Possible SSRI Rx, for trouble falling asleept, but never taken

D

Dr. Strangelove

Guest
How does the FAA look at this situation?

This was close to a decade ago. The script may have been filled once, but the drugs were never taken.
 
The standard answer is going to be to Contact Dr Bruce and do not mention anything else here on the board that someone with the power to make a decision could see.
 
My understanding, and I could be totally wrong, is that the only Dx for SSRI's is depression. In other words, You may have been given it for sleep, but the doc would have had to Dx depression.
 
Mike Smith said:
My understanding, and I could be totally wrong, is that the only Dx for SSRI's is depression. In other words, You may have been given it for sleep, but the doc would have had to Dx depression.
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If the doc is putting stuff in my chart that shouldn't be there that's his rear end.
 
Mike Smith said:
My understanding, and I could be totally wrong, is that the only Dx for SSRI's is depression. In other words, You may have been given it for sleep, but the doc would have had to Dx depression.
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Your understanding is incorrect. There are off list uses for medications that allow their prescription to treat other than the primary use of the medication. Those prescriptions are referred to as "off-label" prescriptions.
 
Can't fall asleep, that's a medical condition now?
 
ircphoenix said:
Your understanding is incorrect. There are off list uses for medications that allow their prescription to treat other than the primary use of the medication. Those prescriptions are referred to as "off-label" prescriptions.
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So the doc would Rx Prozac and write it up as insomnia?
 
I don't know that Prozac has an off-label use as a sleep aid. If it does, then sure.

Trazadone is not infrequently prescribed as a sleep aid when other prescription sleep aids aren't well tolerated. Wellbutrin has been prescribed to help with stopping smoking. I think Prozac has an off-label use in migraine prevention.

And those are all 100% legitimate prescriptions. A doc doesn't have to write a script for something OTHER than what he intends to treat using the medication. So he doesn't have to write depression even if the intent is to deal with sleep just because the medication in particular is mainly prescribed to treat depression.
 
Mike Smith said:
My understanding, and I could be totally wrong, is that the only Dx for SSRI's is depression. In other words, You may have been given it for sleep, but the doc would have had to Dx depression.
Click to expand...

You're totally wrong. There are on-label uses for SSRIs beyond depression and even the FAA will approve them for SI.

Getting back to the original poster, if he had a transient condition and never took the pills, getting certified isn't likely to be a problem. If he did take the pills, he's going to need to be off them for a period (60 or 90 days IIRC) and then show he has no problem.
 
From memory, which is not as good as a really good AME - short term, temporary use of medication for depression is ok but needs to be explained by the doctor. If filled the perscription bu tyou never took them, then you could have turned the medicine back in to a pharmacist or doctor. Otherwise you are deemed to have taken the medicine.

The fact that this was 10 years ago and a one time prescription is both good and bad. Good because it's not a chronic condition, bad because it was so long ago that you might have trouble getting records or a statement.
 
flyingron said:
You're totally wrong. There are on-label uses for SSRIs beyond depression and even the FAA will approve them for SI.

Getting back to the original poster, if he had a transient condition and never took the pills, getting certified isn't likely to be a problem. If he did take the pills, he's going to need to be off them for a period (60 or 90 days IIRC) and then show he has no problem.
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Not to hijack, but I know there are some meds that the only Dx is depression, I have read a lot of threads where someone took X drug for Y condition and it was said, you better check. That's what I was thinking. Am I totally off base, I do not want to repeat bad info.
 
Mike Smith said:
Not to hijack, but I know there are some meds that the only Dx is depression, I have read a lot of threads where someone took X drug for Y condition and it was said, you better check. That's what I was thinking. Am I totally off base, I do not want to repeat bad info.
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That's not what you said, you were repeating BAD INFO. All the SSRIs that the FAA will issue SIs for have ON LABEL use for things other than depression. Fluoxetine (Prozac) is on-able for OCD, bulimia, and panic disorders. Sertraline (Zoloft) is on-label for OCD, panic and anxiety disorders, PTSD, and PMDD. Escitalopram (Lexapro) is on-label for generalized anxiety disorder. Paroxetine (Paxil) is not eligible for the SI, but is also used on-label for OCD, anxiety, PTSD, PMDD, and in some formulations hot flashes menopause.

It's quite obvious that SSSI have FDA approved and medically accepted uses other than depression. There are some SSRIs (Citalopram) where that there is no on-label use other than depression, but that's NOT what you said. There are also SSTIs that aren't on-label for depression at all (Fluvoxamine is one).
 
flyingron said:
That's not what you said, you were repeating BAD INFO. All the SSRIs that the FAA will issue SIs for have ON LABEL use for things other than depression. Fluoxetine (Prozac) is on-able for OCD, bulimia, and panic disorders. Sertraline (Zoloft) is on-label for OCD, panic and anxiety disorders, PTSD, and PMDD. Escitalopram (Lexapro) is on-label for generalized anxiety disorder. Paroxetine (Paxil) is not eligible for the SI, but is also used on-label for OCD, anxiety, PTSD, PMDD, and in some formulations hot flashes menopause.

It's quite obvious that SSSI have FDA approved and medically accepted uses other than depression. There are some SSRIs (Citalopram) where that there is no on-label use other than depression, but that's NOT what you said. There are also SSTIs that aren't on-label for depression at all (Fluvoxamine is one).
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Which is why I said, I could be wrong. Which is why I said in the second post, I don't want to repeat bad info and asked the question, are there some meds whos only Rx is for depression? I admit I may be getting something else confused. Im not arguing, you seem to know what you are talking about and I was asking for clarification. Do you always reply with such an crappy tone?
 
Mike Smith said:
Which is why I said, I could be wrong. Which is why I said in the second post, I don't want to repeat bad info and asked the question, are there some meds whos only Rx is for depression? I admit I may be getting something else confused. Im not arguing, you seem to know what you are talking about and I was asking for clarification. Do you always reply with such an crappy tone?
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To be fair, your first (incorrect) posts had a factual tone. When your assertions were questioned, you replied in a dismissive tone. After a couple of us corrected you, then your tone changed to being curious as opposed to being an expert.
 
OK, is the Doc still in business in your area? Do you still have the bottle with all the pills? If yes to both, Visit the Doc and return the pills to him, requesting that he mark your chart that all of the pills were returned.

There. Documented that you never took them. Now go fly.

If no to either or both, then contact Dr. Bruce for his advice. -Skip
 
ircphoenix said:
To be fair, your first (incorrect) posts had a factual tone. When your assertions were questioned, you replied in a dismissive tone. After a couple of us corrected you, then your tone changed to being curious as opposed to being an expert.
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I figured opening with "my understanding is, and I could be totally wrong" conveyed that I was not presenting myself as an expert and my follow up was a question that I really just wanted to know the answer to. No need to act superior, I was only opening the dialog. Have a good day.
 
Mike Smith said:
I figured opening with "my understanding is, and I could be totally wrong" conveyed that I was not presenting myself as an expert and my follow up was a question that I really just wanted to know the answer to. No need to act superior, I was only opening the dialog. Have a good day.
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Nope. Reviewing the thread and the posts, you're absolutely right. And I was wrong. There was zero negative tone in your posts and I sincerely apologize for misstating what you said. My fault.
 
ircphoenix said:
I don't know that Prozac has an off-label use as a sleep aid. If it does, then sure.

Trazadone is not infrequently prescribed as a sleep aid when other prescription sleep aids aren't well tolerated. Wellbutrin has been prescribed to help with stopping smoking. I think Prozac has an off-label use in migraine prevention.

And those are all 100% legitimate prescriptions. A doc doesn't have to write a script for something OTHER than what he intends to treat using the medication. So he doesn't have to write depression even if the intent is to deal with sleep just because the medication in particular is mainly prescribed to treat depression.
Click to expand...

that was it.

Doc is still my GP today and only one of two I have visited. All records will be easy to get a hole of.
 
Mike Smith said:
My understanding, and I could be totally wrong, is that the only Dx for SSRI's is depression. In other words, You may have been given it for sleep, but the doc would have had to Dx depression.
Click to expand...

That is an incorrect understanding. There are formulations of SSRI's that are prescribed for insomnia now, and there are low dose formulations that are indicated for it. The thinking is... many folks with insomnia are actually slightly manic... hypomanic, for instance.. The low dose is more than adequate to allow folks with this form of insomnia to quiet their minds and get to sleep. If I was to prescribe it for insomnia, my dx on my billing and in the record would be insomnia.. not something else. Whether its paid for or not is another issue. You dont fudge diagnoses. Thats how you (as a prescriber) get your tit in a wringer when things happen and you get audited.

When I asked Doc Bruce about the low dose SSRI's being approvable or not, when Rx for Insomnia, at the time he reported that any dose of SSRI was disqualifying at that time, because of the underlying processes the med was treating.
 
Doggtyred said:
That is an incorrect understanding. There are formulations of SSRI's that are prescribed for insomnia now, and there are low dose formulations that are indicated for it. The thinking is... many folks with insomnia are actually slightly manic... hypomanic, for instance.. The low dose is more than adequate to allow folks with this form of insomnia to quiet their minds and get to sleep. If I was to prescribe it for insomnia, my dx on my billing and in the record would be insomnia.. not something else. Whether its paid for or not is another issue. You dont fudge diagnoses. Thats how you (as a prescriber) get your tit in a wringer when things happen and you get audited.

When I asked Doc Bruce about the low dose SSRI's being approvable or not, when Rx for Insomnia, at the time he reported that any dose of SSRI was disqualifying at that time, because of the underlying processes the med was treating.
Click to expand...
Can you give me more detail about this part?
 
Dr. Bruce is one of the authors of the FAA SSRI SI protocol. It's approvable now and has been expanded over the initial depression diagnoses as well.
The big issue is that you have to be taking one of the four SSRIs in the protocol (Prozac, Zoloft, Celexa, Lexapro). Trazodone is NOT approved and due to it being sedating nature and other side-effects, almost certainly never will be. As previously mentioned, Trazodone is not an SSR and doesn't act through the same pathways and has completely different effects.

Trazadone isn't "on-label" for insomnia in the US (it seems the EU has approved it for such).
 
flyingron said:
Dr. Bruce is one of the authors of the FAA SSRI SI protocol. It's approvable now and has been expanded over the initial depression diagnoses as well.
The big issue is that you have to be taking one of the four SSRIs in the protocol (Prozac, Zoloft, Celexa, Lexapro). Trazodone is NOT approved and due to it being sedating nature and other side-effects, almost certainly never will be. As previously mentioned, Trazodone is not an SSR and doesn't act through the same pathways and has completely different effects.

Trazadone isn't "on-label" for insomnia in the US (it seems the EU has approved it for such).
Click to expand...
Sorry to barge in but this one is accurate, I must agree with you on this.
 
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