SSRI & Cognitive-Enhancement Medication
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Answered By AOPA

The 2021 Guide for Aviation Medical Examiners states that, “An individual may be considered for an FAA authorization of a Special Issuance (SI) or Special Consideration (SC) of a Medical Certificate (Authorization) if…”, in addition to other things, "…the applicant DOES NOT have symptoms or history of: 

  • Psychosis
  • Suicidal ideation
  • Electro convulsive therapy
  • Treatment with multiple SSRIs concurrently
  • Multi-agent drug protocol use (prior use of other psychiatric drugs in conjunction with SSRIs.)

 

If an individual has a history of using an SSRI and a cognitive-enhancement medication (ADHD med) at the exact same time, is that a complete and total disqualifier for a FAA medical certificate? If so, why?

5 Replies
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AOPA Staff Answer

Hi Nathaniel,

The answer to this question is not a simple yes or no. The FAA is concerned with those conditions that were severe enough to require treatment and if the said condition has resolved and will likely require a HIMS evaluation before deciding if a pilot is eligible to hold a medical certificate. Be prepared, this process is both costly and lengthy. 

AOPA is happy to discuss this further with you over the phone. Any one of our Medical Certification Specialists are available to speak with you Monday-Friday 8:30am- 6:00pm EST We can be reached at  1-800-872-2672 #3 

Ron Levy and/or Dr Chien will likely reply to your question as well. They both have a vast amount of knowledge on this subject.

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1296 Posts

Since she invited my attention…

When you don't qualify for the standard SSRI protocols (which you don't), the process gets a whole lot more lengthy, difficult, complicated, and expensive – and your medical insurance will NOT cover it. What you do NOT want to do is even start an FAA medical application until you are sure it will be successful.  That means working with an expert on this particular process like Dr. Chien, who helped the FAA write the policy. He will probably pop in here, or you can reach him via his web site www.aeromedicaldoc.com.

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The issue here is the mood disorder associated with the cognitive weakness.  You should understand that FAA  divides the firmament of psychiatry issues into two blocks- “one offs” and those conditions reasonably thought to be recurrent, e.g  > 5 years or there has been a break and then a resumption of treatment.  FAA uniformly denies "recurrent disease, untreated and unmonitored.

The bit that you cut an pasted applies to the "ON SSRI" program, which is the only pathway for recurrent disease. They are excluders intended to EXCLUDE from consideration, the more severe cases.  It is INTENTIONAL.  Yes, that's how it is.

You should also know that if an individual with recurrent disease has a practitioner with guts enough to supervise you of meds and you can subsequently show ten years, no meds, no recurrence,  successful life test for that whole 10 years a documented by persons in a position to know (on LETTERHEAD),  AFTER ten years the agency will reconsider the diagnosis.  

Hope this helps.

 


 

 

 

 

 

 

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1296 Posts

Bruce Chien: 
You should also know that if an individual with recurrent disease has a practitioner with guts enough to supervise you of meds and you can subsequently show ten years, no meds, no recurrence,  successful life test for that whole 10 years a documented by persons in a position to know (on LETTERHEAD),  AFTER ten years the agency will reconsider the diagnosis.  

I think Bruce's fingers were a bit behind his high-speed brain when he typed that.  I think he meant to say:

…if an individual with recurrent disease has a practitioner with guts enough to supervise you off meds and you can subsequently show ten years, no meds, no recurrence, … 

So, given that you were on an SSRI plus another psychiatric med, I think that means unless you've been off all those psychiatric meds for at least 10 years, you're going to have to wait until you have been off them all for at least that long.

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Thanks, Ron. The practitioner has to give the blessing.  For some folks discontinuation is the worst life decision one might make.