HI,
Looking for some additional info on pursuing a class 3 med with a hx of depression well-controlled with SSRI or non SSRI meds. Lets hypothetically say that pt was diagnosed with mild depression approx 12 years ago (new wife, new kids, stressful job). Depression was continually treated with sertraline. Physician/Pt never really discussed discontinuation of meds. Occasionally, physicians would increase dosage given the broad therapeutic window, and the pt's sense that perhaps the med's impact wasn't as apparent as previously. Just over one year ago, the sexual side effects of the sertraline became problematic, so physician suggested a taper to and trial of wellbutrin, which pt did not tolerate. Physician then suggested venlafexine, which was well tolerated at 37.5mg (the traditional starter dose), and was then increased to 75 mg.
Recognizing that neither wellbutrin nor venlafexine are “approved” druges (nor SSRIs), what are the patient's options? Is it viable to d/c all meds under a dr's supervision and pursue pathway 1, or does the long term tx preclude that approach? Would a supervised transition back to an approved SSRI permit an SI under pathway 2? Or is the pt forever foreclosed from getting a PPL?
Thanks
@Thomas Howell
As I read the rules, continuing on the psychoactive anti-depressant venlafexine is not an option. You'll have to get off it if you want to get an FAA medical certificate, and even if your long term plan is Basic Med, you'll need that first issuance before you're eligible for Basic Med. If you can go 60 days off venlafexine with a favorable report from the treating physician indicating stable mood and no aeromedically significant side effects (and STAY off it permanently), you can go Path I.
As for your second option, you could transition to one of the four approved SSRI's, and then go Path II, which allows you to keep taking that approved SSRI while you fly. And, of course, once you get that first special issuance, you can then move to Basic Med while continuing to take the SSRI as long as there are no further changes and the physician signing your Basic Med feels you remain safe to fly.
On the third hand, I believe that as long as you have a valid US driver's license, and feel you can fly safely while on venlafexine, you could go the Sport Pilot route and skip all the rest. That would limit your flying somewhat but avoid all the other stuff. And I'm checking with the FAA to be sure I'm reading the Sport Pilot rules on this correctly. That said, if I knew a Sport Student Pilot I was training was on venlafexine, I would be concerned about the potential for “side effects, such as agitation, anxiety, blurred vision, confusion, diarrhea, dizziness, fast or irregular heartbeat, headache, irritability, nausea or vomiting, numbness or tingling feeling, restlessness, seizures, sweating, thoughts of hurting yourself or others, trouble sleeping, unusual dreams, or unusual drowsiness, tiredness, or weakness...trouble concentrating, memory problems, confusion, weakness, or feel unsteady when standing…and blurred vision.” [Mayo Clinic]. I'd want to know that they'd been on it long enough that any side effects for them would already have manifested themselves.
@Thomas Howell
As I read the rules, continuing on the psychoactive anti-depressant venlafexine is not an option. You'll have to get off it if you want to get an FAA medical certificate, and even if your long term plan is Basic Med, you'll need that first issuance before you're eligible for Basic Med. If you can go 60 days off venlafexine with a favorable report from the treating physician indicating stable mood and no aeromedically significant side effects (and STAY off it permanently), you can go Path I.As for your second option, you could transition to one of the four approved SSRI's, and then go Path II, which allows you to keep taking that approved SSRI while you fly. And, of course, once you get that first special issuance, you can then move to Basic Med while continuing to take the SSRI as long as there are no further changes and the physician signing your Basic Med feels you remain safe to fly.
On the third hand, I believe that as long as you have a valid US driver's license, and feel you can fly safely while on venlafexine, you could go the Sport Pilot route and skip all the rest. That would limit your flying somewhat but avoid all the other stuff. And I'm checking with the FAA to be sure I'm reading the Sport Pilot rules on this correctly. That said, if I knew a Sport Student Pilot I was training was on venlafexine, I would be concerned about the potential for “side effects, such as agitation, anxiety, blurred vision, confusion, diarrhea, dizziness, fast or irregular heartbeat, headache, irritability, nausea or vomiting, numbness or tingling feeling, restlessness, seizures, sweating, thoughts of hurting yourself or others, trouble sleeping, unusual dreams, or unusual drowsiness, tiredness, or weakness...trouble concentrating, memory problems, confusion, weakness, or feel unsteady when standing…and blurred vision.” [Mayo Clinic]. I'd want to know that they'd been on it long enough that any side effects for them would already have manifested themselves.
Thanks for weighing in with thoughts. I do understand that venlafexine is not an SSRI, and not approved. Conceivably, discontinuation or transitioning to an approved med are within the realm of possibility. My primary concern, though, was the length of treatment. From reading other posts, I was of the impression that even once meds are discontinued, the FAA looks unfavorably on long-term antidepressant treatment. It is encouraging that path 1 may still be possible (even with lengthy treatment), although given that both path 1 and path 2 are issued through SI, perhaps there's not really any difference (particularly if using Basic Med after the initial issuance).
Greatly appreciate your assistance here.
@Thomas Howell
From reading other posts, I was of the impression that even once meds are discontinued, the FAA looks unfavorably on long-term antidepressant treatment.
I can tell you a lot about the rules and published procedures, but medical judgments are beyond my ken. The real expert is Dr. Bruce Chien, who shows up here from time to time. You can reach him via his website www.aeromedicaldoc.com.
Update:
After further research…
Per a real expert (i.e., not me), your 12-year history of anti-depressant use should not by itself prevent issuance under the approved SSRI protocol unless your history includes:
- Use of two or more meds simultaneously
- Suicidal modality
- Affective instability
Alternatively, you can skip medical certification and just go Sport Pilot even while taking your venlafaxine as long as you can look yourself in the mirror and say to yourself honestly that you do not know or have reason to know of any medical condition that would make you unable to operate the aircraft in a safe manner. A lot of that decision could be based on your experience undergoing initial Sport Pilot training with a flight instructor.
Whether you choose to disclose your medical situation to that instructor is legally up to you, but if I were your instructor, I would want to know so I could watch for any indications of the several possible side effects of venlafaxine which would contraindicate being a pilot. I'd hate to sign you off for solo and then have something bad happen. Yes, some of those effects might show up in any trainee, but being able to narrow it down to the venlafaxine might allow you to shift to a different med and keep training.
Update:
After further research…
Per a real expert (i.e., not me), your 12-year history of anti-depressant use should not by itself prevent issuance under the approved SSRI protocol unless your history includes:
- Use of two or more meds simultaneously
- Suicidal modality
- Affective instability
Alternatively, you can skip medical certification and just go Sport Pilot even while taking your venlafaxine as long as you can look yourself in the mirror and say to yourself honestly that you do not know or have reason to know of any medical condition that would make you unable to operate the aircraft in a safe manner. A lot of that decision could be based on your experience undergoing initial Sport Pilot training with a flight instructor.
Whether you choose to disclose your medical situation to that instructor is legally up to you, but if I were your instructor, I would want to know so I could watch for any indications of the several possible side effects of venlafaxine which would contraindicate being a pilot. I'd hate to sign you off for solo and then have something bad happen. Yes, some of those effects might show up in any trainee, but being able to narrow it down to the venlafaxine might allow you to shift to a different med and keep training.
Thank you. That is good to know.
None of those factors (multi-med, suicidality, etc) apply here, so it sounds like starting Sport Pilot while consulting with an AME about an eventual class 3 Med might be a good way to start.
Thanks again.
@Thomas Howell
Am somehow unable to post in this thread even after multiple logins…See your private email……