Grief and anti-depressants

[Anon]

I recently lost my son. I am struggling with my mental health and it feels like I am getting worse. I plan to get help. I may ask for medication.

I have a PPL and 3rd class medical.

What are the likely impacts?

 

[mandm]

I’m sorry for your loss, there are a couple AME’s on here who will chime in.

 

[Clip4]

Hopefully this is an adjustment disorder and you will recover with some time and help. Your situation is one that a normal person would be depressed.

https://www.faa.gov/ame_guide/media/SituationalDepression.pdf

 

[UTLonghorn_1979]

I recently lost my son. I am struggling with my mental health and it feels like I am getting worse. I plan to get help. I may ask for medication.

I have a PPL and 3rd class medical.

What are the likely impacts?

I’m very sorry for your loss.

 

[Half Fast]

I recently lost my son. I am struggling with my mental health and it feels like I am getting worse. I plan to get help. I may ask for medication.

I have a PPL and 3rd class medical.

What are the likely impacts?

First of all, health first. Flying is secondary.

But that's not what you asked, so.....

The FAA has established protocols and several approved antidepressants, so it is quite likely that you could get approval and continue to fly under your Class 3. @bbchien has expertise in this area, having had a role in writing the protocols, so a private consultation with him would be a good idea. You would likely need a Special Issuance and you may have some hoops to jump through; sometimes this becomes expensive and takes a long time.

An alternative to the FAA hoops would be Basic Med, and in fact you might want to go ahead and get Basic Med in place right away just to take the worry off your plate. Basic Med does require a one-time special issuance for certain mental health conditions, but simple depression is not one of them. Here's the FAA guide:

Operating under Basic Med might give you and your treating physician more flexibility in your treatment without the added anxiety about what could happen to your Class 3 medical. Regardless, be cautious of side effects of any prescribed medication and discuss your desire to fly with your doctor.

Having your Class 3 revoked will wipe out your ability to go with Basic Med, so tread cautiously if you work with an AME or seek to renew your medical.

You might want to try counseling first. I'll note that many ministers are trained in grief counseling and such visits can be done outside the insurance and medical records system. If you're part of a church, a discussion with your pastor or priest would be a good idea, and he might be able to recommend a counselor.

I have also known people to have good results with natural remedies, such as St John's Wort or Passion Flower, which can be bought OTC. Be aware that these can take several weeks to build up in your system and become effective, but they do work for many people. While these are not prescription substances, it would still be wise to discuss them with your physician before you try them.

Hope all this helps a bit. I can't tell you how sorry I am for your loss. There are some things that only time can heal, and some that time alone can never heal. Seek wise counsel and take care of yourself.

 

[bbchien]

Look up the Anxiety Depression and related conditions "fast track pathway".
You can do counseling currently, and if no meds in the prior 2 years, an AMe can issue you.

So, go get to a counselor.

 

[sourdough44]

Besides the drug talk, have you looked into a support group? Not saying anything would be a panacea for the loss of your son.

 

[mryan75]

What are the likely impacts?

Hopefully helping you through this immeasurable loss. Worry about flying later. Get the help you need. And my sincere condolences to you.

 

[benyflyguy]

Pills don’t fix crappy situations. Time and talk can. Ask yourself- given the trauma you have experienced- are you supposed to feel the way you do? Pills don’t fix normal reactions to f’ed up situations.

 

[Kenny Phillips]

Pills don’t fix crappy situations. Time and talk can. Ask yourself- given the trauma you have experienced- are you supposed to feel the way you do? Pills don’t fix normal reactions to f’ed up situations.

"Pills" can keep you alive, sometimes. Geez.

 

[Daleandee]

"Pills" can keep you alive, sometimes. Geez.

They can also kill you. Grief is a very natural process that people go through and it is part of the healing process. There are many ways to deal with it but IMHO meds would be a very last resort (if at all) as they only mask the reality and have a tendency to make the grieving person dependant upon the drugs to relieve the pain which reappears when the drug is removed.

Good spiritual counseling and time will help heal the wounds. Realizing that the time spent together more than covers the pain of loss eventually helps bring relief ...

 

[Lindberg]

I recently lost my son. I am struggling with my mental health and it feels like I am getting worse. I plan to get help. I may ask for medication.

I have a PPL and 3rd class medical.

What are the likely impacts?

Does your employer have an EAP? Is there a religious leader you can talk to? These are not reportable to the FAA, and they might help. Or they might help you realize you need a higher level of care. Seeking help is the right thing to do, and it shouldn't cause you more anxiety. Of you do decide that to want to go the medication route, I would implore you to do that with a psychiatrist, not your GP.

 

[Anon]

I will get advice on therapy and meds from my health care providers. My first appointment with a grief counselor is tomorrow.

Thanks for the answers on Basic Med and Fast Track.

Right now I am leaning towards selling my plane anyways. I am nowhere near being ready to fly and have zero desire to get there.

I pray none of you ever experience this level of pain. It is literally soul crushing.

 

[mryan75]

I will get advice on therapy and meds from my health care providers. My first appointment with a grief counselor is tomorrow.

Thanks for the answers on Basic Med and Fast Track.

Right now I am leaning towards selling my plane anyways. I am nowhere near being ready to fly and have zero desire to get there.

I pray none of you ever experience this level of pain. It is literally soul crushing.

You’ve made a great choice, and know that many are praying for you as well.

 

[Anon]

Went to the airfield today with a friend. I could not bring myself to go near my plane. I was cleaning my hangar when my son died. Feelings of guilt are overwhelming.
Pretty sure I will sell the plane, so meds question is irrelevant. However, it did not come up at grief counseling, so I will attempt to work through without for time being.

 

[Half Fast]

Pretty sure I will sell the plane, so meds question is irrelevant.

Give it time. Hasty decisions made while you’re going through this are best avoided.

And you can always go Basic Med, so meds would be between you and your doc; no FAA involvement.

It’s very early days yet. Hang in there.

 

[Jon Wilder]

Went to the airfield today with a friend. I could not bring myself to go near my plane. I was cleaning my hangar when my son died. Feelings of guilt are overwhelming.
Pretty sure I will sell the plane, so meds question is irrelevant. However, it did not come up at grief counseling, so I will attempt to work through without for time being.

Just sit on the plane and give it time. Now is not the time to be making big decisions. Just focus on grieving and processing.

 

[Anon]

Revisiting as my situation evolves.

I began counseling about a month ago. Also went to a support group. Thought I was starting to trend in the right direction. Joke's on me.

Last week I had an anxiety attack caused by persistent intrusive thoughts. Have never had anxiety in my life, but this floored me. Lasted about 4 days. Slept maybe 3-4 hours a night. Heart pounding, weak muscles, nausea, etc. Pretty much incapacitated for that entire time.

I made an appointment for later this week to discuss with my provider. In discussing with various folks, seems I will probably have two options:
A) Short term sedative to take in the event of another episode.
B) Sleeping pills as needed.
C) SSRI such as Lexapro for a limited period, say 6 months.

So now I am back to impact on flying again. My Class III expires a year from now. I don't foresee any serious flying in the next year, but I might fly with a buddy.

I have been reviewing the AME guide. Is this a general summation of the possible outcomes?

1. 2 or less conditions, counseling, no meds: OK on medical.
2. 2 or less conditions, counseling, one med: Wait 2 years, then OK on medical.
3. 3 or more conditions, 2 or more concurrent meds, recurrent meds, or suicide/MDD noted: Spend $$$ and try to get SI.

If condition two applies, can I get Basic Med in place before my current Class III expires next fall, fly on that for 2 years, then return to Class III if needed?

 

[Half Fast]

If condition two applies, can I get Basic Med in place before my current Class III expires next fall, fly on that for 2 years, then return to Class III if needed?

Certainly.

Why not go ahead and get Basic Med now, and take one worry off your list?

Remember, there are only a handful of psychological conditions that require you to get a one-time SI in order to use Basic Med. Depression and anxiety aren't on the list unless they turn into psychosis. See post #5 above.

Hang in there. This will take time, but it will get better.

 

[Walboy]

can I get Basic Med in place before my current Class III expires next fall, fly on that for 2 years, then return to Class III if needed?

I don't think a lapsed Class III medical has any impact on qualifying for Basic Med. If you want to put aviation out of your mind now while you cope with your loss, you can do so without any future jeopardy to the Basic Med path. Further, the Basic Med physical exam is good for four years, not two. There is however a requirement to take a continuing education course every two years.

I don't see that you would ever need a Class III medical again if the only type of flying that you would do in the future is personal. I think you're safe to just forget about Class III medicals.

The main objective would be not to do anything that would cause your medical to be deferred.

Hopefully other posters will chime in if I'm wrong.

 

[UTLonghorn_1979]

Certainly.

Why not go ahead and get Basic Med now, and take one worry off your list?

Remember, there are only a handful of psychological conditions that require you to get a one-time SI in order to use Basic Med. Depression and anxiety aren't on the list unless they turn into psychosis. See post #5 above.

Hang in there. This will take time, but it will get better.

Keep in mind, just because anxiety or low lever depression doesn’t mean automatic SI, it still means 1-2 years in deferral process.

If I were in your shoes and wanting to still fly solo, I’d go basic med.

 

[Anon]

Met with psych nurse yesterday. She will work with me to ensure diagnosis does not make FAA process worse.

She proposed situational anxiety and situational depression. One week of Xanax to get sleep pattern stable, then 3-4 months of Lexapro.

Looking at the Situational Depression and Anxiety/Depression tools, this looks like it will pass review without deferral, assuming my situation resolves itself without recurring.

Seems to me the Xanax is riskier that the SSRI from an FAA perspective. Should I ask her to write for situational depression and Lexapro only?

 

[bnt83]

I can't imagine what you are going through, I went through a really difficult loss recently and this helped me.

 

[SoCal 182 Driver]

...can I get Basic Med in place before my current Class III expires next fall, fly on that for 2 years, then return to Class III if needed?

Is there a reason you need a Class III? If not, then why not just go Basic Med now, before filling any prescriptions for meds? At that point, it becomes between you and your doc as to whether you're competent to fly.

 

[Anon]

Is there a reason you need a Class III? If not, then why not just go Basic Med now, before filling any prescriptions for meds? At that point, it becomes between you and your doc as to whether you're competent to fly.

I do not need a Class III. Main impediment to going Basic Med is effort. I would have to find a doctor and navigate the process. That takes time. It also takes energy. TBH I am barely functional right now.

Is there a reason I should get Basic Med in place BEFORE starting meds?

 

[SoCal 182 Driver]

Is there a reason I should get Basic Med in place BEFORE starting meds?

I'm not the expert, but the issue is going on anti-depressants while having a Cass III, and the impact of that on your ability to legally fly with a Class III, which then impacts your ability to transition to Basic Med. Hopefully one of the docs or other subject matter experts will chime in to give you a better explanation.

Health first. My sincere condolences.

 

[Half Fast]

....which then impacts your ability to transition to Basic Med.

Not really. As long as the class 3 is never revoked or denied, Basic Med is available. Just don’t reapply for a class 3. Basic Med is between the pilot and the doc; no FAA involvement.

 

[Half Fast]

One week of Xanax to get sleep pattern stable, then 3-4 months of Lexapro.

Seems to me the Xanax is riskier that the SSRI from an FAA perspective.

Having both prescribed simultaneously would likely be an issue for the FAA. They’re a bit out of step with typical practices. Antidepressants take a few weeks to take full effect, so it’s not uncommon for docs to use Xanax for immediate relief while waiting for the the antidepressant to build up. Unfortunately, use of two psychiatric meds is an FAA no-no.

Why not a sleep med instead of Xanax if sleep is the goal? That would avoid the FAA obstacle.

BTW - a psychiatrist (MD, not a nurse) can conduct a Basic Med exam, at least from a legal standpoint.

 

[SoCal 182 Driver]

Not really. As long as the class 3 is never revoked or denied, Basic Med is available. Just don’t reapply for a class 3. Basic Med is between the pilot and the doc; no FAA involvement.

If he's prescribed and takes meds on the FAA' no-no list, doesn't he have to self-ground and then apply for a SI?

 

[Lindberg]

If he's prescribed and takes meds on the FAA' no-no list, doesn't he have to self-ground and then apply for a SI?

No.

 

[Half Fast]

If he's prescribed and takes meds on the FAA' no-no list, doesn't he have to self-ground and then apply for a SI?

No.

There are no “prohibited” meds for Basic Med, and there are only three types of issues that require getting a fresh SI class 3 prior to using Basic Med. Depression and anxiety aren’t on the list.

 

[SoCal 182 Driver]

No.

There are no “prohibited” meds for Basic Med, and there are only three types of issues that require getting a fresh SI class 3 prior to using Basic Med. Depression and anxiety aren’t on the list.

My question wasn't clear. If he has a Class III (not Basic Med), and is prescribed and takes meds on the FAA no-no list, doesn't he have to self-ground and apply for a SI?

 

[Half Fast]

....then 3-4 months of Lexapro.

FYI - there’s no way to tell a priori which of several antidepressants will work best for a given patient. It’s a trial & error process, so if Lexapro isn’t having the desired effect after a couple of weeks it may be necessary to try a different med for a couple of weeks. This is another reason some psychiatrists like to augment with some Xanax temporarily. The patient has some relief while finding the right longer term med.

 

[Half Fast]

My question wasn't clear. If he has a Class III (not Basic Med), and is prescribed and takes meds on the FAA no-no list, doesn't he have to self-ground and apply for a SI?

No. He can simply switch to Basic Med, if a physician is willing to approve it. Nothing requires him to go back to the FAA for a mother-may-I step.

 

[SoCal 182 Driver]

No. He can simply switch to Basic Med, if a physician is willing to approve it. Nothing requires him to go back to the FAA for a mother-may-I step.

OK...so let's play this out. Anon has a Class III. He gets prescribed medication for depression that is on the FAA's no-fly list. He fills the prescription and takes the medication. Are you saying under these circumstances he's legal to fly? Does the taking of medication on the no-fly list invalidate his Class III without an SI?

I guess my concern is that once he's on the no-fly med(s), his Class III becomes invalid, and he therefore cannot transition to Basic Med. Is my concern inaccurate/misplaced?

 

[Lindberg]

My question wasn't clear. If he has a Class III (not Basic Med), and is prescribed and takes meds on the FAA no-no list, doesn't he have to self-ground and apply for a SI?

If exercising Class III privileges, he would have to self-ground while he has any condition, including taking a medication, that makes him unable to meet the criteria for the Class III medical. But there's no obligation to report that to the FAA or to apply for an SI.

 

[SoCal 182 Driver]

If exercising Class III privileges, he would have to self-ground while he has any condition, including taking a medication, that makes him unable to meet the criteria for the Class III medical. But there's no obligation to report that to the FAA or to apply for an SI.

So in that circumstance, the medication and self-grounding don't "invalidate" the Class III, and he can still transition to Basic Med (if doc agrees). Am I understanding correctly?

 

[Half Fast]

Are you saying under these circumstances he's legal to fly?

Under Basic Med, yes.

I guess my concern is that once he's on the no-fly med(s), his Class III becomes invalid,

No. Only if he applies for a fresh class 3 and it’s denied. No denial, he’s good to go Basic.

Many pilots have conditions that would require an SI, and they would need to self-ground under class 3. Think sleep apnea, diabetes, liver disease, etc., etc. They can all switch to Basic Med.

Again, there’s a very short list of conditions requiring a pilot to go back for an SI before using Basic Med. See https://www.faa.gov/licenses_certificates/airmen_certification/basic_med

So in that circumstance, the medication and self-grounding don't "invalidate" the Class III, and he can still transition to Basic Med (if doc agrees). Am I understanding correctly?

Yep!

 

[Lindberg]

So in that circumstance, the medication and self-grounding don't "invalidate" the Class III, and he can still transition to Basic Med (if doc agrees). Am I understanding correctly?

By what regulation would his medical be invalidated?

 

[SoCal 182 Driver]

By what regulation would his medical be invalidated?

Obviously I've been trying to understand the parameters here, and @Half Fast has been patient in answering my questions.