drugs.

But the FAA has updated its regulations with certain diseases, depression being one of them, and they will allow pilots to fly even if they currently take anti-depressants. Obviously, the list of approved meds is very short, the pilot needs an SI or SODA, and it's a case by case scenario. Are you saying that if I were to stop the meds due to recovery, the FAA would want to see 12 months time off those meds?

Per your attachment. Thank you for reporting it Col.:confused:

We all know the FAA can be arcane and clumsy, especially with regards to medical certification. They base a lot of their decisions off of medical knowledge and practices 30 years old, and I wonder how many FAA docs in OKC are really up to date. But they're starting to get with the program, as slow and painful as it is. I'm reporting because I think I still stand a decent chance, and if I lied about it I'd always be looking over my shoulder for the rest of my career, which isn't how I want to spend it. :)

No, you don't. Nor 'should' you have a need to.

Airmen, less perfect ones like me that is, don't necessarily always DO what's required. Specifically, when the cure is worse than non-compliance. Crewmembers at every major airline take their own lives every year. More than gets attention. Anyone even track what part of these cases untreated depression is clinical?

Reading comprehension is key. Yes, the FAA will issue a medical certificate while you are on certain medications, AFTER a minimum of 12 months of established history on the medication.

If you're off the medication, you'll need to establish a track record and history to demonstrate function without the medication. Think about it.

Again, this is NOT something you should navigate on your own.

https://youtu.be/FebHBtwezwE

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


Because your condition lasted longer than six months the AME will not be able to issue, your case MUST be referred to FAA Med standards folks at OKC. Whether they will issue a SI at all, as well as what the timing might be for such issuance is dependent upon the specific facts of your case, the quality of the recommendations by your treating physician, and the skill and experience of the AME putting it in to the system.

My guess - and it’s only that - is that it will not be quick, not be cheap, and no guarantee of eventual success. It’s a big CYA bureaucracy and can proceed with glacial-like speed at times. I wish it were different for you, but I doubt that it will be.

Nor do I plan to. I'm in the early stages of preparation and just collecting as much data as I can, kind of like I was writing a research paper, which I have a fair share of experience in. I already know an AME will have to defer the application, and I also know the FAA wants to see as much documentation and letters from docs as you can possibly provide. Applications that get sent without sufficient paperwork will only be delayed further and that's the part I'm trying to avoid. I'm also not going to fork over thousands to a place like Leftseat to "speed my application through", when I think the claim is false, costs too much, and something that me, my doctor, and AME can put together ourselves. I do appreciate your input though, and in no way do I expect this to be a cake walk.

Thanks for those links, man. Yeah, it's not going to be a walk in the park.

Indeed, that is true. I myself have no idea what the suicide rate is for pilots, it's a job that can be high stress but I don't see flying as a profession on any list known for high suicide rates... like for doctors and some other white collar jobs. After the Germanwings thing the heat is definitely up on mental health, including depression. What the FAA and other aviation authorities don't get (yet) is people like Andreas Lubitz had more than a serious case of depression going on. Depressed people don't do mass murder along with it, and though we may never know, Lubitz probably had a case of PSYCHOTIC depression and other co-morbid features. Psychotic means you hallucinate and/or have delusions. Lucky for me, mine never got nearly that bad, but it was bad enough it took some flying years away and definitely some skin off my back.

I highly recommend using AMAS or another reputable complex-case AME. Many AMEs aren't familiar with the intricacies of all the FAA protocols. The good complex-case ones will know exactly what the FAA needs to see and will put all the packet together BEFORE you ever get an exam done and deferral. That way only one submission needs to take place without a lot of back and forth and wasting more time.

Thanks. AMAS... that's a newer service I've heard about but not familiar with, and if I hear good things, maybe try them. Doesn't AOPA have something too? Re AMEs... yeah I will definitely seek out a HIMS one. While mine isn't technically a HIMS case, they'd at least be lots more familiar with what the FAA will want, and about SIs in general.

AMAS has been around for a long time, by another name. They have also been the ALPA medical consultants for a long time. Probably more relevant for 1C than AOPA.

If you don't have any *documented* substance issues, I wouldn't worry about HIMS. In fact I'd probably stay far away.

I think that *resolved* depression, without any complications and without the need for meds will be straightforward. Maybe eventually a regular issuance, not SI.

He did not say he was depressed for 3+ years, just unemployed. Sounds like the depression resolved fairly quickly with the right meds. Even if took the meds for a few years that doesn't mean he was depressed or that he actually needed the meds. For most people, the docs may just leave you on meds longer term rather than risk relapse. For a pilot, it's obviously better to get happy and then try to get off and stay off the meds.

Red flags would be going off meds and then needing to go back, or multiple episodes of depression/anxiety. Anything other than depression/anxiety is bad.

For one episode, they know that most people can learn to stay happy without meds... once they know how it all works.

Some issues:

1. The AME CANNOT ISSUE. This is not a situational depression or adjustment disorder with depressed mood of six months or less duration. This is a diagnosed Major Depression. It will HAVE to to go to OKC. The AME doesn’t have the authority to issue.

2. The individual has been on three different drugs and failed two of them and is still on the third and seeing a clinical Psychologist. If symptoms or treatment extends beyond 6 months, even a situational depression or adjustment disorder would still have to go to OKC. A SI WILL BE NEEDED, either permitting him to continue on an acceptable antidepressant or only after a period of being off his current medications without relapse.

3. I’m not saying he even needed to be on the meds for 3+ years, but that doesn’t matter. It’s like the legions of kids who never needed to be on Ritalin to begin with, and never did have ADD. Once the diagnosis has been put on them, the FAA will make them jump through hoops before they can hold a physical.

not saying it can’t be done, just that it won’t be quick, won’t be cheap, and there is no guarantee of approval.

I never said an AME can issue it.

An SI doesn't really matter either way since few airlines would deny you for that anymore, and I'm not even sure they legally can. Worst case an SI would probably be a nuisance if it had a 3 month duration or something like that.

What he was diagnosed with is one thing, that will have to be addressed with the FAA. What he described is a different animal, sounds like it might be one and done since he's made lifestyle changes.

But no way know for sure, just have to try and see what happens. I agree with others that a good consultant service is the place to start.

Also need to decide whether to try to get certified with meds (that's a permanent SI for sure), or ditch the meds, do the waiting period, and then try.

Per your first point, I think we understand that an AME can't issue a normal 1C and it will get deferred to OKC. On point #2, I hope the FAA doesn't interpret it as "failing" two drugs. Depression isn't like the onset of cancer where you may have a 50/50 chance of responding to chemo. Most people basically have a 1 in 2 or 1 in 3 chance that the first medication will work for them, so there's the math. I see a psychologist because he's the one who first diagnosed me, and he also does Cognitive Behavioral Therapy, which is shown to dramatically increase a person's chances in addition to the Rx. I could go to a regular counselor/licensed therapist, but why bother changing clinicians when he's got the additional Phd and clinical practice?

Nah, it was a little more serious than one-and-done. I did have one recurring episode, but it didn't last very long and this was just after I transitioned to my third and final Rx (which by the way can take 1.5+ months to take effect) and started working out.

Exactly. It's looking like it may be less time and hassle in the long run requesting SI and just stay on Rx, than ditching them even at doctor's guidance and waiting 12 months. So I have to be drug dependent on SSRIs to fly sooner... makes a ton of sense.:confused:

There's a grey area related to different meds, maybe that will mitigate the relapse situation in the eyes of the FAA.

But others are hinting, correctly, that this will take time and money with no guarantees of outcome. My gut feel is that you've got a good shot but you'll need an aviation-oriented medical professional to review all the details to get a better idea.

If that works you could just get on with your career... try to get hired at a major (regional???) with a decent disability program for sure, that way you can still get paid down the road if you need or want to get off meds and have to do the wait period.

My nephew was interested in flying. Long story short he slef admitted himself in a hospital for suicide. Next day he was released. Basically felt the need for hell from family which he wasnt receiving. Is this an end all be all for getting a First Class Medical? Anyone have experience with this?

That is one hell of a strategy if I ever heard one, and now I know about paid disability at some airlines. By the way, you said in a previous post that if I didn't need a HIMS AME, it might be good to "steer clear". Could you elaborate on why this is true? The regs are complicated and I'm still digging, but it's looking like I might HAVE to see one. My guess is the FAA feels that either depression and substance abuse are inextricably linked (they aren't), or they're tired of incomplete applications they know they'll have to reject based on insufficient documentation, and a HIMS doc already knows the drill. There surely must be an AME out there who's worked with depression and the FAA, finding one might be the tough part.

Some in the pilot-addict community feel that the HIMS provider enterprise takes advantage of them to keep milking them for costly services. They allege that HIMS providers wield a lot of power over pilots' careers, and that some arbitrarily abuse that power. No personal experience, but that's the rumor.

If the FAA requires it, then you need to, but I'd try to get some info about who you work with.

Again, I'd recommend professional consulting services BEFORE you engage the FAA or any affiliates. You can really step on your crank if you try to wing it.

Thank you, yes I did a little background on AMAS; I was familiar with the name VFS back then, and hear they've always had a pretty good rep. My guess is they also know where a depression-experienced AME exists, taking that part out of the equation for me. I hear some of their "complex" case testimonies say $2000 or more, but I'm optimistic mine isn't among the most serious cases they get. Even so $1k-$2k isn't horribly expensive in this day and age, for a shot at what regionals are paying now. I even have enough time left I might get to a legacy and retire as F/O (I could care less), providing the economy and hiring are still good then.

A whole lot of variables affect the answer to this including admitting and discharge diagnoses, age at time of occurrence, circumstances, time since occurrence, other psych issues (if any).

The only thing that can be told with certainty is that he won’t walk into an AMEs office and come out with a physical of ANY kind without the FAA guys at OKC getting the answer to all those questions first.

https://i.ibb.co/8PJ4Z3n/D91-B5-CED-...38-D3834-F.jpg

Wait, so he self-admitted for an actual suicide attempt or suicidal behavior, or he did it as a plea with his family? If he was actually suicidal and they released him the next day with no report, I think someone screwed up or he was never give a full psychological work-up. Exception might be they did discharge him with a diagnosis of something, but any chance he could have *lost* or *forgot* about it? It would still be in his treating physician's medical database.

I'd guess if that if it only costs $1-2K you're pretty lucky.

No kidding. The difficult part is that many of the tests and consults are ‘not medically indicated.’ That is, they are occupational related - necessary for you to get your SI, but not necessary for treatment. Because of that, your medical insurance company may well decline to pay for them.

https://www.fwneuropsych.com/cost

https://i.ibb.co/x5xMtgq/CFFC9108-13...E8-D9-CDEE.jpg

https://www.neuropacific.com/rates/

It was within past couple months. Let me ask him to get exact details. Maybe that will be more helpful to you to give me better advice. Thanks

If your relative is serious, he should spend the money on a consulting service to see where he stands. The devil will most certainly be in the detailed medical reports.

Or try to talk with his regional flight surgeon. They could probably provide a reasonable idea of the process that would be necessary and a SWAG of the probability of success:

https://www.faa.gov/licenses_certifi...tification/rfs

The recency of the event is unlikely to be in his favor although it ought to help with the documentation..

Sure, and you may PM me for the sake of privacy if you wish.