Getting Started: 3rd Class Medical with SSRI?
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Hi all,

I am an aspiring private pilot. It's a family tradition and it's something I've planned to do since I was a child. Anyway, like everyone here I'm sure, this goal is very important to me. I'm just getting started with this process, doing an online ground school and studying for my written exam. I'm also in touch with a CFI I would like to work with when I get everything squared away and am ready to start flight lessons. However, in all this reading, I learned that I will need a Special Issuance in order to get a 3rd class medical certificate since I currently take one of the FAA-approved SSRIs. Based on the FAA guidelines I can find online, it seems there's a path for this, but it is a very specific one and even with help from the right experts it might take quite a while. In my experience with government beaurocracy (I work for a federal agency myself, but not this one), it is important to understand the documentation and the process before you charge into something or you can get caught in a loop. In that spirit, I'm wondering if this community has advice on where I should start in order to be as thorough and efficient as possible. I'm not sure if I should start with a local AME first, or if I should go straight to a consultation with a HIMS AME. For documentation on the medication and my status/symptoms/stability, I'm not sure if I should get a letter from my primary care doctor, or if I need to be assessed by a psychiatrist. Maybe both?

[Removed personal details]

I'll be grateful for any feedback or advice the community can offer. I'm looking forward to joining the rest of you in being able to call myself a pilot!
8 Replies
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Just stand by and wait for Dr. Bruce Chien to stop in.  Might be a day or two, but he's the real expert on this process and you don't want to do anything until you get his advice on how to proceed, because if you do it the wrong way or in the wrong order, you could dig yourself a hole so deep you can't climb out.
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Hi, Lisa.

The SSRI pathway is for those with longstanding need for Rx who would otherwise have recurrent anxiety/depressive disorder.

There are exclusory, severity indicators that can preclude this pathway, check them out here..... SSRI.modifications03.12.14.pdf   
Your caretaker HAS to be a local psychiatrist, see here and you have to be stable on the allowed SSRI for six months, with no other psych or anxiety meds.  ssri_initial(certificationAid03.29.17)07.2018.pdf
The original SSRI path (there were 4 petitioners for this, one still works at AOPA, (shout out to Gary Crump), I am the second or th e 4 of us).....is here:  SSRI.pdf

You will need to engage a HIMS AME, that list is on FAA.gov (there are about 120 of us) and the prep. to get to the door is about $4K in experts (non-healthcare, it's pricey) + the HIMS AMEs time spent.  https://www.faa.gov/pilots/amelocator/  , last link on the page.

I would caution that once on, it's really tough to get off of, unless you go to Basic Med....because if you have recurrent illlness, how does one,  now convince the FAA that you don't have "illness likely to recur or that as already recurred".  FAA always denies, "Recurrent disease, unmonitored and untreated".  I have about 20 of these folks who would otherwise NEVER have been certified.

The time budget for this is ONE WHOLE year.  Washington DC is THAT SLOW.

 
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Ronald and especially Dr. Chien, thank you for your time and your responses! These are great resources for understanding the medical evaluation criteria here. Dr. Chien, thanks for your work and advocacy to develop this pathway for airmen who need SSRIs. Your cautionary statement has given me real pause. The rationale you describe makes sense, so I can see where the FAA is coming from. I will consider carefully and I have a call in to my doctor to discuss whether I really need this medication and what my actual diagnosis is. It certainly raises my stress tolerance and makes things easier, but being with it forever is not really what I want. I may need to make some changes before approaching the medical.

Thank you again!
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Bruce can correct me if I'm wrong, but I think you have to be off the SSRI for at least six months before you can go the "no longer using" route.
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it's actually 90 days, Ron, but that's not Lisa's problem.....
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I'd also like to jump in on this topic.  I elected to discontinue my SSRI as shown on SSRI Decision Path - I.

I made the original mistake of applying on FAA MedXPress before realizing the gravity of the situation.  Since then my original application has been removed and allows me to re-apply.  Do I still need a HIMS for this? or can I go with any AME?  I'm not going to give up on this tedious and lengthy process.  Although it has been very discouraging, I'm hopeful to one day to get approved without the additional $4-5k in expenses since I no longer take the medication.

Any advice is greatly appreciated!

SSRI Decision Path - I.pdf
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Marc, you don't necessarly need HIMS AME (decision path 1) if ALL of:
(1) the record shows this was the ONLY period of expsure in your life
(2) Your Doc agreed to the discontinuation, ON RECORD. "throwing your pills away and declaring I am well" is frowned upon @ FAA..
(3) It helps if you had a  psychiatrist taking care of you- you can use his 90 day after discontinuation evaluation to support the application
(4) You NEED A HIMS psychiatrist if you ever had TWO psych meds at one, any suicidality in the record, or an admission to hospital for psychiatry.

But bear in mind, FAA takes great comfort from an expert "known to them" opining that you are a "one off" rather than having factors which make it likely to recur.
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Hey Bruce, thanks for taking the time to respond. I've been going to the Dr. having them keep record of my ween off period and the time after being off the SSRI.  I have about 30 more days to go!

Without being too detailed and boring you with my past, I was \ prescribed Celexa when a Dr. basically decided I had anxiety and my family physician at the time was basically a script writer saying "well your fine on the meds, keep taking them". I regret that decision now, but I was young and didn't know better.

I've never seen a psychiatrist but if that helps with the FAA I'm open to it.  Is there a reference sheet from the FAA for HIMS psychiatrist like that of HIMS AME, or do I just need to find the speciality of each HIMS AME? 

Again I want to thank you for your time.  When I first started this process months ago I reached out to several HIMS in different states via the FAA listing and ONLY ONE every touched base back and took time to explain things.  Obviously I want to get past medical before I even begin to pay for instruction.