BasicMed and SSRI
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Hope everyone had a great Thanksgiving.  I am finding the rules on 3rd class medical certificates to be quite confusing, despite much reading.  Please forgive a question.  If I understand correctly, a pilot who holds a 3rd class medical after 2006, lets it expire, then develops depression and starts an SSRI would be eligible to fly under BasicMed as long as their community physician signs off.  No special issuance, AME, nor special testing needed.  Is this true?  Can a pilot can fly with depression on an SSRI under BasicMed in the circumstances I described?

Thanks,

Eric

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@Eric Samstad
In theory, yes.  In practice it might be problematic.

As I read the applicable regs, there Is no regulatory bar to what you want to do (assuming your depression hasn't "manifested itself by overt acts").  The remaining question is whether you can find a physician willing to sign the certification at the end of the Basic Med exam checklist knowing that the you suffer from clinical depression severe enough to put you on an anti-depressant. I've never heard of anyone going that route so I can't tell you the likelihood of success.  I suggest you discuss this with the physician you intend to use, as theirs is really the only opinion which matters.

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@Eric Samstad
Also please note that there are currently only four SSRIs that the FAA consider acceptable, so if you're not taking one of those four you may encounter additional problems. Also, you need to have been taking the medication for at least six months with no issues.

The process of being approved for a medical while taking an SSRI is onerous and expensive. I wish you success in overcoming this obstacle.

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@Glyn Gowing
 

Also please note that there are currently only four SSRIs that the FAA consider “acceptable”, so if you're not taking one of those four you may encounter additional problems.

I'm not sure that a Basic Med pilot taking an SSRI is limited to those four.  I think that only applies to getting a standard medical certificate.  For Basic Med, assuming no “overt acts”, I think it's entirely up to the signing physician.  But to be sure, you'd have to ask someone who knows the deep details, like Dr. Bruce Chien.

And remember that Ed's only asking about Basic Med, not a Third Class.

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@Ronald Levy

When I was with the FAA, I had several conversations with the person at HQ who was in charge of Basic Med.

When I put a similar scenario to him, he said that pilots need to consider 61.53(b).  The condition requiring the SSRI would not allow the pilot to operate in a safe manner (his words, not mine).

Also, in the section for physicians in the CMEC, the doctor is instructed to consult the “Do Not Issue - Do Not Fly” list on the FAA website.  SSRIs show up in the Do Not Issue portion of the list.  This would seem to indicate that if the physician signing the CMEC does his due diligence, he would not sign the form for someone on SSRIs, unless the person has procured a Special Issuance medical addressing the condition requiring SSRIs.

While performing the exam and signing the CMEC rests solely with the physician, if a situation occurred for which the FAA would conduct an investigation, then the opinion of the Inspector conducting the investigation becomes relevant.  He would, as a result of the investigation, gain access to the CMEC and to any supporting medical records.  The first thing that would be questioned would be why the doctor signed off the CMEC when the pilot was taking an SSRI (assuming that the pilot declared the SSRI in block 17 of the CMEC).
 

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1590 Posts

@Kristian Kortokrax

I appreciate Kris' insider perspective on this.  However, it sounds like that interpretation came from inside Flight Standards, not the Chief Counsel, and they've been overruled by the Chief Counsel before (Viz., the question of whether logging a VOR approach filled the interception and tracking square).  For that reason, you might want to get this in writing from the FAA lest you and your physician run afoul of any Imperial entanglements.

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@Ronald Levy
Just to clarify, it was not a legal interpretation.  The person I spoke with was in Flight Standards and managed the division that oversees Basic Med.

I would wonder what a potential question to Legal on this subject would look like.

If one were to ask for a definition of “unable to operate the aircraft in a safe manner”, I suspect the response from Legal would be the same as the response received when people have asked for a definition of “congested area”. No definition would be provided, only a statement that it is determined on a case by case basis.

Also, Legal appears to be issuing interpretations only for questions that they deem appropriate.  You may ask a question, but they may decline to answer it.  (Not sure now they get away with this, since they work for us).

I see only two NTSB cases.  Neither dealt with Basic Med questions.

It seems to me that since they refer the Basic Med doctor to the “Do Not Issue - Do Not Fly" list, that they consider it to be a factor in deciding whether he should sign the certification.

I have no medical or psychological expertise.   However, I do find it interesting that 14 CFR 68.9(a)(1) uses the term “mental health disorder” and the CMEC in block 18m shows “Mental disorders of any sort (depression, anxiety, etc.)”.  Why did they include depression on the form, if it were not to be considered?

As Ron said, Dr. Chien would be a great resource in finding an answer to your question, which should be “Can I operate an aircraft in a safe manner, given the diagnosis and medication”,  not “Can I find a doctor who will sign off my CMEC”.  I did ask the guy at HQ about the possibility of a pilot “doctor shopping”, trying to find one somewhere who would sign the CMEC, even if others had refused.  He told me that there were no safeguards in place to prevent that.  (Not endorsing this, just presenting all the facts)