Class Three Medical and SSRI
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I recently had my Class Three Medical and was differed  by the AME due to me being a type 2 diabetic. I received paperwork from the FAA with forms to be filled out by my attending physician for my diabetes. It is controlled with diet and medication but not insulin dependent. My last two A1C's were 7.0 and 7.8 respectfully. In the packet also was paperwork pertaining to me being on Prozac. I was on the medication because I was extremely grouchy all the time and not for any psychological or mental disorders such as Bi-Polar, Psychosis, Depression, etc.   Under the FAA's SSRI Decision Path I, I had the option to discontinue the medication and after 60 days off the med and a favorable report from the treating physician, I could reapply for a certificate. I have chosen this path  and  I have my follow up appointment this coming Wednesday. I have had no bouts with me being grouchy or irritable with-in the past 60 days. I am expecting a favorable report from my Physician. I guess my question is what is your thoughts on receiving my medical certification upon the FAA receiving the documentation based on your experiences. Thank you in advance.
2 Replies
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Randy, it's Dr. Chien, here. 
So, there are several variables:
(a) Have you ever had an episode of any psychiatry situation before, in the record? (and can you get testimony that this is the one and only)
(b) That here is no suicidality in the record.
(c) That here were never multi-combinations of medication for this episode.

If you have  "no-no-no" to the above AND yourduration of treatment is <6 months, get a note sayin ALL of teh below (don't miss a ONE!):
(1) Treatment start date
(2) Diagnosis (a PCP will not have a precise diagnosis, he isn't equipped for that)
(3) Date of START treatment and with what.
(4) Date of Cessation of treatment.
(5) That your episode can be related to WHAT stimulus
(6) That the stimulus is gone
(7) that the in-person after cessation evaluation has occurred (give date, it has to be >60 days from #4) and there is nothing left to treat.
(8) That to his knowledge this is the ONE AND ONLY event in your lifetime.

Now, if it's >24 month's exposure you will need an evaluation visit to a insurance system board certified psychiatrist.  They hate to do these especially if you are off meds already (they don't get paid much and it's all risk).  In that case you get stuck paying for a forensic psychiatry evaluation out of pocket and they run about $1,500.
 

Bruce
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1069 Posts
Dr. Bruce Chien is the real expert on this issue, having participated in the development of the SSRI protocols.  Don't do anything until he responds here or you contact him directly (www.aeromedicaldoc.com).

That said, you are somewhat in a corner at his point.  Because you applied without preparing for the inevitable questions over both your diabetes and your SSRI history, you have placed yourself where unless you fully meet the FAA's requirements with your re-evaluation next Wednesday, you will be denied, which closes the Basic Med and Sport Pilot options until you do get an issuance.  You'll also forever have to check "yes" in the "Have you ever been denied" box on future applications for both medical certification as well as aviation insurance policies.  The good news on your diabetes is that the FAA limit for issuance is A1c of 9.0, but they may be concerned that your A1c has risen from 7.0 to 7.8.  Bruce can tell you more on that.  Also, he can give you guidance on what needs to be in your treating physician's report, but at this point you have very little time to sort that out.

All things considered, it would have been a lot better if you'd talked through these issues with an FAA medical certification expert like Bruce before you submitted an application to an AME, and I hope anyone else reading this who is contemplating getting an FAA medical with significant health issues gets that message.