Lexapro and Basic Med

D

Dreamster

Guest
I'm on Basic Med since early 2022. Not currently flying and not sure if I will return, but looking for info.

My GP wants to prescribe Lexapro for 30-60 days to see if it helps my insomnia. Also changing diet, eliminating caffeine, etc.

No depression, no anxiety, nor any mental health diagnoses.

What FAA-related issues might I face if I starting taking the Lexapro?

What would the FAA want if I were to start flying again, or if I renew my Basic Med?

Thanks.
 
I don’t see why it would cause an issue with Basic Med, if your doctor considers you safe to fly. The FAA doesn’t get any Basic Med records and doesn’t get a say, since this doesn’t fall under one of the conditions that require you to go back for an SI.

Now, whether it’s wise to fly while taking that drug is another matter. Tread cautiously.

Personally, I would try passion flower and one of the sleep teas first, then Benadryl, before leaping to Lexapro. But I’m not a physician. I don’t even play one on TV.
 
I tried a Benadryl once for sleep. Took a while to shake it off in the am. My experience is I wouldn't recommend for a good night's rest prior to a flight. Melatonin is another option.
 
Dreamster said:
I'm on Basic Med since early 2022. Not currently flying and not sure if I will return, but looking for info.

My GP wants to prescribe Lexapro for 30-60 days to see if it helps my insomnia. Also changing diet, eliminating caffeine, etc.

No depression, no anxiety, nor any mental health diagnoses.

What FAA-related issues might I face if I starting taking the Lexapro?

What would the FAA want if I were to start flying again, or if I renew my Basic Med?

Thanks.
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BasicMed aside, I would be looking at something other than an SSRI anti-depressant to combat insomnia. The FAA doesn’t review BasicMed medical history but the doctor signing your exam is required to consider your medications and discuss with you how they might effect your ability to safely operate an aircraft. It may also present issues if you ever need to go back to a part 67 medical for some reason.
 
This is near comical!! First off lexapro is not indicated for insomnia. While there are many off label uses out the lexapro would be one of the last arrows to pull out of the quiver.
Second thing is 30-60 day course?? Takes a good 30 to even start to work correctly.
Your pcp likely thinks you do have anxiety/depression/psych diagnoses in some way shape or form
There are a lot of ways pharmaceutically as well and non-pharmaceutically, to treat insomnia. In 22 years practice I haven’t seen lexapro used this way, ever.
 
If your doc truly thinks you need a prescription sleep aid, why wouldn’t he try something like ambien before going to an SSRI?

GPs prescribing antidepressants unnecessarily have caused problems for lots of pilots.
 
Dreamster said:
I'm on Basic Med since early 2022. Not currently flying and not sure if I will return, but looking for info.

My GP wants to prescribe Lexapro for 30-60 days to see if it helps my insomnia. Also changing diet, eliminating caffeine, etc.

No depression, no anxiety, nor any mental health diagnoses.

What FAA-related issues might I face if I starting taking the Lexapro?

What would the FAA want if I were to start flying again, or if I renew my Basic Med?

Thanks.
Click to expand...

Read the SSRI policy. Pilots can get medicals with SSRI scrips if they fit the model and go through the motions. As for Basicmed? The aeromedical pathway is established so not prohibited. It’s up to your physician. Ask the prescribing doc if he’d sign your Basicmed form. That may be an interesting answer.
 
Lexapro has no bearing on BasicMed.

It also isn’t a treatment for insomnia. Sounds like you said “I’m having trouble with insomnia” and your doctor said (perhaps silently) “ah! Probably anxious and depressed like everyone else. I’ve seen good results with Lexapro.”
 
OP here. Thank you for the fast and solid responses - very helpful.

My insomnia feels to me caused by 'loud mind' versus stress or anxiety, and I don't feel I have many external factors creating bad stress or anxiety.

MedicalNewsToday.com (hardly a vetted website) did state "if high serotonin acts on a certain part of the brain, such as the dorsal raphe nucleus, it can also induce sleep."

Might that be a worthwhile reason to prescribe Lexapro for insomnia?

I'm more concerned with overall quality of life than flying, since the insomnia is limiting me. Comments here are illuminating and I'm wondering if I want to 'argue' with my GP, whom I respect?

Any further thoughts? Again, thanks...
 
Being your own advocate and asking your GP to show their work is not arguing with them. While a nonissue for BasicMed, there are lots of levers to pull before pharmaceuticals, much less SSRIs. I'd try diet/exercise/caffeine first, and also would avoid benadryl. If you drink alcohol, try not doing that. Turn your phone off an hour before bedtime. Be patient, things don't change overnight. Good luck!
 
CBD/Melatonin gummies work pretty well for sleep.

I think this is a great topic. I’d like to hear more factual replies but I suspect most guys in the know will stay silent. Statistics say 15% of adults in the USA have taken an SSRI in the last 30 days. That means we’re dealing with SSRI patients pretty much everywhere we go. My own physician talks about pro pilot patients who need to be on anti-depressents but refuse because of the FAA. She’s convinced they’d be better suited for their work with meds than they are without. I know several people who take SSRIs and all are fully functioning professionals, spouses, and parents. They’re happier versions of themselves with the meds. This isn’t One Flew Over the Cuckoo’s Nest stuff.
 
I second use something else if you're on Basic med. SSRIs can really interfere subtly with cognition. But your doc is in control. SSRI are on teh links to the "state licensed medical doctor" as "do not fly".
 
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From the CMEC / 8700.2:
You should consider consulting available aeromedical resources on the flight hazards associated with medical conditions/medications, to include:
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n.b. the DNI list is part of the AME Guide.
 
If he had a third class or higher before? He wouldn't.

My interest in the topic is driven by a nephew and a son-in-law who've used SSRI meds and want to become private pilots and have never had a medical. The FAA's hurdles to approve are the only thing crazy here. The men dictating policy need to wake up and join the 21st century. The proportion of the younger population who've had ADHD and SSRI meds is pretty high, and those kids I know aren't crazy or dangerous.
 
Having had trouble sleeping in the past, if you're drinking any alcohol or caffeine, any at all, I would cut that to zero before taking any "sleeping pills." And next on the list would be an hour of vigorous exercise a day.

I know that wasn't your question, but don't these things will have only positive impacts on your medical fitness to fly.
 
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We have a teenage young lady who rides horses with us who was quiet and withdrawn to the point of being sullen. She was prescribed an SSRI, and the change in a very short time has been remarkable. In a matter of days she's become vivacious, outgoing and gregarious to the point of being chatty. Night and day change, and I have to say a little unsettling. I'm not sure it's healthy to have such a drastic change in such a short period. I think they are still adjusting the dosage, but man is it ever resulting in behavior modification.
 
Chip Sylverne said:
I tried a Benadryl once for sleep. Took a while to shake it off in the am. My experience is I wouldn't recommend for a good night's rest prior to a flight. Melatonin is another option.
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I’m on Basic Med. Whenever I need to use Benadryl, I adhere to the FAA “5x dosing” standard. Since dosing for Benadryl is 4-6 hours, so I use a 30 interval between using Benadryl and flying.
 
Actually, I wasn't misinformed. The FAA document is inconsistent, or at best confusing. This is the text on which I was relying. Benadryl is considered a "conditionally acceptable medication." The table later in the document says 60 hours.

benadryl.png
 
Chip Sylverne said:
We have a teenage young lady who rides horses with us who was quiet and withdrawn to the point of being sullen. She was prescribed an SSRI, and the change in a very short time has been remarkable. In a matter of days she's become vivacious, outgoing and gregarious to the point of being chatty. Night and day change, and I have to say a little unsettling. I'm not sure it's healthy to have such a drastic change in such a short period. I think they are still adjusting the dosage, but man is it ever resulting in behavior modification.
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I’d call it giving her brain some assistance. Correcting an imbalance. I wouldn’t characterize it as behavior modification.
 
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warm milk before bed
white noise generator
stay away from electronics for an hour before bed
meditation

all sorts of options before any medication
 
Many physicians are quick to want to prescribe medications. In their defense, many patients are quick to demand them. If your physician wants to give you any psychotropic medication for a non mental health condition then there are typically one of two things happening:

1 - they think you have a mental health condition and just don't want to tell you or
2 - they just aren't a very good doctor

Either way, be very cautious about off label use of any psychotropic medication.
 
Or maybe he’s a doctor who’s treating a patient that he just examined? Maybe the OP should just get treatment from strangers on the internet!
 
There are lots of things you can try before going on a medication like Lexapro, especially if you don't think that you are anxious or depressed. Have you tried changing your diet, exercising more, and not watching TV/using a phone or computer before bed? I would at least try those before jumping to such drastic measures as taking a SSRI. Despite the benefits they provide some people, there can be rather undesirable side effects.

Other (non-medicated) things that might help include drinking a hot cup of chamomile tea with honey before bed, burning lavender-scented candles in the bedroom for 10 or 15 minutes, or keeping a notebook and pen beside the bed to write down the stuff that pops into your head and keeps you awake. There are also lots of non-addictive, non-prescription sleep aids that are very effective - and if nothing else works, there's always prescription sleep aids as well. It seems odd to me that your doctor jumped straight to Lexapro unless you really are anxious/depressed.
 
OP here... Thank you all for the excellent suggestions and well-meaning advice. Unfortunately, I've been fighting this 'loud mind' insomnia for ~10 years and have tried or am using just about all the techniques and tools that have been mentioned.

Many of them are very beneficial, no doubt, but have no sufficed.

At this point, we're going further afield because the insomnia is noticeably affecting my life. (No, I will not even think of flying until this is fully resolved.) Concurrently doing some significant diet changes, no caffeine or alcohol, mandatory exercise, and trying my best to learn to meditate.
 
Brad Z said:
I mean, if you're gonna go all in, I found propofol to be pretty effective. Just don't hire the king of pop's doc to administer it.
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Sorta like hiring Casey Anthony to administer chloroform.....
 
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Dreamster said:
I'm on Basic Med since early 2022. Not currently flying and not sure if I will return, but looking for info.

My GP wants to prescribe Lexapro for 30-60 days to see if it helps my insomnia. Also changing diet, eliminating caffeine, etc.

No depression, no anxiety, nor any mental health diagnoses.

What FAA-related issues might I face if I starting taking the Lexapro?

What would the FAA want if I were to start flying again, or if I renew my Basic Med?

Thanks.
Click to expand...

Sleep disturbances can serve as a key indicator of mental health issues. If your doctor has recommended Lexapro, it may be because they suspect it could help address these concerns. However, it is important to consult your doctor directly to confirm if this is their reasoning. It is worth noting that opting for Lexapro could have implications if you plan to return to class 1, 2, or 3 medical certifications later. Basic med is essentially unaffected.

I personally experienced a similar situation where my doctor attributed my sudden insomnia to situational anxiety. They prescribed Lexapro, and it proved effective in helping me return to my normal self and feel better. However, I remained on the medication for over a year. My doctor explained that Lexapro is a long-term treatment option, as it takes time to reach therapeutic levels in the bloodstream and requires a gradual tapering off process.

In my case, being on basic med and taking a break from flying allowed me to address my health concerns. Now, as I strive to regain regular medical certification, I am encountering significant time and expense due to the brief period I was on medication. My advice to you is to prioritize your health first and deal with flying concerns later. However, it would be wise to explore alternative solutions before considering Lexapro
 
Dreamster said:
No, I will not even think of flying until this is fully resolved.
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That’s wise.

One unintended benefit of Basic Med is you can do this without fear of losing your ability to fly or facing an expensive SI process. This freedom does require that you be responsible in assessing your fitness to fly, and it sounds like that’s exactly what you’re doing.

Health first. Basic Med and flying will still be there when you’re ready.
 
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