Grief and anti-depressants

A

Anon

Guest
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 sorry for your loss, there are a couple AME’s on here who will chime in.
 
Anon said:
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?
Click to expand...
I’m very sorry for your loss.
 
Anon said:
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?
Click to expand...

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:

1726790359815.png

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.
 
Besides the drug talk, have you looked into a support group? Not saying anything would be a panacea for the loss of your son.
 
Anon said:
What are the likely impacts?
Click to expand...
Hopefully helping you through this immeasurable loss. Worry about flying later. Get the help you need. And my sincere condolences to you.
 
Kenny Phillips said:
"Pills" can keep you alive, sometimes. Geez.
Click to expand...

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 ...
 
Anon said:
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?
Click to expand...
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.
 
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.
 
Anon said:
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.
Click to expand...
You’ve made a great choice, and know that many are praying for you as well.
 
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.
 
Anon said:
Pretty sure I will sell the plane, so meds question is irrelevant.
Click to expand...

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.
 
Anon said:
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.
Click to expand...
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.
 
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?
 
Anon said:
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?
Click to expand...

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.
 
Anon said:
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?
Click to expand...

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.
 
Last edited:
Half Fast said:
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.
Click to expand...
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.
 
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?
 
I can't imagine what you are going through, I went through a really difficult loss recently and this helped me.

 
Anon said:
...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?
Click to expand...
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.
 
SoCal 182 Driver said:
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.
Click to expand...
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?
 
Anon said:
Is there a reason I should get Basic Med in place BEFORE starting meds?
Click to expand...
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.
 
Anon said:
One week of Xanax to get sleep pattern stable, then 3-4 months of Lexapro.
Click to expand...

Anon said:
Seems to me the Xanax is riskier that the SSRI from an FAA perspective.
Click to expand...

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.
 
Half Fast said:
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.
Click to expand...
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?
 
SoCal 182 Driver said:
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?
Click to expand...

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.
 
Half Fast said:
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.
Click to expand...
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?
 
Anon said:
....then 3-4 months of Lexapro.
Click to expand...


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.
 
SoCal 182 Driver said:
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?
Click to expand...

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.
 
Half Fast said:
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.
Click to expand...
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?
 
SoCal 182 Driver said:
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?
Click to expand...
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.
 
Lindberg said:
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.
Click to expand...
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?
 
SoCal 182 Driver said:
Are you saying under these circumstances he's legal to fly?
Click to expand...
Under Basic Med, yes.

SoCal 182 Driver said:
I guess my concern is that once he's on the no-fly med(s), his Class III becomes invalid,
Click to expand...
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


SoCal 182 Driver said:
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?
Click to expand...
Yep!
 
Back
Top