Stopping SSRI after Med certificate denial
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Hello, everyone.

I am trying one last time to obtain my medical, and I wanted to toss this out there for thoughts, input (especially hoping Dr. Chien or another AME will comment). I have discussed this plan with my AME and she believes that it should word. My wife has started her flight training and to be honest, I'm a bit jealous. :-) She's having so much fun with it that I am going to try again to obtain my medical.

Brief history: SSRI use for 27 years following my only suicide attempt, and hardly an attempt because I stopped myself and drove to the doctor's office to seek treatment for depression. No further incidents. I've changed jobs three times since that incident (including a 20 year stay in my most recent job before current job), and I've been in my dream job for the past 5 years. I have had NO incidents since the initial one, the SSRI I have been taking is on the FAA's approved list, but I don't want to have to spend $3000+ on a COGSCREEN every two years.

Also, I moved half-way across the US to take the dream job.

I've only continued taking the SSRI for these 27 years because I was afraid to stop taking the medication. My mood has been stable.

I applied for a 3rd class in Jan 2021 (after an A in ground school) and was denied only because I did not pursue the HIMS/COGSCREEN route. I was on the SSRI at the time. I passed everything else.

PLAN: I stopped taking the SSRI with my nightly dose on Monday, Feb 7. According to the FAA document SSRI Decision Path 1(link below), if I am off of the medication for at least 60 days without any significant changes, I should (in theory) be good to go. I informed both my AME and my PCP of the exact date I have stopped taking the medication so that it is in my records. I have informed numerous people around me (family, co-workers) of what I am doing and have asked them to keep a close watch on my mood so they can tell me if anything seems to be going wrong.

The plan is to wait 90 days (end of the semester) then apply for my medical / have my exam. Once I pass the exam, I'll take my written and then pursue flight training.

It has been a week and other than not sleeping as much (which I hear is typical initially when stopping an SSRI), I'm doing just fine. By this coming Friday, I will be at ~0% blood level of the medication based on the medication's 35-hour half life.

Thoughts/comments? 

 https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/SSRI%20Decision%20Path%20-%20I.pdf

 

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Glyn Gowing: 
 

The plan is to wait 90 days (end of the semester) then apply for my medical / have my exam. Once I pass the exam, I'll take my written and then pursue flight training.

It has been a week and other than not sleeping as much (which I hear is typical initially when stopping an SSRI), I'm doing just fine. By this coming Friday, I will be at ~0% blood level of the medication based on the medication's 35-hour half life.

Thoughts/comments? 

 

I believe the AME  guide has a description of what must be in that treating physician's status report.  Make sure you take that to the AME examination.  You might also want to run that report past an expert in these certifications like the aforementioned HIMS AME Bruce Chien for consultation on the viability of your application so you don't get a second denial which could have been avoided.  You can reach him at www.aeromedicaldoc.com.

It also occurs to me that you might need to return your unused meds to a pharmacy and obtain a receipt including pill count as proof that you are no longer taking the meds.

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Good idea on taking the meds back to the pharmacy. That will be easy enough as I did not even start the new bottle.

The “attempt" was hardly one - I stopped myself before anything actually happened. I didn't even start anything. I just realized that suicide was not the answer and I drove myself to the doctor's office.

Thanks. My AME is familiar with the situation regarding SSRIs at least because of working with me last year. (That and she's been an AME for a couple of decades.)

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Just in case anyone's curious… I stopped the SSRI with my primary care physician's approval, and after more than 90 days off (SSRI Path 1 requires 60) with no problems, I had my exam. I'm waiting to see what the FAA says.

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An update because a kind and concerned soul here sent me a private message asking what was happening…

I had my medical in May. The FAA sent me a letter in early June (3 weeks after my medical was transmitted to them) asking for more information. Two weeks later I had all of the information they requested (as far as I can tell) and sent it to them.

Three weeks ago (after checking medxpress on a daily basis) medxpress told me that it had been more than 60 days and that I should call them on the phone, so I did. The first time I called, a kind lady told me that they wanted to be sure I was keeping track of what was happening and she instructed me to call back in a week, so I did. I was told by the gentleman who answered (David), after he put me on hold to call someone else, that he thought it would be one or two more weeks and that I should call back every week to keep on top of it.

I called back last Monday and was told, after the woman who answered put me on hold to call someone, that there was no indication that they needed any additional information and that my case was still in review, and that I should call back in a week, which will be this coming Monday, September 28, 2022.

I'll keep folks updated as the private message I received indicates to me that people are at least curious, and since I shared all of this initially I feel that I should be polite and follow up. It's just that nothing really happened other than being told to wait.
 

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@Glyn Gowing

Sadly Glyn, you're going to be hard pressed to convince any Psychiatrist, let alone a HIMS (Part 67) psychiatrist, that with 27 years of meds, you DON'T have chronic recurrent disease. OFF Meds, FAA denies 100% “recurrent disease untreated and unmonitored”.

On meds, you should know that the FAA has specific excluders for the ON Single SSRI program whcih are:

Suicidality, Multiple meds at once, Use of hospital for psych, cognitive instability at any time in the past, ECT, andy pscyhosis.  These forever excusions have been policy for the past eigth years as “severity exclusions”.

After any suicidality, the FAA will reconsider the diagnosis of severity, and of recurrent disease, only if you have:

TEN continuous years of: Successful life test as demonstrated by “cards and letters” from supervisory persons on letterhead in a psotiion to know; No “Events”, No Meds (the last one is what is problemmatic for you).

So unless I misunderstand something, I'm the “bearer of bad news”. I wish I could offer you something more useable. I suspect, if you wish to proceed, and if someone up river @ FAA wants to give you a chance, you'll be getting the “Finds a HIMS AME” letter as a keyway to getting to a HIMS psychiatrist……  :(.

 

 

 


 

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@Bruce Chien
Thank you, sir. The only reason I stayed on the meds was that I was afraid to stop taking them. 

I just got off of the phone with the FAA and all they could tell me is that my medical is “still in the review process” and that there is no indication that they need any additional information from me, so while there is very little hope based on what you're telling me, I'm not giving up quite yet.