Zoloft and generalized anxiety and HIMS

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sandiegolady

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I took my son for his medical exam, due to him being on a very low dose of zoloft the Dr. Said he would needs the HIMS neurological exam. Is this normal? It's very cost prohibitive and I feel discriminatory, he has zero depression or anything that would ground a pilot. I understand the psychological report needed but it's my understanding HIMS is pretty serious stuff. He is just getting his private license so we were shooting for 3rd class, now I'm wondering about basic med just to get his solo flight finished.
 
If he is currently taking Zoloft, he needs to go through the special issuance process. He will need to have been on the drug for at least six months, and complete the testing required. Here's the details if you don't already have it.


Yes, the FAA is blowing this up, but that's the rules and arguing "discrimination" isn't going to get you anywhere. If he wants to fly at this point you have NO OPTION but to do this. You can't do basic med unless you have had at least one medical issued. Using the "drivers license" medical aspect of sport pilot is now off the table since he made an application. He can fly under sport pilot but if he fails to complete the SSRI special issuance, they will eventually deny him and then sport pilot is also off the table.
 
Not directly to the OP but in general....the FAA really needs to add a section to the FOI about informing students and potential students about medications. No need to ask specifically, but the same approach I use when talking to parents at Young Eagle and CAP events - I let the parents know that there are medications that will prevent or at least substantially delay successfully getting an Class 3 (or any other class) medical, and they need to schedule a CONSULTATION with an AME before spending any money on flying lessons.

That medical exam is a requirement of flight privs in the USA and should be a required topic of the FOI.
 
I do… I flat out tell them I really don’t have any right asking blah blah blah… but they GOTTA know what consequences of this or that is.

I flat out tell them I’m by no means an expert, but no one else is gonna help them.

I even called a local AME and made SURE he and his staff were good with consults, and all that, he personally assured me we were on the same page. And then immediately deferred the first guy I sent him! AFTER telling him he could issue in the office. Once in a while no matter how hard ya try, it still gets fouled up….
 
he isnt eligible for basicMed unless he has held a class 1/2/3 medical and the last one wasnt denied or revoked. So that isnt an option since he has never held a medical, and the current one will be denied if he doesnt address the deferral.
 
sandiegolady said:
I took my son for his medical exam, due to him being on a very low dose of zoloft the Dr. Said he would needs the HIMS neurological exam. Is this normal? It's very cost prohibitive and I feel discriminatory, he has zero depression or anything that would ground a pilot. I understand the psychological report needed but it's my understanding HIMS is pretty serious stuff. He is just getting his private license so we were shooting for 3rd class, now I'm wondering about basic med just to get his solo flight finished.
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Oh crap

Why is he on Zolft if he has zero depression? I have a bad feeling some well intentioned PCP put him on it because he was "stressed at school" or something like that. Lord knows what the doc put in the medical record.

How long has he been on Zoloft? If only a few months, stop taking it. Might be a chance to have this classified as non recurring. If he's been on it since pre school (I exaggerate), for a year or so, then stop with the private pilot lessons. It could take years and thousands of dollars to sort this out.
 
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flyingron said:
We need a fundamentals of bureaucracy test.
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i think its partially intentional. . . and honestly cant fault them. They want an honest and thorough application. And the less you know - the more honest its going to be. The end game isnt about how to slide your way around a medical - but that you actually qualify and pass through their standards. its if you meet /their/ standards - not the other way around.

So in a way - its almost intentional that way. And the lack of information or prep - while easy to do the research beforehand to determine and perhaps work around, it does "catch" a lot of for lack of a better term - easy prey.
 
WDD said:
Why is he on Zolft if he has zero depression? I have a bad feeling some well intentioned PCP put him on it because he was "stressed at school" or something like that. Lord knows what the doc put in the medical record.
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The real question is why doctors feel the need to hand out mind-altering drugs, that we don't even fully understand and have questionable efficacy, like skittles. Especially to kids. The FAA's standards wouldn't seem unreasonable if every kid dealing with the uncertainty of existence, or who had trouble sitting quietly, wasn't "diagnosed" and medicated.
 
Yes, I had a friend who was a psychologist up in Maryland. She was working with the group to come up with criteria for them to be able to be able to prescribe (she had taken some additional pharmacology courses not normally part of the psych PhD program). These trained mental health people are jumping through hoops where as any general practitioner can misprescribe what they want.
 
I used to be in managed care, working to better understand the patients / insurance members so we could keep people healthier (cheaper).

Problem we ran into was well meaning PCP’s who would prescribe Zoloft, Prozac, etc. when they were not trained in pych. Not just the PCPs though. Other docs, the specialists, would also prescribe.

No coordination between docs, and each doc saw himself/herself as the one and only quarterback.

And there is no central source for a doc to see what prescriptions a patient is on, so they prescribe often “in the dark”.

We even had cardiologists prescribe Zoloft - with no proper follow up, drug management, etc.
 
I think blaming the pcp for this problem is misplaced blame. It’s parents who don’t want to accept the responsibility of their actions or their upbringing. This statement only applies to those that we are talking about over prescribed, prescribed without reason or taking the early way out. For those kids that need it and are prescribed accordingly - I don’t think we are including in this discussion. But parents are looking for an excuse these days - and meds for kids or themselves is the easy way out.
 
Anthem said:
I think blaming the pcp for this problem is misplaced blame. It’s parents who don’t want to accept the responsibility of their actions or their upbringing. This statement only applies to those that we are talking about over prescribed, prescribed without reason or taking the early way out. For those kids that need it and are prescribed accordingly - I don’t think we are including in this discussion. But parents are looking for an excuse these days - and meds for kids or themselves is the easy way out.
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This is also absolutely true. Kids don't go to the doctor by themselves.

Here's a story. Our one boy is a handful. He causes more trouble than the four girls put together. My wife made a comment about his antics at one of his checkups, and they suggested he get screened for ADHD. I guarantee that he would have been diagnosed and medicated had we acted on that suggestion. A year later...he's still a handful, but he's calmed down a lot. I'm beginning to think he may become a productive member of society at some point. And, he'll have the opportunity to become a pilot (assuming that's still a thing) because we chose to deal with a rambunctious kindergartener rather than put him on low-dose Meth.
 
Parents are the ultimate responsible party. But I can see how PCPs are also causing issues. As a parent I’ve already determined that I can trust the doc I’m sending my kid to. So when the doc says “take this”, I’m going to be swayed.

Today isn’t like when you were a child at the family doctor. Some education on today’s situation for parents is needed, and it won’t be coming from the doctor.
 
There are different thoughts on this relating to "getting better" vs "getting cured".

Generally it's considered a spectrum disease, though the FAA has made it black & white. If you perform below the 15th percentile of their home-grown dataset you have it, if above you don't.

There is a thought that someone at say the 20th percentile could be treated and perform at maybe the 60th percentile (getting better), this makes sense to many. But not at the FAA where you are OK to fly at the 20th percentile, but not if treated and at the 60th. Untreated is preferred. They have reasons I suppose.

I can easily imagine well intentioned parents and physicians not knowing the FAA's unique perspective and opting for the being better option. In my day they literally beat it out of you, but I'm not really convinced that's better.
 
Jim K said:
This is also absolutely true. Kids don't go to the doctor by themselves.

Here's a story. Our one boy is a handful. He causes more trouble than the four girls put together. My wife made a comment about his antics at one of his checkups, and they suggested he get screened for ADHD. I guarantee that he would have been diagnosed and medicated had we acted on that suggestion. A year later...he's still a handful, but he's calmed down a lot. I'm beginning to think he may become a productive member of society at some point. And, he'll have the opportunity to become a pilot (assuming that's still a thing) because we chose to deal with a rambunctious kindergartener rather than put him on low-dose Meth.
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if your farm is anything like the one I grew up on, the good news is there are plenty of ways to direct that energy.

Of course, we still occasionally talk about something we did as kids that Mom responds with “I had no idea you were doing that.”

I have 3 grandsons, and quite frankly, I can see how parents could think that drugs are a solution. I give my daughter tremendous credit as a parent. (I probably should say that to her more often.)
 
WDD said:
Lord knows what the doc put in the medical record.
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Whatever it took to get the insurer to pay. QED

jbarrass said:
Untreated is preferred. They have reasons I suppose.
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If there's no record of treatment there is no way to fault the bureaucrat for "missing it" or "allowing" the person to act as PIC, even in his/her own private aircraft.
 
WDD said:
Oh crap

Why is he on Zolft if he has zero depression? I have a bad feeling some well intentioned PCP put him on it because he was "stressed at school" or something like that. Lord knows what the doc put in the medical record.

How long has he been on Zoloft? If only a few months, stop taking it. Might be a chance to have this classified as non recurring. If he's been on it since pre school (I exaggerate), for a year or so, then stop with the private pilot lessons. It could take years and thousands of dollars to sort this out.
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He was diagnosed with general anxiety disorder, zoloft isn't for depression it's for anxiety. He's been on it at a very low dose for about 2 years.
 
I guess I should clarify, he can get his 3rd class, he just has to do the hims which feels excessive as it's really geared towards dui's and drug abuse. The ame said zoloft isn't a problem and is on the acceptable list, referencing a pilot he sees on 400mg, which is a whole lot more than my sons 50. I just feel like 3500 to 7 grand for this test is pretty excessive. In the end we will pay and he'll fly, I was just hopi g perhaps with the new legislation passed y mo the ago on GAD there may be some better news. Kinda scary to know pilots can really never see a psychologist or therapist without possible grounding. In the end ma y pilots fly while on zoloft, if anyone else comes across this post, was just hoping he didn't need the HIMS.
 
sandiegolady said:
I guess I should clarify, he can get his 3rd class, he just has to do the hims which feels excessive as it's really geared towards dui's and drug abuse. The ame said zoloft isn't a problem and is on the acceptable list, referencing a pilot he sees on 400mg, which is a whole lot more than my sons 50. I just feel like 3500 to 7 grand for this test is pretty excessive. In the end we will pay and he'll fly, I was just hopi g perhaps with the new legislation passed y mo the ago on GAD there may be some better news. Kinda scary to know pilots can really never see a psychologist or therapist without possible grounding. In the end ma y pilots fly while on zoloft, if anyone else comes across this post, was just hoping he didn't need the HIMS.
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Zoloft (bad ssri/ssni) are all psychotropic drugs - which affect moods, behavior, thoughts etc. so they will want to test to make sure he can function on or off of them.

Just be aware - the FAA “approved “ list of drugs does not mean you can take them freely. It just means that they will allow that drug with testing or whatever that passes. So he has two choices right now - ssri pathway I or pathway II. Pathway I is off of the ssri and testing to determine he functions adequately while off. Pathway II is that he stays on and gets tested. It appears he has been on it awhile.

He can get any class of medical if he passes the cogscreen testing.

Both pathways will need to be administered by a HIMS doc. And HIMS isn’t mostly tied to duis and drugs - I’m willing to bet they do more work with adhd/depression than the other stuff.

Dr Bruce can advise much more about this than any of us could.
 
Sounds like you’ve reached a decision on the probability of getting your son the third class, the cost and timing of it, and how to get it.

IMHO it’s fantastic that you’re able to and you are supporting your son’s pilot training.

Many opinions on general anxiety diagnosis and teenagers, but you’re not asking about that.

I still offer for your consideration to not start flight training until you get the medical issue squared away. It might surprise you how long it could take. I hope not.

At this time, get your son the Sporty’s written test training package and have him get ready for the written test. Might as well get that out of the way while waiting.
 
Oh …. And when the 3rd class expires in 4 years switch to Basic Med.

But during the time the 3rd class is in effect you might need several on-going HIMS evaluations, an SI, etc. Dr Bruce and other smarter people can correct / clarify what I just wrote.
 
sandiegolady said:
I guess I should clarify, he can get his 3rd class, he just has to do the hims which feels excessive as it's really geared towards dui's and drug abuse. The ame said zoloft isn't a problem and is on the acceptable list, referencing a pilot he sees on 400mg, which is a whole lot more than my sons 50. I just feel like 3500 to 7 grand for this test is pretty excessive. In the end we will pay and he'll fly, I was just hopi g perhaps with the new legislation passed y mo the ago on GAD there may be some better news. Kinda scary to know pilots can really never see a psychologist or therapist without possible grounding. In the end ma y pilots fly while on zoloft, if anyone else comes across this post, was just hoping he didn't need the HIMS.
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Was this a HIMS AME's?
Do you have the underlying, guiding documents for this issuance path?

First you need his care to be not by a PCP nor ARNP but by an MD psychiatrist. GET that started- he needs six months of said care before he can succeed.

But, if what you wrote is inclusive and doens't leave anything out, all he should need is the Neurocognitive. Heck in CHI for the cogscreen (if he's normalized that's all that should be necessary) we can get that for $1,500 (but, NB if "Major depressive disorder" appears anyplace in the record, He will also need the HIMS Psychiatrist).

Using HIMS resources is NOT the same as doing HIMS. When the four of us wrote the "ON SSRI petition", the FAA just threw it in with drugs and alcohol as that's where the Part 67 trained Psychiatrists, Psychologists, and Trained AMEs were....

The other option is of course, if he has had
(1) only one period of treatment, and it's
(2)<5 years in duration,
(3) never dual drugs and
(4) no suicidality in the record, and
(5) no use of spych hospital....

He still has the decision path 1 option. It too requries (but) a community psychiatrist MD's take on the discontinuance and the risk factors for recurrence. And you really only get to see him if your son has someting to bill Blue Cross for- e.g if hes' off the meds already, they won't see him. Then you DO need the HIMS psychiatrist (about $4K).

In the first four years after the ON SSRI pathway became real (2010-2014), I used to whine a bit about cost. However, the trash that we get in the community providers' records has changed my mind. You really do need the Part 67 trained professionals who know what's what....
 
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