Depression and SSRI, but MISDIAGNOSED!!! Have I lost my medical for good??

[RockyPilot]

A little dramatic in the title, but after hearing my story you might understand. I am a pilot in the military and in 2018 I reported to medical with some issues. I was told nothing was wrong and sent on my way. This occurred every 4-6 months until 2020 when I was diagnosed with depression. I went through counseling with minor success, but my mental and physical symptoms continued. In 2022 I finally said enough is enough when I started having heart palpitations, tightness in my chest, muscle fatigue, joint pain, and continuing mental health struggles. Medical placed me on sertraline (zoloft) to treat my “depression” and ultimately I had side effects to include a suicidal ideation. At that moment I took myself off the medication and the military decided I was going to be medically discharged due to mental health. Two months after the med sep process began, it was discovered that I had hypothyroidism. And after going on the medication for that, ALL of my symptoms both mental and physical went away.

I went to my AME and have been working through the process and my medical application is at the federal air surgeon office likely getting adjudicated around the holiday season. I am still being medically separated from the military on mental health despite attempts to correct their error. My VA disability is at 100% which is largely because each of my symptoms were diagnosed individually. Now, my military treating psychiatrist stated in writing that they retracted their depression diagnosis of me in favor of the hypothyroid diagnosis (this exact misdiagnosis is common). And the HIMS AME report states they have no mental or aeromedical concerns, but thinks that the hypothyroidism and depression exist as a comorbidity. My primary military physician has written a letter stating that with proper thyroid treatment there are no mental health concerns. For me it is genetic, as my Father has been on thyroid medication for 30 years (why he didn’t tell me is a separate issue and irrelevant).

Seems like I have done all I can, but honestly what do you think my chances are of getting my medical back? It’s scary that the SSRI use and the suicidal ideation exist, and I really hope the military medical mistake has not wrecked my career.

 

[redbaron]

Did you have a suicide attempt or just ideation?

Nobody here can say for certain without your complete medical record. But if you provided the FAA everything they asked for, the chance of eventually receiving a SI is fairly good, although it will depend on how complete of a picture you and your AME presented in your case to the FAA.

 

[RockyPilot]

@redbaron It was just an ideation. Single. It was like driving down the street and seeing a Taco Bell. Some things are simply a no-go. Just kept driving. The HIMS AME however wrote that I had an ideation with a plan, which is false and I never said anything of that nature. It says nothing about a plan in any of my psych treatment records either. A problem I have is the distance from the ideation, as it only occurred last fall. I only came off the SSRI over new years’ and only started on the thyroid medication in April and saw improvements then. So I am not sure how big a deal is with the proximity to the “dark days”.

 

[MountainDude]

Which medication did you take for hypothyroidism that also treated your other symptoms?

 

[redbaron]

Did you get a HIMS Psychiatrist eval? Whatever is in that report + the AME evaluation is what drives your results. If it's with the federal air surgeon (did you get the letter from Dc?) then it has already passed initial QC checks and needs to be reviewed by an external psychiatry expert. Patience is key here. I didn't get answers from DC for over 14 months.

 

[RockyPilot]

Which medication did you take for hypothyroidism that also treated your other symptoms?

Levothyroxine/synthyroid. It is approved for flight. My hypothyroidism symptoms started over 5 years ago, and as it went untreated my symptoms got worse and worse. My TSH levels were over 20 when they finally put me on medication. Being an Ironman triathlete and all the endorphins and hormones suppressed my TSH levels down to 20. My brother, who is not an athlete was diagnosed at the same time as me and his TSH levels were in the 70’s. Our T4 levels were nearly nonexistent.

Did you get a HIMS Psychiatrist eval? Whatever is in that report + the AME evaluation is what drives your results. If it's with the federal air surgeon (did you get the letter from Dc?) then it has already passed initial QC checks and needs to be reviewed by an external psychiatry expert. Patience is key here. I didn't get answers from DC for over 14 months.

Yes. And I have complied with all letters for information to this point. I had a call on Monday with DC confirming it has been in the office of the federal air surgeon for about a month (letter dated June 7). I did apply for a class one.

 

[bbchien]

This is a toughie. Suididal ideation is spec'ed in the 10 year “no consideration” clause. It just depends exactly how it is described……

 

[RockyPilot]

@bbchien From my HIMS report:
“In August of 2022 he was started on sertraline by his psychiatrist, Dr. XXXX. Dr. XXXX also noted that he needed his thyroid followed up, but this did not happen. “RockyPilot” was titrated up to 150mg daily of sertraline as ‘my symptoms were getting worse’. He was told in January of 2023, he would be processed out [of the military] medically due to his ongoing depressive symptoms. At 150mg daily of sertraline he had side effects at this dose, which included muscle twitching, worsening insomnia, headaches, dizziness, and passive suicidal ideations. He described the suicidal ideations as passive without plans or intent. He adamantly denied any intent or plans and cited his children, faith and family as protective. Following his January 2023 visit with Dr. XXXX and the increase to 150mg of sertraline, he made the decision to taper his medication slowly and took the last dose on January 31, 2023.”

The next paragraph goes on to talk about the treatment for my thyroid and the dramatic change in my symptoms.


I did not get my thyroid rechecked as the military psychiatrist wanted, because the corpsman wouldn’t allow me to see my doctor about it since it can only through a blood test. It’s not like I can wake up and say “I think my thyroid is feeling funky” and see the doc, was their reasoning. Despite having been diagnosed with subclinical hypothyroidism in June 2022 and not receiving treatment then. Ironically, in the doctors write up diagnosing the subclinical hypothyroidism, they said it could be the reason for my symptoms. Yet chose not to treat in favor of the “previously known diagnosis” of depression.

Don’t ever underestimate how much military medicine can mess things up.

 

[WingmanMed]

Believe me, the military part of the mess up has nothing to do with it. We see crap documentation from all kinds of doctors. Don't assume that all civilian doctors are awesome and only the bad ones are in the military. That will just set you up for more disappointment.