Page 14 - Volume 10 Number 11

Unfortunately, the majority of medications, essentially all psycho- since serotonin affects nerve cell
psychiatric diagnoses are not clear cut. When does sadness become depression? When does vigorous hyperactivity become mania? When does compulsive behavior, something that can be really useful for a pilot, cross into abnormally compulsive behavior? Generally speaking, the line between normal and pathological is drawn when the behavior in question begins to interfere with normal everyday activities. When feeling low makes it hard to go to work, or accomplish tasks or personal goals, or when compulsivity gets in the way of normal functioning, we call it pathologic. It’s very important for pilots to be diagnosed accurately when they have complaints that can point to actual psychiatric problems. Situational sadness, for example, is not depression. Yet it is often treated as if it is. The problem for a pilot arises when he or she goes to a health care professional and is given a psychiatric diagnosis. This diagnosis will almost certainly come with a prescription for a sedative, a tranquilizer, or an anti- depressant, and at that point the pilot will run into major problems with the FAA.
Briefly stated, most psychiatric diagnoses are disqualifying and an AME cannot issue a medical certificate. These diagnoses include: Adjustment Disorders requiring medication, Attention Deficit Dis- orders, Bipolar Disorders, Minor Depressions requiring medication, Major Depressive Disorders, Per- sonality Disorders, Psychosis, History of Suicide Attempt and Substance Dependence. While an applicant might be able to obtain a certificate via the Special Issuance Process, the AME is not allowed to issue the certificate to an applicant with any of those conditions, and those categories make up the bulk of psychiatric diagnoses.
The real difficult part for pilots who have psychiatric issues is that while many psychiatric conditions can be fairly well managed with
12 • KING AIR MAGAZINE
active medications, with four specific
exceptions, are not acceptable to
the FAA. The FAA will not certify
pilots who are taking sedatives,
tranquilizers, antipsychotic drugs,
antidepressant drugs (with four
exceptions), analeptics (nervous
system stimulants), anxiolytics (anti-
anxiety agents), and hallucinogens.
The four exceptions are all in the
antidepressant drug category
and are specific SSRI (Selective
Serotonin Reuptake Inhibitors).
Serotonin is a chemical that is
involved in transferring information
between neurons (nervous system
cells), and SSRI drugs increase the
amount of serotonin available in
the brain. These drugs are quite
useful in treating depression, but
because they increase the available
serotonin levels in the brain, and expensive and generally very
transmission generally, they have potential side effects, including drowsiness, nausea, insomnia, diarrhea, restlessness, dizziness and blurred vison.
The four specific SSRI medications that can be approved by the FAA are: Fluoxetine (Prozac), Sertraline (Zoloft), Citalopram (Celexa), and Escialopram (Lexapro). But even here, there are conditions.
Below is the decision tree that an AME must use when evaluating an applicant on one of the “approved” medications:
As you can see, getting approval when you are on an “approved” SSRI antidepressant is not for the faint of heart. It’s time consuming,
NOVEMBER 2016