how will medical reform handle SSRIs?

G

guywithaquestion

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I used to take lexapro for mild anxiety, and stopped taking it for the purpose of flying. With the medical reform here will I be anle to start taking it again? As far as I can tell as long as it doesn't preclude me from having a drivers license then it shouldn't be an issue.
 
Let me ask a rhetorical question - if you already function to the level of complexity of operating an aircraft absent drugs in your blood stream why do you want to be dependent on a drug?
 
Sorry "Guy" but the new "no third class" is much more than just "I have a driver's license so I'm good." While the details haven't yet been enacted, it's not clear that you are going to be OK taking SSRIs.
 
Why the harsh reply? This is probably going to be a very common question going forward - a lot of pilots who quit flying because of the FAA's policy on depression and anxiety are now going to consider getting back into it, and wondering what they need to do to operate within the new rules. It does appear that the *diagnosis* will no longer be disqualifying as long as you haven't been dx'd with bipolar or some other major disorder. But AOPA has said that the new rules won't change the verboten drug list, and as of now, unless you're on the depression SI, SSRIs aren't allowed. Chances are that isn't going to change, and I wouldn't be surprised if the FAA tries to expand the list of disqualifying conditions in the psychiatric category. There is even a section in the re-authorization bill on expanded mental health screening for pilots (I don't recall off hand if it is for all pilots or limited to commercial pilots).

So my answer would be, we don't know yet but if I was in this position I would not want to get my hopes up. Unfortunately, Germanwings is going to make things harder for anyone with a psychiatric diagnosis and I don't expect the new rules post-PBOR2 will totally mitigate that. Maybe not even at all.

Hopefully Dr. Bruce will weigh in on this as he would be in a better position to have an informed opinion. Everyone else (including me) is just speculating.
 
My point was that it is NOT going to be like Sport Pilot where all you need is to be breathing enough to pay the DMV your license fee.

Dr. C doesn't know much more than anybody else at this point (he even said so over on the red board). We won't know until the rulemaking process happens. We know for certain that it will NOT be any more lenient than what is in the reauth bill. This is one of those times where it's "be careful what you wish for." The bill was amended through it's development to add conditions which are now effectively CAST IN STONE. The AOPA/EAA and the FAA can't wish them away at this point. One of those criteria is that the non-AME doctor now responsible for signing off pilots MUST REVIEW all drugs being taken as to their impact. Now if it goes into the regs pretty much as minimally written in the law, then it will be determined by whether your doc wants to put his name on the line like that or not. Chances are you can do some doctor shopping to find one that will give you the "I don't see any reason why you can't operate the plane safely" statement you'll need. If the regs provide some guidance to non-AME providers, we may find things more sticky.
 
The text of the law being sent for signature reads the following and is not up for speculation:

(1) IN GENERAL.—An individual who has qualified for the third-class medical certificate exemption under subsection (a) and is seeking to serve as a pilot in command of a covered aircraft shall be required to have completed the process for obtaining an Authorization for Special Issuance of a Medical Certificate for each of the following:

(A) A mental health disorder, limited to an established medical history or clinical diagnosis of—

(i) personality disorder that is severe enough to have repeatedly manifested itself by overt acts;

(ii) psychosis, defined as a case in which an individual—

(I) has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis; or

(II) may reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis;

(iii) bipolar disorder; or

(iv) substance dependence within the previous 2 years, as defined in section 67.307(a)(4) of title 14, Code of Federal Regulations.
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Bipolar disorder, in my opinion is going to be an umbrella term that will include mania, depression or a combination of both anywhere on the spectrum of mood disorders.

The Current FAA guidance to AME's on Bipolar, and what they consider it...
Decision Considerations - Aerospace Medical Dispositions
Item 47. Psychiatric Conditions - Bipolar Disorder
Bipolar Disorders are considered on a continuum as part of a spectrum of disorders where there are significant alternations in mood. Generally, only one episode of manic or hypomanic behavior is necessary to make the diagnosis. Please note that cyclothymic disorder is part of this spectrum. Even if the bipolar disorder does not have accompanying symptoms that reach the level of psychosis, the disorder can be so disruptive of judgment and functioning (especially mania) as to pose a significant risk to aviation safety. Impaired judgment does occur even in the milder form of the disease.

All applicants with a diagnosis of Bipolar Disorder must be denied or deferred.
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What happens if a private physician refuses to approve a pilot for flight? Is that going to be the same as an AME denial under the present situation?
 
Dr. O said:
Let me ask a rhetorical question - if you already function to the level of complexity of operating an aircraft absent drugs in your blood stream why do you want to be dependent on a drug?
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Obviously I can function without it, but honestly it did offer relief.

Mostly helped with sleep, I have a hard time falling asleep because my mind won't shut off. Sleeping pills never really helped (plus they are a no no too).
 
JimNtexas said:
What happens if a private physician refuses to approve a pilot for flight? Is that going to be the same as an AME denial under the present situation?
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Not really. If the first doctor you go to says no (for example because they are afraid of liability as some have suggested will be a problem) but you find another doctor that says yes, you are good to go.

As for the ability to fly sport pilot, unless the FAA changes the sport pilot rules in some way, a denial by a private physician won't stop you from flying sport pilot under the sport pilot driver's license medical rules. Of course, the FAA is legally free to change the sport pilot rules at any time, up to and including abolishing sport pilot privileges altogether. But, it would really surprise me if the FAA tightened the sport pilot medical rules. Congress just overwhelmingly told the FAA it wanted less restrictive and less burdensome medical regulation for non-commercial pilots.
 
Doggtyred said:
Bipolar disorder, in my opinion is going to be an umbrella term that will include mania, depression or a combination of both anywhere on the spectrum of mood disorders.
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I highly doubt that. Under the definition that you quote, depression is simply not bipolar disorder unless there has been an episode of mania or hypomania. Most people who have been treated for depression have never had a manic or hypomanic episode.

Some people seem to have the view that the FAA can write whatever regulations it wants to implement this new law, but that's not true. Agencies often have an enormous degree of discretion in implementing regulations, but they only have the discretion that Congress gives to them. If Congress says "non-commercial pilots only need a special issuance if they have conditions A, B, or C," the FAA doesn't get to add conditions D, E, and F just because they think Congress should have included them.
 
What a disappointing mess. Don't be so sure the FAA can't mess this up. Huerta had been useless and obstructionist all the way so far.
 
It would seem to me that since depression/anxiety aren't explicitly called out among the mental health conditions noted and since Prozac, Zoloft, Lexapro and Celexa are already approved under the current SI, there could be some relief at least for those on these four meds. That said, in this post-Germanwings world, who knows.
 
"Who knows?" is the watch phrase for much of all of this. Until the new rules/regs are actually published, it's just conjecture and WAGs
 
And you DON'T want to be the guy who helps the FAA decide on its policy.

At least now we have a law. The FAA will have some limit as to what they can do.

Though the courts will rule that the FAA judgments as to meds and conditions are entitled to deference.

Remember. The FAA did NOT want this. They have a vested interest in screwing this up.
 
comanchepilot said:
And you DON'T want to be the guy who helps the FAA decide on its policy.

At least now we have a law. The FAA will have some limit as to what they can do.

Though the courts will rule that the FAA judgments as to meds and conditions are entitled to deference.

Remember. The FAA did NOT want this. They have a vested interest in screwing this up.
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Don't forget as soon as it's published, the idiots who will ask the Chief Counsel to re-write it via "opinions". I've asked folks if they want to start a pool for how long that one takes. I'm thinking, six months.
 
From the text of the bill as passed:

(e) Special issuance process.—

(1) IN GENERAL.—An individual who has qualified for the third-class medical certificate exemption under subsection (a) and is seeking to serve as a pilot in command of a covered aircraft shall be required to have completed the process for obtaining an Authorization for Special Issuance of a Medical Certificate for each of the following:

(A) A mental health disorder, limited to an established medical history or clinical diagnosis of—

(i) personality disorder that is severe enough to have repeatedly manifested itself by overt acts;

(ii) psychosis, defined as a case in which an individual—

(I) has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis; or

(II) may reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis;

(iii) bipolar disorder; or

(iv) substance dependence within the previous 2 years, as defined in section 67.307(a)(4) of title 14, Code of Federal Regulations.
Click to expand...

On the surface of reading that language it SEEMS like no special issuance will be required for a private pilot operating under the third class medical exemption just for taking an antidepressant drug UNLESS the pilot has been diagnosed with some sort of serious mental illness like schizophrenia or bipolar disorder. I'm not a doctor mind you, but I'm fairly certain depression and/or anxiety are not considered psychoses.

The FAA will be publishing a checklist for pilots to be presented to their family doctors every four years. The checklist will look like the old AME physical form except it is not sent to the FAA. It will be filled out by both the pilot and his or her physician and kept with the pilot's logbook.

(ii) a signature line for the individual to affirm that—

(I) the answers provided by the individual on that checklist, including the individual's answers regarding medical history, are true and complete;

(II) the individual understands that he or she is prohibited under Federal Aviation Administration regulations from acting as pilot in command, or any other capacity as a required flight crew member, if he or she knows or has reason to know of any medical deficiency or medically disqualifying condition that would make the individual unable to operate the aircraft in a safe manner; and

(III) the individual is aware of the regulations pertaining to the prohibition on operations during medical deficiency and has no medically disqualifying conditions in accordance with applicable law;
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The question I think is, does "medical deficiency" or "medically disqualifying condition" include depression and/or anxiety well controlled with medication? Further, will the current FARs prohibiting the issuance of third class medical certificates to airmen taking SSRI drugs be overruled by this new bill? It's hard to say as I'm not a lawyer but...I suspect in practical effect, this will all be left to the individual PPL and his doctor.
 
Actually, the FAA will be publishing "interpretation" based on the DSM. All the 310-319 disorders are psychoses, in fact.

The essential problem is that the Federal Medical Standard has not been changed, and in litigation, the endorsing family practice docs are likely to show their deficiencies.
 
So when I tried to tell someone that the FAA could just use the same standards and make the doctors liable for enforcing them, I might have been right, despite the immediate condemnation that I didn't understand the law making process. Disappointing if I'm right.
 
bbchien said:
Actually, the FAA will be publishing "interpretation" based on the DSM. All the 310-319 disorders are psychoses, in fact.

The essential problem is that the Federal Medical Standard has not been changed, and in litigation, the endorsing family practice docs are likely to show their deficiencies.
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Could you elaborate on this post, please?
 
Looks like AOPA says nothing changed, OP. Sorry. :(

Will this reform change the rules regarding medications?
No. The rules regarding medications will remain unchanged. So pilots who take a medication that the FAA disallows will still be unable to fly while taking the disallowed medication. Please contact AOPA’s Pilot Information Center if you have questions about a medication you are taking or that your doctor has recommended.
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Again, though, as a practical matter...well, that's between you and your doctor and the level of risk you're willing to accept. You could always just fly LSA or gliders or move to Australia, I guess. Apparently Prozac doesn't affect your ability to safely fly in the southern hemisphere.:D
 
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