Anyone taken SSRI decision path 1 recently?

A

AspiringPilot

Guest
I am looking at FAA's decision path 1 (link below). I have discontinued my use of the SSRI but have to wait the 2 months out. While waiting, I want to be sure I have all the paperwork needed.

Anyone taken this route recently and got a successful medical? How involved or cumbersome was the process? What paperwork did you need? And how much time did it take for the various stages with FAA?

https://www.faa.gov/about/office_or...am/ame/guide/media/SSRI Decision Path - I.pdf

Thank you!
 
FAA may or may not want the HIMS route. Once they receive the deferd application ~ 3 to 6 week response. If HIMS add 4+ months. Do not send paperwork till asked. I just had an airman with your profile and he just was issued his lic without going thru the more lengthy and costly HIMS.
 
The key here is that you cannot have any underlying diagnosis with a higher propensity to recur. Recurrent Major depression, Dysthymia, Chronic anxiety, are all situations where FAA does not want to certify you except on the SSRI protocol. The first of the list has a 50% recurrence rate in 4 years.

They will want to review your entire record to assure themselves that you do not have these items, and there are others. Unfortuanately most Family practitioner notes don't contain enough info to make that determination....and you end up need the testimony of a psychiatrist.

If you have a single episode and they can tell that it is not one of these three, then they use a "time yardstick", e.g
Cases on the med for over 2 years-->family doc's notes.
Cases more than 2 years on the med--->needs psychiatrist.
Cases more than 4-5 years--->HIMS psychiatrist.

They are very caution since Andreas Lubitz and the Germanwings A321 Suicide. Can you blame them?

(One of 4 petitioners, for the SSRI protocol). B
 
lbfjrmd said:
FAA may or may not want the HIMS route. Once they receive the deferd application ~ 3 to 6 week response. If HIMS add 4+ months. Do not send paperwork till asked. I just had an airman with your profile and he just was issued his lic without going thru the more lengthy and costly HIMS.
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Thanks for the advice. I was reading up somewhere that I should send paperwork as soon I have everything in order. I guess I'll just wait for the FAA mail to arrive. The airmain you mentioned, did he just wait 2 months and reapply for a "normal" certificate?

bbchien said:
The key here is that you cannot have any underlying diagnosis with a higher propensity to recur. Recurrent Major depression, Dysthymia, Chronic anxiety, are all situations where FAA does not want to certify you except on the SSRI protocol. The first of the list has a 50% recurrence rate in 4 years.
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I did not have any of the above. I was diagnosed with mild Asperger's and the medication was to merely help me through the burden of finishing school and getting a job. I have obtained a copy of my neuropsychologist's report of the evaluation done few years ago. Trying to get the physician's notes who prescribed the medication for me. Does this make my case any less complicated?

bbchien said:
If you have a single episode and they can tell that it is not one of these three, then they use a "time yardstick", e.g
Cases on the med for over 2 years-->family doc's notes.
Cases more than 2 years on the med--->needs psychiatrist.
Cases more than 4-5 years--->HIMS psychiatrist.
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As I mentioned above, the medication was to help me finish school and not to deal with any episode as I had none. Since there were no side-effects and it made my life a bit easier, I stayed on it after school. Had I known that it would result in this situation later in life, I would have gotten off of it immediately. My use has been on and off for a little over 4 years (I can produce all the prescription refill statements to prove that I wasn't on it continuously). Since you mentioned "more than 4-5 years", will I need to visit a regular psychiatrist after the 2 month wait period, or will I need HIMS psychiatrist? Want to give the psychiatrist a heads up so I can get on it as soon as I have the FAA's letter - I won't if you advice me that's not a good idea.


Thank you very much for all the advice - means a lot!
 
If the record shows Aspergers' you have a five year slog ahead of you. Asperger's is forever. The trick is proving you are mild enough to get the SI. There is a poster on the red board that you may be able to "pick up" who got certified and after five years I managed to get off the SI. Those are all "Individual consideration" cases, and the HIMS psychiatric + ALL your records is mandatory. And it will show up in the record, which FAA will review.

Forget about certifying in 60 days. You need to see the HIMS Psychiatrist after the 60, with all your records and I mean ALL of them, to be credible to FAA. These take average 8 months (and that's if everything is okay). I do a lot of these.

You WILL need local psychiatric follow up at least every 6 months to even get considered.
 
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Oh, didn't realize it will be so involved. Will check the red board. Thanks for your answers.
 
AspiringPilot said:
I am looking at FAA's decision path 1 (link below). I have discontinued my use of the SSRI but have to wait the 2 months out. While waiting, I want to be sure I have all the paperwork needed.

Anyone taken this route recently and got a successful medical? How involved or cumbersome was the process? What paperwork did you need? And how much time did it take for the various stages with FAA?

https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/SSRI Decision Path - I.pdf

Thank you!
Click to expand...

How has your situation progressed? I am currently in a similar situation and was hoping to get an idea of what I am up against. Any reply would be helpful. Thanks!
 
bbchien said:
The key here is that you cannot have any underlying diagnosis with a higher propensity to recur. Recurrent Major depression, Dysthymia, Chronic anxiety, are all situations where FAA does not want to certify you except on the SSRI protocol. The first of the list has a 50% recurrence rate in 4 years.

They will want to review your entire record to assure themselves that you do not have these items, and there are others. Unfortuanately most Family practitioner notes don't contain enough info to make that determination....and you end up need the testimony of a psychiatrist.

If you have a single episode and they can tell that it is not one of these three, then they use a "time yardstick", e.g
Cases on the med for over 2 years-->family doc's notes.
Cases more than 2 years on the med--->needs psychiatrist.
Cases more than 4-5 years--->HIMS psychiatrist.

They are very caution since Andreas Lubitz and the Germanwings A321 Suicide. Can you blame them?

(One of 4 petitioners, for the SSRI protocol). B
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I was hoping to get your take on my situation, if possible.

I was on SSRI for just shy of 3 years (2 years 10 months to be exact). I was taking this medication strictly for stagefright type situations with work presentations and also as a part time musician. I came off in December, waited the 60 days, etc. My doctors notes are very clear and prove this was strictly the case with stagefright type anxiety. Never had any type of episode or anything of that nature. I submitted my doctors notes on March 28th, 2017 and just playing the waiting game now.

Any idea on the outlook here as far as how long this could take as well as if this situation seems favorable to be awarded a standard issuance? Any help at all, I would greatly appreciate. Thanks!
 
I have been on SSRI med for 27 months. Discontinued yesterday. Med app was denied last April requesting SSRI list completed and sent for review. I spoke with AOPA today regarding immediate reapply or wait 60 days. He advised I could reapply immediately, but I stood a great chance of having to do the SSRI HIMS protocol anyway. Doesn't seem quit right that they make rules to compensate for other rules and then they themselves don't adhere or allow the rule to work for you or them.
Really difficult to know what to do? It testing and doctors were at a reasonable cost it wouldn't be so bad, but when I read where guys have paid 2,500 and stilldenied because the psyc HIMS completed the paper work wrong or incorrectly.
Sad, but it if a Government institution.
 
There's zero chance for Path I certification before 60 days off PERIOD. The FAA is going to want to see an evaluation AFTER that time to see if you are functioning without the drug. Depending on what you were on the SSRI for and what sort of provider he is as to whether they'll buy your doc's assertion that you are doing sufficiently well unmedicated (and of course, if the underlying condition isn't still disqualifying).
 
Well, mine was anxiety (not a disqualifying condition) over retirement and health issues, copd, cyst on lung or heart. Med was Lexapro.
I understand the 60 day wait before consideration, but you can go ahead and reapply immediately and the AME makes note of that in line/box 60 I believe?
I had a class III in 2008, and let it expire. Had I not got a hair to fly last spring, and waited to grow the hair two weeks ago.. I'd be Basicmed and on my way.
 
They are just going to kick your application back if you do not have the physician's report 60 days after you cease taking the drug. Doc Bruce can tell you if the early application gets you around any of the queue delays in Joklahoma City.
 
flyingron said:
They are just going to kick your application back if you do not have the physician's report 60 days after you cease taking the drug. Doc Bruce can tell you if the early application gets you around any of the queue delays in Joklahoma City.
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So, do you think wait 60 after cessation of meds and then go to AN AME?
 
bbchien said:
You don't get it yet, Dave. It'a about the underlying diagnosis at high resolution which is controlling. You never mention it.
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I appreciate you response Dr. Bruce, but it appears veiled with regard to my original question. I don't understand what I should or haven't never mention?
 
why you were on an anti-depressent, what other mental health issues you may or may not have, your current cognitive function and finally your diagnosis that put you on the med(s), your diagnosis while on the med and your diagnosis now greater than 60 days off the med. all of this is what you have to pay for to resume flying. Then if you are issued a SI it will continue for ~ 5 years.
 
lbfjrmd said:
why you were on an anti-depressent, what other mental health issues you may or may not have, your current cognitive function and finally your diagnosis that put you on the med(s), your diagnosis while on the med and your diagnosis now greater than 60 days off the med. all of this is what you have to pay for to resume flying. Then if you are issued a SI it will continue for ~ 5 years.
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Thanks for the imput.
 
Nothing veiled. By not disclosing (and I sure do understand that) you leave us all guessing. That's what's "veiled".

It's not just the med or lack thereof (the LACK of such can be a issue itself), it's also the condition. I think your're "getting it" now. :)
 
bbchien said:
Nothing veiled. By not disclosing (and I sure do understand that) you leave us all guessing. That's what's "veiled".

It's not just the med or lack thereof (the LACK of such can be a issue itself), it's also the condition. I think your're "getting it" now. :)
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Good to hear from you again. He is my med, ("SSRI") LEXAPRO, prescribed for anxiety/depression- (Copd diagnosis, early retirement) Had been on it 10 months when AME kicked application to FAA for decision, which was denied for SSRI medicine and current PFT (7 months was not current enough). Well, you see, you just don't order yourself a PFT and you, I, just can't jump up and pay $4,800-5,600 for a more current PFT.
Now I have a current PFT, 18mths since the last, and am making a push for class III; although a Basicmed would be a better fit for folks if done by their PCP (my personal opinion).
 
Except you've already been denied. BasicMed is not an option until you pass the 3rd class at least once again.
 
flyingron said:
Except you've already been denied. BasicMed is not an option until you pass the 3rd class at least once again.
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I held a class III (with the exception of the years I flew commercial) since 1974 up until I let it expire in 2008, due to fuel cost for pleasure flying and AD's on current aircraft. Had I waited till now, aircraft and all AD's, current, with fresh annual; instead of getting ahead of myself last year, I'd be flying today on a Basicmed and would not have run across all these threads.
 
Dang! Wow I see your problem now. You've been healthy and flying class III since 1974. All of a sudden in 2008 you have very stressful event (lung issue plus retirement changes) and the "helpful" doctor treats your SITUATIONAL anxiety with an SSRI. Now you are past that life speed bump and want to get back to flying but screwed yourself by applying again and getting denied. So now you can't go BasicMed without first getting the Class III again. Cheeeez this sucks.

If I were you I would NOT reapply. I would contact Dr. Bruce here privately and let him look over all your paperwork. If you were on the med 27 months that's just over 2 years so will need psychiatrist but not a HIMS if I read his post right.

Bruce, this isn't the OP, this guy flew for over 30 years on a class III and then had a big life situation that appears possibly just temporary adjustment. David here is not the OP that mentioned Asbergers. Right David? You might should have started your own thread.
 
Rushie said:
Dang! Wow I see your problem now. You've been healthy and flying class III since 1974. All of a sudden in 2008 you have very stressful event (lung issue plus retirement changes) and the "helpful" doctor treats your SITUATIONAL anxiety with an SSRI. Now you are past that life speed bump and want to get back to flying but screwed yourself by applying again and getting denied. So now you can't go BasicMed without first getting the Class III again. Cheeeez this sucks.

If I were you I would NOT reapply. I would contact Dr. Bruce here privately and let him look over all your paperwork. If you were on the med 27 months that's just over 2 years so will need psychiatrist but not a HIMS if I read his post right.

Bruce, this isn't the OP, this guy flew for over 30 years on a class III and then had a big life situation that appears possibly just temporary adjustment. David here is not the OP that mentioned Asbergers. Right David? You might should have started your own thread.
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Thanks Rushie, pretty much sums it up. And no I am not the Asbergers guy New to the forum seeking advice and yes jammed up after a "life speed bump"
 
David Matheny said:
Thanks Rushie, pretty much sums it up. And no I am not the Asbergers guy New to the forum seeking advice and yes jammed up after a "life speed bump"
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I had a similar thing when I had a "minor" surgery go horribly wrong. Left me with a crippled right hand for about two years. They also put me on an AD although depression has never been my problem except second to severe pain. I ended up getting my third class after just submitting extra statements from doctors and myself but I think I was on it less than two years. Anyway, I've grown older and sicker since so gave up flying for good. But seriously if I were in your shoes today I'd go through Bruce's site here:

http://www.aeromedicaldoc.com/

Read the links how to start and how it works. If it is possible to get your certification back he will guide you through it, if not you will know you have turned over the last stone.
 
Rushie said:
I had a similar thing when I had a "minor" surgery go horribly wrong. Left me with a crippled right hand for about two years. They also put me on an AD although depression has never been my problem except second to severe pain. I ended up getting my third class after just submitting extra statements from doctors and myself but I think I was on it less than two years. Anyway, I've grown older and sicker since so gave up flying for good. But seriously if I were in your shoes today I'd go through Bruce's site here:

http://www.aeromedicaldoc.com/

Read the links how to start and how it works. If it is possible to get your certification back he will guide you through it, if not you will know you have turned over the last stone.
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Hate to hear that for you Rushie. It's one thing when you are able to make a decision about flying for yourself, and another thing when someone is able to make it for you without having a clue about you or your circumstances.
Dr. Bruce has posted on my comments, but I may make contact with him through the link you provided.
Again, sorry to hear that you had to let it go, and thanks again for the help and support.
Be safe.
 
Short question first: Can a Basicmed pilot fly and take an SSRI (Fluoxetine) without all the BS? Anyone know the answer for sure? Having read the above discussion on "decision 1 and HIMS", not sure why anyone would want to open a can of worms if there is not an underlying diagnosis. Which would be this pilot in questions case. No diagnosis of any underlying problem. Tried the med years ago from a family doc and discovered more patience, hence less frustration.
 
There are 4 SSRI that require a psychiatrist and HIMS, If there were taken over a certain period of time, 2 years or longer. If you had a class III after 2006, and it has simply expired, go to a physician and do the Basicmed. All the paperwork you do is keep in your log book and nothing is sent to the FAA.
 
David Matheny said:
There are 4 SSRI that require a psychiatrist and HIMS, If there were taken over a certain period of time, 2 years or longer. If you had a class III after 2006, and it has simply expired, go to a physician and do the Basicmed. All the paperwork you do is keep in your log book and nothing is sent to the FAA.
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The first part of your comment contradicts your ending suggestion.
 
How does the FAA know you are on a SSRI anyway? Had I not applied for a class III a year ago, I would have a Basicmed and on an SSRI.
 
David Matheny said:
How does the FAA know you are on a SSRI anyway? Had I not applied for a class III a year ago, I would have a Basicmed and on an SSRI.
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I hear what you are saying. If there is an accident or incident where blood is drawn , they will discover it. If you are flying on basicmed is there a disclosure requirement for SSRI? This is a legal question Im asking.
 
I think I printed my Basicmed application from AOPA site. You fill out your basic information, list all medications and make an appointment with your PCP or another physician, they will review and discuss anything need be and sign it, you sign it and you're done. Not done by an AME. In the end you determine when you are good to fly and when you're not. You will also take a test regarding flight and ability to fly and not, this to off AOPA site.
 
Found this on AOPA, which I interpret to say flying on an SSRI is at the discretion of the basicmed sign off physician:

Medication usage under BasicMed
If you are taking a medication that is currently on the disallowed list, it doesn't automatically mean it is disallowed under BasicMed. When you visit your physician for the BasicMed examination, the checklist that you and your physician complete will list any prescription or non-prescription medication that you currently use, as well as information such as the medication name and dosage. Your physician will then address, as medically appropriate, any medications the individual is taking and discuss the medication’s potential to interfere with the safe operation of an aircraft or motor vehicle. Certain medications are not safe to be used at all while flying and others require a reasonable waiting period after use. Pilots, in discussion with their physician, should consult available aeromedical resources to understand potential flight hazards associated with any medications being taken, such as whether the underlying condition the medication is being taken for makes flight unsafe, or to understand side-effects that may be unnoticeable before flight but could impair the ability of a pilot to make sound decisions. In addition to the BasicMed rules, pilots taking medication must also comply with existing Federal Aviation Regulations, such as the self-grounding requirements of FAR 61.53 and FAR 91.17’s prohibition on operations while using any drug that has effects contrary to safety. AOPA’s online medical education course will include medication considerations when evaluating your fitness to fly. AOPA is also continuing to work with the FAA concerning the use of certain medications under BasicMed rules.
 
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Who knows you better, longer, and the meds you are on and how they affect you? Your PCP. That's my whole point. Then it is up to you to determine whether you should or shouldn't fly based on your knowledge, capabilities, and your physical/phycological condition before each and every flight. Should not be forbidden to fly based on how someone interprets you based on checks in some boxes on a uniform form.
Good luck to you.
 
The FAA considers a general practice PCP to be a blithering idiot with regard to psychological issues and in most cases, they aren't far off.
 
flyingron said:
The FAA considers a general practice PCP to be a blithering idiot with regard to psychological issues and in most cases, they aren't far off.
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The PCP I go to refers me to a specialist when needed.
 
Rushie said:
Read the links how to start and how it works. If it is possible to get your certification back he will guide you through it, if not you will know you have turned over the last stone.
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Yes either Bruce or lbfjrmd can help you though this, but you need to be committed to seeing things through. I'm presently working with Bruce to get past my own (different) speed bump from a few years back, as a one time SI will let me fly on BasicMed going forward. Now waiting on the latest test results :)
 
I am in the same boat, about to submit paperwork after coming off them for 60 days, how is yours coming?
 
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