SSRI Rule Outs Reality
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Hi folks -
Background -
I take one of the four allowable SRRIs for anxiety. I am currently in the SSRI Decision Path II process seeking to remain on the SSRI and obtain a third class special issuance. I worked with a HIMS AME and completed all the steps/reports from the board certified psychiatrist, my physician, neuropsychologist (including Cogscreen-AE), HIMS AME etc. The Cogscreen-AE scores were all good and the HIMS AME, psychiatrist and psychologist reports were all in alignment in their summary/recommendations -- that I am stable on one SSRI and my condition/treatment would not adversely affect flight safety. My submitted package is currently in DC for evaluation.

Question -
My records indicate I do not meet one of the "SSRI Rule Outs" listed in Item 47 in the Guide for AMEs: "Multi-agent drug protocol use (prior use of other psychiatric drugs in conjunction with SSRIs)" since I used an approved SSRI with a benzodiazepine in 2013. I meet all of the other "Rule Outs" (no dual SSRIs, no suicide ideation, etc)

Is that one problematic "Rule Out" nearly 10 years ago going to be an Absolute Denial in DC? Or can the deciding physician in DC be a little more discerning and consider the whole package and findings/recommendations from the reporting doctors. Is there precedence for obtaining an SSRI SI when that "Rule Out" is not met? 

Looking forward to anyone's experience with this… Thanks!

4 Replies
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1516 Posts

@Joe Cabral
You need truly expert advice.  Contact the AOPA Medical Help desk or Dr. Bruce Chien (www.aeromedicaldoc.com).

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@Ronald Levy
 

@Joe Cabral
You need truly expert advice.  Contact the AOPA Medical Help desk or Dr. Bruce Chien (www.aeromedicaldoc.com).

Thank you. Dr. Chen just chimed in on another forum and shared that some have made it through in the past if the benzos use was rare and far back enough, and other factors are favorable… That's encouraging and I know every case is different. I have a few months to go until a decision is made and I'll hop back on this thread to share what my outcome is…

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@Joe Cabral

Hi Joe.  I am Dr Chuck Denison, owner of Aviation Psychology LLC in Denver, aviation neuropsychologist and a member of the AOPA Board of Medical Advisors.  One of the primary uses of a “special issuance” is that it allows the FAA to make exceptions in cases where certain conditions would be otherwise disqualifying.  Since you do not have rule outs in addition to the use of benzodiazepine medication in 2013, you appear to have a very good basis for the SSRI special issuance.  Right now over 1500 pilots are flying with that program.  The fact that it requires a good bit of monitoring (HIMS AME, HIMS psychiatrist, and biennial CogScreen-AE testing with the HIMS neuropsychologist is one good reason for the FAA to certify pilots even if the history does not align perfectly with the published expectations (rule outs).  Hang tight while the FAA reviews your case.  Given the rule out, it may be that Oklahoma City will refer your case for a “review”, which adds some time.  If everything looks good (as you have already described in your post), I believe it is very likely that you will receive good news.  Blue skies…

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@Chuck Denison

Thanks Dr. Denison. I appreciate the reality check. OKC referred it to DC last month so now I'll just wait to see how it goes. Looking forward to sharing an update with the forum in a few months…