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Any Way to Get Medical Certificate Without Being on SSRIs
If you recall from a post back in September of 2020, I knew it would be a hell of a road to get a third class medical certificate, and so I opted to go the BasicMed route.  Thus far it's great.  I'm flying, I'm soloed, and I'm happy, but I'm thinking I might want to eventually try to get a new medical, possibly even a second class.  To be clear, I have no desire to be an airline pilot, and I'm way too old (41) to even consider starting down that road, but it would be nice to be able to fly into Canada, fly a Saratoga without an STC, and get away from some of the other BasicMed limitations.  I'm wondering, based on my history, if there's any way I could do so without being required to take SSRIs.  I suspect the answer is no, but I figured I'd check anyway.

I have a relatively moderate psych history with anxiety disorder and ADHD.  I have never made any suicide attempts at all.  I've had panic attacks back in the early 2000s, but I haven't had any of those in a long time.  I have also had generalized anxiety disorder with a rule out diagnosis of OCD (NOT OCPD!)  I had an eating disorder not otherwise specified as well.  I have no history of depression, bipolar, or any of the other automatically disqualifying conditions at all.  I've been on psych meds thrice.  The first time was in the early 2000s when I was on Celexa (which didn't work), Buspar (which I don't know if it did anything), Valium, and then I got switched from the Celexa to Effexor XR, which worked remarkably well but was banned by the FAA.  I got my original medical before I had any of these problems, but because of these problems I grounded myself, and I had been off the meds for a couple years before applying for my second medical back in 2004, and I went through a rather rigorous neuropsych exam that was all sorts of fun.  Ultimately, the FAA cleared me without an SI, which surprised me a bit, but hey, I'll take it.  That medical expired in 2007.  Around 2009, the EDNOS issue popped up, and I treated with Prozac for that for several months, but the Prozac had a tendency to cause chemical burns in my esophagus, probably due to either reflux or issues with swallowing the capsule (the latter is what the doctor thought to be most likely).  Additionally, Prozac helped, but the side effects were intolerable and left me sleep-deprived and practically impotent.  It was simply not a workable solution.  So it was discontinued, and the condition resolved itself in relatively short order.

Fast forward to 2018, when I had some issues with possible OCD and additional generalized anxiety disorder.  I tried to deal with them on my own, but I ultimately felt it was better to get treatment before it spiraled out of control, which it was headed far in that direction.  As a result, I was in and have been in psychotherapy with a psychologist since that time.  However, additionally, my psychiatrist prescribed me Effexor XR (which I know is actually an SNRI) and Valium for about 2.5 years while I worked through the issues.  With my psychiatrist's approval, I discontinued the Effexor XR and Valium back in August of 2020 and have been free of them since.  The Effexor XR worked perfectly, and the side effects were minimal, but again, the FAA, in its infinite wisdom (HEAVY sarcasm) has seen fit to declare it an off-limits drug, despite it being safe, effective, and on the market for over 20 years.  I want to make it very clear that I do not lack insight into my condition.  I realize it could come back again, and if it does, then I will probably just ground myself until it's gone again or go back to BasicMed on Effexor XR while waiting for the rest of my life for the FAA to approve it.

I think I already know the answer to this question, but the question is, is there any way, assuming an otherwise favorable HIMS evaluation and favorable reports from my psychiatrist and therapist, that I could ever hope to get a medical certificate again without being on SSRIs?  It seems, based on what I'm reading, that the FAA has no understanding of the difference between recurrent chronic and recurrent non-chronic conditions, or if they do, they don't care to distinguish between them. As an physical analogy, if I'm correct, their reasoning seems to be that if you have recurrent back pain, you should take pain meds every day for the rest of your life because it might come back.  To be clear, I'm not ever going to go the SSRI route with the four approved meds.  One did nothing whatsoever (which might be a good thing, considering the effects the Prozac had), the other I took was of limited usefulness and had horrendous side effects, and from what I hear, the other two are worse for side effects than Prozac.  Nobody could pay me to go through that nightmare again.  So unless and until the FAA approves Effexor XR (which I've been told might not happen even in 100 years), if taking an SSRI is going to be required, I'm going to stick with BasicMed and just eat the limitations on the aircraft I can fly and never fly into Canada (which sucks, because I live on the border).  Any input would be appreciated.
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1217 Posts
Have you consulted a Special Issuance expert AME like Dr. Bruce Chien?  If not, do so.

I am not in the business of discouraging pilots about a planned course of action, but with your complex history, the FAA will put you through hell with no assurance you will end up with a medical certificate at the end of the line. The pathway to an SI for mental health history is wrought with landmines, and FAA does issue in many cases, but it is an expensive, time consuming, and highly frustrating experience not for the faint of heart! 

I'm not chunking rocks at the FAA, but in light of the GermanWings crash in 2015 that resulted in many fatalities, the FAA takes a very serious look at anything related to behavioral health, as well they should.  It's a thorough process, but a brutal one!  And keep in mind that if you apply and are not issued, your BasicMed privileges evaporate, too.