Diagnosed autistic & medical history of depression - best path forward?
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Hi everyone, new member here. Learning to fly is, and has been, a life-long dream of mine. However, after reviewing the medical requirements I have concerns about whether or not I'd even be able to pass a medical review.

My first concern: I am diagnosed with Asperger's Syndrome, a high-functioning form of autism spectrum disorder. My question is, would be if the FAA would consider an autism diagnosis in and of itself grounds for denial?

My second concern is that I am currently taking medications for depression and anxiety. One of these, Wellbutrin, I know is on the DNI/DNF list. The other one is an atypical antipsychotic called Seroquel. Seroquel itself is not in the medication database but since it is an antipsychotic I am fairly certain it falls under a blanket ban. I have been on these medications for quite some time, and while I have been quite stable the last few years with these medications I know they are not allowed. I am considering consulting with my psychiatrist about switching my treatment to one of the four SSRI's that are permitted special issuance by the FAA, and seeing if I am able to manage with that alone. However, my biggest concern is the fact that even if I do switch to a different medication, or am able to manage my depression/anxiety without medications in the future, that the fact I took them at all will be a permanent black mark.

Finally, there is the fact that I have been on Social Security Disability Insurance before, due to issues finding employment related to the autism and depression/anxiety. I'm not sure if they will consider these records when reviewing medical.

Lastly I want to say that despite having clinical depression/anxiety I have never been hospitalized for it, nor have I had any severe depressive episodes (i.e. suicidal). I also have a clean record - both legally and medically - when it comes to substance abuse and addiction. I have been sober my whole life and I intend to keep it that way.

Level with me here: what are my chances? What would be my best options going forward? I don't plan on flying commercially, and while I am open to a sport license to begin with I would like to eventually get my PPL.
9 Replies
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I should also mention that I am not planning on getting my pilot's license right away - I am planning on waiting at least a few years from now before I start the process, since as things stand right now I don't have the money for it. When I do I will likely start with the medical first, then go to my knowledge exam and from there, flight training.

Right now I'm wondering what my best option would be for when I do decide to get started. Should I ask my psychiatrist about one of the approved SSRI's to see if it would work with managing my depresison/anxiety? Should I maybe try and do a sport license instead, at least to start with? Should I try and get to a point where I can manage my symptoms without medication? I think it is possible, given time - as I've gotten a bit older I've been getting better at managing depressive episodes using behavioral therapy techniques, as well as self-examining my mental state

. I'm unfamiliar with the medical certification process, all I know so far is what I've researched in the last month or so. I do plan on fulfilling my dream one day, but I understand safety is paramount and that the FAA/NTSB wants to minimize the risk of an accident.
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Review of FAA actions and guidance on ASD cases suggests your chances are lousy.  It will take a lot of time (I'm guessing at least six months) and money (the things the FAA wants cost many thousands and are not covered by your health insurance) to out together what they'd want, and given how the FAA feels about ASD alone, not to mention whatever reason it is you're taking an antipsychotic, I suspect they are very unlikely to approve.  Stand by here for Bruce Chien, who's the real expert on this, to check in with the list of all the things you'd have to do if there is any chance at all of issuance.

For some reading on the FAA's position on ASD, see:
https://www.faa.gov/other_visit/aviation_industry/designees_delegations/designee_types/ame/fasmb/media/autism.pdf
https://www.faa.gov/other_visit/aviation_industry/designees_delegations/designee_types/ame/fasmb/media/201102_color.pdf (page 12)
 
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...I see. That is unfortunate, to say the least. I understand some of the FAA's position on the subject, but it does seem somewhat ableist. I can't tell how much of their stance is genuine concern for safety and how much of it is disproved 60's-era psychological theory combined with post-9/11 paranoia.

One other thing I'm curious about is if this will affect my chances of getting a light sport aircraft license or a commercial sUAV (part 107) license. I've been considering doing the latter as a career opportunity, and for the former I understand all you would need is a driver's license (provided, of course, you haven't been denied a medical previously).

It does seem, based on the case studies done previously, that a lot of it boils down to where one falls on the spectrum and the level to which one's cognitive abilities are impaired. In my case I do not believe I am as impaired as most of my peers with the disorder. I'd certainly be willing to be tested to find out, but at the same time if the prognosis is that grim then perhaps I should stick to LSA, drones, and simulators.
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Ref: 14 CFR 61.53(b) and (c)(2).  If the FAA says the medications you're taking and the conditions they're treating are incompatible with safe flying, and you know you can't get a special issuance, can you credibly say that your medical condition would not make you unable to operate an aircraft in a safe manner?  Substituting your judgment for theirs isn't likely to be availing if push comes to legal shove, and that's certainly not what the FAA had in mind when they created the Sport Pilot/LSA option.

Beyond that, if you get an aircraft, i think it unlikely any insurer would write you a policy.  Speaking as a flight instructor, if I knew you had those conditions and were taking those meds, and were going the Sport Pilot route because you knew you could not get a medical (not just to avoid the time and expense of obtaining the SI), I would never sign you off for solo, no less a practical test -- I couldn't stand to take on the liability and responsibility.  I'm pretty sure any Sport/LSA flight school around would take the same position.

That said, I can't speak to the issue of drones because I don't know those rules well enough, but I do find 14 CFR 107.61(c), which says you cannot "...know or have reason to know that he or she has a physical or mental condition that would interfere with the safe operation of a small unmanned aircraft system."  Not being either a drone guy or a psychiatrist, I can't tell you if your conditions and meds put you in that category -- something you'd probably have to talk over with your psychiatrist and maybe someone who knows a lot more about operating a drone than I do.
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I guess I should apologize for my previous post. I want to be clear that I am in no way looking for a loophole or a way around the rules that have been established. They are there to protect people both in aviation and the ones down below.

To that end, I am not planning on attempting even a light sport license unless the medication I'm taking is a non-issue. I will hold off until things are a little more stable in my life, and then talk to my psychiatrist about slowly weaning me off over the course of a year or two to see if I am able to maintain a stable mental state without them. It may work, or it may not. That will be a discussion I will have to have with her.

That aside, now that I know a special issuance will likely be required for a diagnosis of autism spectrum disorder, and that while the chances are slim it is still possible. Case in point - the young airman in the first link was granted a special issuance. I want to know more about that process and what I will be expected to do. Based on the case studies you provided, it seems it is still considered on a case-by-case basis. I'm hoping Brian Chien will be able to shed more light on the subject.

I also want to make it clear that I am committed to doing this the proper way. I suspect that my previous reply to you earlier may have implied a cavalier attitude toward regulations - which I understand is a huge no-no in aviation - and if that was the case then I apologize. I'm not quite ready to give up on my dream just yet, but whether I end up flying for career, for fun, or not at all, I am committed to doing so safely and in compliance with ALL relevant regulations, even ones I may not agree with. And I am committed to learning everything I can and doing all I can to ensure this. This is one of the reasons I joined AOPA, so I can know what I would need to do if and when I do decide to go for my wings.
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Kevin, 

With dual drug therapy at any time in your life, you can never be certified on the SSRI protocol, it is a historical severity disqualifier.
Now read this very carefully: if you have had any interruption in your treatment of chronic depression, you have by definition "recurrent disease".  If you have been on more than 5 years without a break you will have a heckova time convincing anyone @ FAA that you wern't kept on the meds unless someone thought you had disease that would recur.  Recurrent disease that is untreated and un-monitored is always denied. 100% of the time.

So without being able to certify ON, and likely being unable to ever certify OFF meds, you have no pathway.

The legal path for your is to stick to light sport aircraft, and never apply and get denied. ONCE you get denied, with no hope oever winning certification you lost the abiilty to do Light Sport aviation.  Pretty much forever.

I hate to rain on your hopes but the only real path for you is (1) never apply to FAA medical, and (2)  find a light sport instructor.

Lastly, in 25 years of doing this and as a HIMS (psychiatry) AME I have only won certification in TWO Asperger's airmen.  The FAA is concerned about your PIC-"relations to persons" capabilities. They hate that diagnosis. 
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I see. Thank you. This may not have been the answer I was hoping for, but it definitely is the answer I was looking for.

I have two further questions.

Firstly, regarding licensing as a drone pilot. I am unfamiliar with the regulations regarding UAV's, especially in commercial applications. Would I be required to get a medical to obtain a commercial drone certification under part 107 or otherwise?

And secondly... this is more of an opinion poll rather than a straight ask. I can't help but wonder how many pilots are currently suffering from undiagnosed mental illnesses but are afraid to seek treatment due to the possibility of losing their wings on their next medical review. There's also the fact that it seems psychiatric diagnoses and treatment have become much more commonplace in the last 10 years or so, especially amongst Gen Z'ers. Based on what I have learned while researching FAA regulations, I'd estimate a good 70% or more of the population in the United States is locked out of aviation due to psychological conditions, and that a good number of currently certified pilots have mental health conditions that would be disqualifying, but are keeping them hidden - and untreated - out of concern that seeking treatment will sabotage their next medical.  I'm curious: what is the AOPA's stance on the issue? I know AOPA had a hand in advocating for the passage of the BasicMed requirements fairly recently, so I'm wondering if the end goal is to relax some of the requirements to help in situations where a person might be barred on paper otherwise, despite having the capability to be a pilot in practice.

Keep in mind I understand the reasoning behind the regulations. Under no circumstances would I ever wish to compromise the safety of aviation, and I know there are some people who just should not be pilots, period, and the goal is to weed out those who simply lack the ability. But I just feel that, rather than absolute blanket bans on conditions and medications, there should be a more nuanced, individual approach to determining whether or not someone is safe to fly. Based on what I've learned thus far, if the trends of mental health treatment continues as it has been the last 10 years or so, I think sooner or later the aviation industry is going to run out of pilots because no one will be able to get certified.

But that's just my opinion, as someone who would never be able to pass medical as it stands now, so take it as you will.

Anyways, thanks for your answers so far.
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We here (I was on AOPA's board of medical advisors for many years) are very familiar with hidden Rx.  It was the statistical "under the table that really fueled the petition for the SSRI protocol.

But understand that we gave up the ability to nonreport as the ACA of 2010 unprotected the insurance codes.  FAA can see the pharmacy codes if they desire.
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Kevin Sutherburg:

I know AOPA had a hand in advocating for the passage of the BasicMed requirements fairly recently, so I'm wondering if the end goal is to relax some of the requirements to help in situations where a person might be barred on paper otherwise, despite having the capability to be a pilot in practice.

 
That was never the purpose of Basic Med. It was and is meant to reduce the time, paperwork, and expense of demonstrating fitness to fly, not to lower the standards of fitness.