UNITED STATES
RX AVIATION
Stan Musick stan@agairupdate.com
SSRIs and the Airman…..
SSRIs have become very commonly used today treating chronic pain, premenstrual syndrome (PMS), depression, anxiety and have been used in smoking cessation therapy.
B 18 | agairupdate.com
SSRIs (Selective Serotonin Uptake Reinhibitors) have become very commonly used in today’s medical practice. They have been shown effective in treating chronic pain, premenstrual syndrome (PMS), depression, anxiety, and have been used in smoking cessation therapy. Typical ones are Prozac, Lexapro, Zoloft, Celexa, and Wellbutrin. Apart from the obvious jokes about “aerial application can be depressing”, it is all too common for a healthcare provider to quickly put a pilot on one of these medications without considering the aeromedical implications. I hope to provide an overview that will help if you have been put on one of these medications, or perhaps have need of one. There are two areas of concern in the use of SSRIs. One is the diagnosis itself…many of the indications for use of an SSRI reflect potential mental impairment, which in and of itself is medically disqualifying. The second is the effect that SSRIs have on the central nervous system (CNS). CNS effects can be debilitating…headache, drowsiness, agitation…which obviously can interfere with safe flying. Two pathways exist for someone on an SSRI. One is to discontinue the medication, the other is to go through the Special Issuance process to continue to take the medication and still fly. The path chosen will depend on diagnosis, medication, and your response to the medication. If you choose to discontinue the use of an SSRI, you must be off the medication for 60 days. After that 60s days (this is important…you must be off the medication for 60 days prior to evaluation), your treating physician will need to generate a report noting stable mood and no adverse effects. Application can then be made for regular issuance of a medical. Note, however, that the FAA may still require reports from your treating physician. Continuing the SSRI is an option, if it is one of the acceptable four medications…Prozac,
Lexapro, Zoloft or Celexa. Note that Wellbutrin is NOT acceptable! To continue the medication you must be on the medication for at least six months, with stable dosage and no side effects. One of four diagnoses are acceptable…major depression, dysthymic disorder, adjustment disorder with depressed mood, or use of the SSRI for a nondepression related disorder.
Two pathways exist for someone on an SSRI. One is to discontinue the medication, the other is to go through the Special Issuance process. If there is a history of suicidal ideation (consideration of suicide), psychosis, electroconvulsive therapy (shock therapy), multiple simultaneous SSRIs or use of other psychoactive medications with the SSRI, issuance is not allowed. Important to note is that even if an airman meets all the above criteria, issuance will still be on a case-by-case basis. To proceed, the airman must be evaluated by a HIMS (Human Intervention Motivational Specialist) AME. The HIMS AME must review all your records, including the records from when you were having symptoms, and not treated, through the treatment. Evaluation by a board-certified psychiatrist is necessary for initial issuance, as is an evaluation by a neuropsychologist. Specific reports are required from your treating physician. In addition, a report from your chief pilot/operator is required. All of the above must be reviewed by the FAA, and then the HIMS AME can issue. ➤
