SSRI Rule Outs Reality

[Joseph2]

Background -
I take one of the four allowable SRRIs for anxiety. I am currently in the SSRI Decision Path II process seeking to remain on the SSRI and obtain a third class special issuance. I worked with a HIMS AME and completed all the steps/reports from the board certified psychiatrist, my physician, neuropsychologist (including Cogscreen-AE), HIMS AME etc. The Cogscreen-AE scores were all good and the HIMS AME, Psychiatrist and Psychologist reports were all in alignment in their summary/recommendations - that I am stable on one SSRI and my condition/treatment would not adversely affect flight safety. My submitted package is currently in DC for evaluation.

Question -
My records indicate I do not meet one of the "SSRI Rule Outs" listed in Item 47 in the Guide for AMEs: "Multi-agent drug protocol use (prior use of other psychiatric drugs in conjunction with SSRIs)" since I used an approved SSRI with a benzodiazepine in 2013. I meet all of the other "Rule Outs" (no dual SSRIs, no suicide ideation, etc.)

Is that one problematic "Rule Out" going to be an Absolute Denial in DC? Or can the deciding physician in DC be a little more discerning and consider the whole package and findings/recommendations from the reporting doctors. Is there precedence for obtaining an SSRI SI when that "Rule Out" is not met?

 

[bbchien]

Generally speaking (and only generally) since the benzos are not in the same league as SSRIs (the exclusion was intially intended to rule against those with severe cases such that the docs through that "amplification" therapy was needed (TWO antidepressives at once). But it does give the analysts the right to deny you for fact. If the case is mild enough and the benzo use rare enought, I do have several who made it through.

YMMV, however.

 

[Joseph2]

Generally speaking (and only generally) since the benzos are not in the same league as SSRIs (the exclusion was intially intended to rule against those with severe cases such that the docs through that "amplification" therapy was needed (TWO antidepressives at once). But it does give the analysts the right to deny you for fact. If the case is mild enough and the benzo use rare enought, I do have several who made it through.

YMMV, however.

Thanks excellent feedback Dr. Chien, thank you. I've got a few months to go and I'll share my experience when the decision is made as another 'data point.'