SSRI Questions

9

98aviator

Guest
Hi, I have been stalking the medical board for a while now, trying to clue together a plan of action for myself, but I figured it would be a good idea to just come out here and ask for help.

Let me give you the lowdown; I'm 20 years old, and I am at school, enrolled in the flight program. However, I've put off flying for a semester now as I've been trying to obtain my medical. When I went in for my test, everything was fine and dandy until we discussed my use of Zoloft, which got me deferred. As of writing this, I have been off of them for shy of 5 months, and have been doing great in school (3.6 GPA, all that).
I got the SI process started with a HIMS specialist in my area, but I'm mainly just worried about the best way to go about this WITHOUT getting too involved in the HIMS program. I was on Zoloft since 2015 because my Father abused me.

I have a cogscreen scheduled for about 20 days from now, but I'm really just wondering if this path I'm taking is the best one to take. I mean, I know the FAA isn't going to forget that I was on Zoloft, but considering I feel as if my depression has been treated, is there any better way to go about this? Or is it time to look for another aviation profession?
Also, does anyone have an idea as to what could potentially happen if they don't receive all this info in time? Would I be able to re-apply for a medical down the road?

Any response is appreciated! And hey, Happy New Year!
 
I would trust what your HIMS specialist and AME are telling you versus us guys on the Internet. They are working with the full gamut of information about you where as we would be WAGging or tails off.

You say you have been monitoring this forum for a while, so should know who Doctors Bruce and Lou are. And that Doctor Bruce was one of the 4 authors of the SSRI acceptance protocol. So if you really are seeking an opinion that will actually work for the FAA, then you already know who you should be talking to instead of random folks on an Internet chat board.

Keep working hard at your school and best of luck to ya!

PS, pinging @bbchien so if he cares to add to this thread, he will know to stop by.
 
Good luck with everything. Among other things, the longer off the meds the better.

I’ll let someone more knowledgeable brief specifics.
 
frfly172 said:
Dr Bruce May be by later.
Click to expand...
Well I stumbled in the door.

So Single episode of depressive anxiety, if you record shows that you have had no other episode in your life, will work 90 days after discontinuance, provided there was no suicidality nor hospitalizaton, and provided that you can substantiate that claim. Ergo, you need your ENTIRE pediatric record. So go obtain it.

Second, FAA has gotten quite choosy after Andreas Lubitz. Google him, and you'll understand why. To have much of a chance you need a forensic psychiatrist's eval, better yet a HIMS trained forensic psyhciatrist's endorsement Your HIMS AME should be able to provide the referral.

"Don't want to get involved with HIMS" only means, to me, you are trying to avoid cost (reasonable) but there is no other way to convince FAA that you are not a Lubitz. Think of it from their point of view: An American candidate, approved by a medical officer does something really really mortal to 150 passengers. What do you think that means for his federal career? After age 40, nobody wants then in private medicine, e.g, the medical career is OVER.

So, you might as well buck up and prepare to see the HIMS forensic psychiatrist because you are likely to end up seeing him anyway (and get certified sooner). The ONE exception is if your care has been not with a PCP, but with a board certified psychiatrist who takes and keeps GOOD NOTES. Then, a Forensic evaulative psychiatrist, not of the HIMS variety might be able to do the job.

But is a good bet you PCP did the care. FAA does not recognize the Family doc as an expert in diagnosis (psychiatrically). they have good instincts (but they actually have about 3 weeks of formal training in psychiatry).

Particularly with FAA medical shut down with the government shutdown, I have an increasing cadre of airmen who opt for the HIMS psychiatry evaluation because the wait for review, on the other side of the shutdown, will be EVEN LONGER THAN BEFORE.

Dr. Bruce
 
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if the FAA determines you need to go the HIMS route, that will be your only recourse.
 
bbchien said:
Well I stumbled in the door.

So Single episode of depressive anxiety, if you record shows that you have had no other episode in your life, will work 90 days after discontinuance, provided there was no suicidality nor hospitalizaton, and provided that you can substantiate that claim. Ergo, you need your ENTIRE pediatric record. So go obtain it.

Second, FAA has gotten quite choosy after Andreas Lubitz. Google him, and you'll understand why. To have much of a chance you need a forensic psychiatrist's eval, better yet a HIMS trained forensic psyhciatrist's endorsement Your HIMS AME should be able to provide the referral.

"Don't want to get involved with HIMS" only means, to me, you are trying to avoid cost (reasonable) but there is no other way to convince FAA that you are not a Lubitz. Think of it from their point of view: An American candidate, approved by a medical officer does something really really mortal to 150 passengers. What do you think that means for his federal career? After age 40, nobody wants then in private medicine, e.g, the medical career is OVER.

So, you might as well buck up and prepare to see the HIMS forensic psychiatrist because you are likely to end up seeing him anyway (and get certified sooner). The ONE exception is if your care has been not with a PCP, but with a board certified psychiatrist who takes and keeps GOOD NOTES. Then, a Forensic evaulative psychiatrist, not of the HIMS variety might be able to do the job.

But is a good bet you PCP did the care. FAA does not recognize the Family doc as an expert in diagnosis (psychiatrically). they have good instincts (but they actually have about 3 weeks of formal training in psychiatry).

Particularly with FAA medical shut down with the government shutdown, I have an increasing cadre of airmen who opt for the HIMS psychiatry evaluation because the wait for review, on the other side of the shutdown, will be EVEN LONGER THAN BEFORE.

Dr. Bruce
Click to expand...

Dr. Bruce, thank you so much for your input!
Unfortunately, the family doc prescribed the Zoloft so am currently on the hunt for a psychiatrist who will work with me. And you're definitely correct about me wanting to avoid the HIMS program for financial reasons, but if I have to go through it, then I will. I do consider myself treated, though, but I know the FAA will think otherwise.
As for hospitalization, I was never admitted but was taken to the ER for psych evals. the two times I went, I never got admitted. Should this impact me too much?
 
I've been on the SI/HIMS path for a couple of years now. It's a pain in the butt: finding a psychiatrist and a HIMS AME, then seeing (and paying) them every 6 months, plus a CogScreen every two years.

I wonder if it would be simpler if you didn't get a special issuance in the first place. You undoubtedly need to see a psychiatrist and a HIMS AME at least once, and possibly a neuropsychologist (for a CogScreen) too.

PS: to exit the SI/HIMS path, you need to have 'been off' your SSRI for 6 months with no ill effects; I'm not sure that applies to you (i.e you might want/need to wait another month to see a HIMS AME).
 
Harry, there are many airmen for which the SSRI pathway is the only pathway they can ever use. Any recurrent disease (more that one episode) wil be that way.
 
Harry said:
PS: to exit the SI/HIMS path, you need to have 'been off' your SSRI for 6 months with no ill effects; I'm not sure that applies to you (i.e you might want/need to wait another month to see a HIMS AME).
Click to expand...

Oops, I forgot to say that this only works if you want to switch to BasicMed.
 
Harry said:
I've been on the SI/HIMS path for a couple of years now. It's a pain in the butt: finding a psychiatrist and a HIMS AME, then seeing (and paying) them every 6 months, plus a CogScreen every two years.

I wonder if it would be simpler if you didn't get a special issuance in the first place. You undoubtedly need to see a psychiatrist and a HIMS AME at least once, and possibly a neuropsychologist (for a CogScreen) too.

PS: to exit the SI/HIMS path, you need to have 'been off' your SSRI for 6 months with no ill effects; I'm not sure that applies to you (i.e you might want/need to wait another month to see a HIMS AME).
Click to expand...

This february will be my 6 month mark and the “ill effects” have been a whopping 0 (just some withdrawl symptoms from the first couple days totally off, but other than that nothing). I would much rather prefer to just not be on the SI/HIMS path, because I feel it would not be necessary for my case, and so far my HIMS AME seems to be on the same page. But, if the big boys say I have to do the SI path, then so be it. But we will have to wait to see what the FAA says... and that may take a second! I’m still on the hunt for a psychiatrist, but I do have my cogscreen this Thursday the 10th.
Thanks for your input!
 
98aviator said:
This february will be my 6 month mark and the “ill effects” have been a whopping 0 (just some withdrawl symptoms from the first couple days totally off, but other than that nothing). I would much rather prefer to just not be on the SI/HIMS path, because I feel it would not be necessary for my case, and so far my HIMS AME seems to be on the same page. But, if the big boys say I have to do the SI path, then so be it. But we will have to wait to see what the FAA says... and that may take a second! I’m still on the hunt for a psychiatrist, but I do have my cogscreen this Thursday the 10th.
Thanks for your input!
Click to expand...
We appreciate the update of your progress.... Please keep them coming as you see fit to share.

Learning how folks progress through their journey helps all of us know how things go so we can share the story with others.
 
Again, I believe that being off for 6 months would qualify you switch from SI to Basic Med, not a regular 3rd class. Of course, you should confirm this with your HIMS AME &/or FAA.
 
Depends, Harry. On review of the record there has to have been no psychosis nor "went to the ER" as a danger to self. See the original legislation as to "may be expected.....or other commonly accepted symptoms of psychosis"
 
So are you saying that that one could, depending on circumstances and the whims of the FAA, go from an SSRI SI to a normal 3rd class medical certificate?

I'm not considering that path at the moment (i.e. I'm not discontinuing my SSRI), but I'd like to be clear on what's possible and what's not.
 
...where did you get that from?
I'm pointing out that BASIC med is unavailable without the SI first, if the depression has been severe enough to require the Emergency Room, or if symptoms of psychosis were present.
 
bbchien said:
...where did you get that from?
Click to expand...

From my HIMS AME.

bbchien said:
I'm pointing out that BASIC med is unavailable without the SI first, if the depression has been severe enough to require the Emergency Room, or if symptoms of psychosis were present.
Click to expand...

Right, I understand that you can't get Basic Med in those severe cases (I think that's what you meant).

Here's the case I'm trying to clarify: A pilot whose depression has *not* been deemed severe, per your description, decides — in consultation with his psychiatrist — to stop taking the SSRI. Six months after stopping, his psychiatrist certifies to the FAA that there are no ill effects, as they define them. Can the pilot now apply for a 3rd-class medical certificate? Or only Basic Med?
 
I don't think you understand your HIMS AME clearly, then. Not all depressions/anxiety conditions are life long. Some are. I have one such situation pending before the Federal Air surgeon. We're making the case that the PCP continued the man on his paxil only because he was on it before, and that he never really had a thing.

Depends on what is in the SSRI certification file. It depends on what the underlying disease is. Recurrent disease that has recurred, will recur.
So if he now has recurrent disease, off meds and unmonitored and applies for a 3rd class he gets denied. that's successful--NOT.

Figuring this out is EXACTLY part of what I do.

So I would say, "only Basic Med".
 
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