FAA allows pilots to take antidepressants

[grumpyoldgeek]

The Associated Press: FAA: Pilots allowed to take antidepressants on job (http://www.google.com/hostednews/ap/article/ALeqM5hhHLaL4b5sI8HfeSe6lavRFlQ5kwD9ER0J6O0)

WASHINGTON — Some pilots taking medication for mild or moderate depression will be able to fly as soon as next week under a new government rule aimed partly at getting those taking antidepressants to disclose the treatment.

The new policy, which takes effect Monday, reverses a ban on flying for pilots taking medications like Prozac. Federal Aviation Administration officials said the old rule was based on outdated versions of antidepressants that could cause drowsiness and other side effects.

The medications have been updated and do not pose that risk with everyone, FAA Administrator Randy Babbitt told reporters Friday. But there was a side effect to the policy that has now been abrogated, Babbitt said. That rule had resulted in pilots taking those medications to keep their depression and treatment a secret, under the threat of losing their certification to fly.

"Our concern is that they haven't necessarily been candid," Babbitt said.

"We need to change the culture and remove the stigma associated with depression," Babbitt said. "Pilots should be able to get the medical treatment they need so they can safely perform their duties."

Under the new policy, pilots who take one of four antidepressants — Prozac, Zoloft, Celexa or Lexapro or their generic equivalents — will be allowed to fly if they have been successfully treated by those medications for a year without side effects that could pose a safety hazard in the cockpit. The antidepressants are classified as SSRIs, which help regulate mood.

In addition, the FAA will grant a sort of amnesty for pilots who have kept their treatment for depression a secret. The agency will not take civil enforcement action against pilots who, within six months, disclose their diagnoses of depression and treatment.

FAA officials said they changed the policy in part to encourage disclosure, but also because their own research by a team of psychiatrists over the past two years showed that the antidepressants have advanced to the point where side effects don't affect everyone and often subside in time. The risk of safety hazard, therefore, has subsided, the agency concluded.

Several labor unions representing aircraft owners, pilots and crews had urged the government to lift the ban. The Army, the Civil Aviation Authority of Australia and Transport Canada already allow some pilots to fly who are using antidepressant medications.

A team of psychiatrists and aviation medical examiners will help the agency monitor pilots under the new policy under a program established 40 years ago to assess and treat pilots suffering from alcohol and drug abuse issues, the FAA said.

Copyright © 2010 The Associated Press. All rights reserved.

[captplaystation]

Whilst I admire the common sense element of this, safer to acknowledge what is already happening in the background and legislate in its favour, which therefore permits monitoring of the situation, am I the only one that finds this whole thing more than a little disturbing.

Shoot me down if I am wrong or exaggerating , but isn't prozac just as much a mind altering substance as alcohol or cannabis ?

If your depression is severe enough to require use of a substance to alleviate the depression, are you really in the frame of mind to fly ?

I have personal experience of flying, whilst life outside the cockpit was in turmoil, and it is only with the benefit of time/reflection, that I can see it is not a wise idea. If you have problems sufficient to need medcation to get you through the day, perhaps you need to either give yourself a kick up the @ss, or, if you can't solve it without medication, sort the problem out first and then seek recertification.

I know many will think that sounds harsh, but is this realy a good idea :rolleyes:

I pose this question with only the most vague knowledge of the drugs in question , so stand to be corrected if I am guilty of over dramatising the situation.

[Zoner]

Sometimes a partial dosage of antidepressants are given for other medical conditions. The medical condition would normally be allowed but the pilot is not allowed due to the extremely (1/10 of normal) small dose of antidepressant. This might help those folks get back in the air.

[grumpyoldgeek]

Speaking only on a very subjective, personal level, I can assure you that the effects are *not* like alcohol or cannabis.

My wife went on Prozac several years ago. Once the correct dose was established, there was no significant change in her personality or behavior as long as the stress level was low to moderate. The real change was at high stress levels. Instead of emotionally loosing control, she remains coherent and functioning.

Exactly what I'd want a pilot to do. I'm totally in favor of the rule change.

[captplaystation]

Ah, now that is a different story, the full monty doesn't sound too good.

Just googled prozac side effects, well. . . .

insomnia 33%
nausea 29
weakness 21
headache 21
diarrhea 18 :uhoh:
drowsiness 17
anxiety 15

If we include rare but possible side effects such as

suicidal thoughts or behaviour :eek:
anxiety or panic attacks
hostility or aggresiveness
restlessness or inablity to sit still:8
extreme elation that may switch back and forth with depression

it has to be said this requires REALLY SERIOUS monitoring.

A colleague of my partner is prescribed one of these wonder drugs, she is always a little bit "shiny happy people" bordering on "space cadet" at times.
Regretably humans get emotional for a good reason, sometimes it is adrenalin/emotion that pushes you to take the actions that keep you alive.
Lack of emotion isn't ALL good := IMHO

[protectthehornet]

so, the airlines have hundreds of guys with depression on their disability lists...paying out money in accordance with contracts

Voila, change the rules and put em back to work!

I think this is a huge mistake, just one more step to weaken the profession.

Does anyone remember the L1011/Delta at DFW that crashed in Microburst? wasn't the pilot taking a drug similiar to an anti depression drug?

And I don't think anyone has studied the side effects of prozac at a cabin altitude of 8000', or during a true emergency regardless of altitude.

[pattern_is_full]

If you understand how SSRIs work (as I do) and you take them (as I do) - you understand why they are not a problem (with one exception I'll get to).

Serotonin is the stuff one nerve cell shoots to the next nerve cell across a brain synapse to pass a signal. To keep the synapses clear for new signals, the serotonin is reabsorbed by the first cell after a brief spell.

But if the downstream cell has reduced sensitivity to serotonin, the reabsorbtion (re-uptake) may happen before the signal has passed clearly and effectively, leading to ineffective "thinking," or whatever brain process is involved, and thus depressed brain function.

Some symptoms can be the classic "blues", irritability, insomnia and "white nights" and a general difficulty focusing and planning effectively.

SSRIs (Selective Serotonin Re-uptake Inhibitors) block the reabsorbtion, allowing the chemical signal to hang around in the synapse longer, giving it more time to work, and thus improving brain function overall. At least, that's a thumbnail description of the theory.

The downside is that after a good high-energy day thinking clearly, when the time to sleep comes, it comes on fast.

This is not a "crash" from the drug running out (it has a long half-life and takes 3-4 days to both reach effective levels and then wear off, so if taken daily a constant level is maintained in the body) - it is just the brain returning to a normal "work hard, sleep hard" daily pattern.

But if you happen to be one of those pilots on a schedule with irregular hours or minimum turnarounds, you might find yourself hitting the wall while still in the cockpit. Just something to note.

On the whole, if a pilot is suffering from chemical depression, I'd rather they be flying treated with SSRIs than flying irritable and with depressed brain functioning.

It may well be true, as recent articles have suggested, that depression is overdiagnosed and antidepressants are overprescribed these days. But when there really is a chemical imbalance in the brain, they can be very effective (IMHO) in returning otherwise capable professionals to full functionality.

[grumpyoldgeek]

Just googled prozac side effects, well. . . .

insomnia 33%
nausea 29
weakness 21
headache 21
diarrhea 18
drowsiness 17
anxiety 15

Eating a BBQ pork sandwich and drinking two cups of coffee will also give me those side effects :)

[ReverseFlight]

I think the new ruling sets a dangerous precedent as there are many modern non-prescription over-the-counter drugs which are marketed specifically to be "non-drowsy" as compared to their "drowsy" counterparts. Are we saying there ought to be an exemption for such drugs as well ?

[Aviast]

Interested parties should read this document:

http://www.casa.gov.au/avmed/download/antidepressant.pdf

If the regulator disqualifies a pilot from flying based upon his/her use of SSRIs then, broadly speaking, there are three possible outcomes.

The pilot will:

not seek treatment for his/her depression; or
covertly take SSRIs, perhaps obtained over the internet and/or without seeking counselling; or
leave aviation.
I think it's obvious that this "head in the sand" approach is not going to result in the best safety outcomes for aviation. I agree with the conclusions of the CASA and the FAA that the way to approach this issue is to allow pilots using SSRIs to fly provided that they are appropriately monitored and their depression is managed. I think the "monitoring and management" part is important; taking SSRIs alone is not enough as not all medications are effective for all people, and the dose may need adjustment. But if the treatment is working then there is no reason why a pilot on SSRIs would be any less-safe than another pilot.

Just my 2c :}

[Just a Grunt]

To be clinically depressed, a person must have at least five symptoms out of a possible 9, and the symptoms must not be due to drug/alcohol abuse or explained by a very recent traumatic event (eg death of a loved one). The most relevant of those symptoms in the present context include:

insomnia or hypersomnia nearly every day;
psychomotor agitation or retardation nearly every day;
fatigue or loss of energy nearly every day;
diminished ability to think or concentrate, or indecisiveness nearly every day
recurrent thoughts of death...or...suicideThese symptoms are readily treated by the use of SSRI anti-depressants, which are not "happy-pills" that magically and suddenly elevate mood. Nor do they have any effect that is even remotely like alcohol/drugs. The commonly reported experience is that, after an initial period of adjustment to mild side-effects (nausea, dizziness...and delayed "ejaculatory response" - in males;)), the patient does not notice any effect...until several weeks have elapsed and they come to realise that their symptoms have gradually subsided.

Should pilots who take SSRI's to treat premature ejacualtion be denied a medical??

This medication has been used widely for the treatment of depression for many years now, and there is an enormous amount of statistical data available as to side-effects.

By way of contrast, older tri-cyclic anti-depressants (which are also very effective), do have side-effects (such has sedation) that are probably incompatible with safe aviation.

Regarding the L-1011 at DFW, my reading of the L-1011 NTSB report did not reveal a reference to any drugs having been found, but said that testing was limited due to the "[un?]availability of suitable specimens". (see [1.13] at p 27)

Here in Australia, where the use of SSRI's by pilots has been permitted for some years, a medical in such a case is endorsed "CASA renew only", meaning that once you've done your standard medical, a report from your psychiatrist is required. If I had the option of flying with an untreated, insightless and depressed pilot, and one who had acknowledged the illness and was receiving properly supervised treatment, I think I'd go for the latter.

[mustafagander]

If I read the first post correctly, the FAA requires a year before reinstating a pilot's medical status. A #@^&* year???

Oz CASA for all their faults are at the leading edge here and only require that a pilot be stable on his/her medication for 28 days and then medical status is restored.

I have been there, done that and found that my medication, Zoloft, caused me no adverse side effects. The common side effects, from which I suffered, were reduced appetite and lowered libido. Given that I was recovering from a traumatic divorce and was overweight anyway I found them ideal. :ok:

A major international operator in Oz had about 20% of its pilots on SSRI medication a few years back and I doubt that the ratio has changed.

After about 18 months I gave the SSRI up under the guidance of my GP, naturally. It needs to be looked at like a broken arm - it needs a "splint" for a while while it heals naturally, then back to normal. Just like me - for those who know me, no smart cracks, OK??

Bottom line - if you think you have a problem with depression, seek help. It really does work. :ok:

[mercurydancer]

Captplaysation

SAM missles are on their way I'm afraid. Most modern antidepressants have few affective effects. They certainly do not have the effect of alcohol or anything like it. SSRIs work biochemically in restoring serotonin in the brain and not as chemical sedatives, which unfortunately many older types of antidepressants do. I would be more concerned about a pilot who has unstable diabetes than a pilot with mild depression taking a measured course of SSRIs and returned to work after 6 weeks since inception of the medication.

As a side comment, RAF aircrew in the Iraq conflict of 1990 were offered zopiclone, a hypnotic, to help them sleep prior to combat. All well and good as the drug has a very short half life and is unlikely to cause confusion and abnormal side effects apart from the 10% who become disorientated as to place and time, and a smaller, but signficant proportion, who become uncharacteristically aggressive or violent, or have signficant episodes of amnesia up to 24 hours after taking zopiclone. I mention zopiclone as it is often prescribed in conjunction with antidepressants. Now SSRIs and Mirtazapine ( another effective antidperessant) are prefectly OK on their own but mixed with zopiclone are a very toxic and nasty combination.

Of course, to mix any antidepressant with even a small amount of alcohol is to render the person unsafe to fly or even drive.

[AEST]

Any chance of a beer sometime soon? :=

[johns7022]

More 'dropping of the standard' in pilots...

Just what we need...suicidal pilots, now medicated, flying passengers around...

[MarcK]

Just what we need...suicidal pilots, now medicated, flying passengers around...

I take it you would prefer suicidal pilots, unmedicated, flying passengers around?

[mustafagander]

johns7022,

I strongly suspect that you haven't a single clue about this subject. Read and learn or piss off.

It's serious, very serious when pilots are unwilling to seek treatment and hide depression from everyone until they finally simply lose the plot one day.

BTW, depression does not necessarily make you suicidal, just indifferent to almost everything.

[clunckdriver]

How about paying pilots a living wage? I bet that would cure most cases of depresion!

[Metro man]

With the continuous erosion in terms and conditions of pilots, it's not unreasonable to expect to have many depressed people out there. Unfortunately it's just acknowledging the symptoms rather than dealing with the root cause.:hmm:

[johns7022]

johns7022,

I strongly suspect that you haven't a single clue about this subject. Read and learn or piss off.

It's serious, very serious when pilots are unwilling to seek treatment and hide depression from everyone until they finally simply lose the plot one day.

BTW, depression does not necessarily make you suicidal, just indifferent to almost everything.

-------
So we have gone from medicated, suicidal pilots, to unmedicated, suicidal pilots that have no sense of responsibility to their passengers, no sense of professional integrity....thus not seeking help...

I guess I am supposed to dredge up some compassion for these pilots, find some 'heart'?

BTW...thanks for clearing that up...I feel much better knowing my captain is 'indifferent to almost everything' and not 'suicidal'.

[mercurydancer]

johns..

Depression in the main takes two forms ( there are exceptions) - reactive and endogenous. Reactive is what it means - Post traumatic stress if you prefer.

Endogenous depression is slow onset and is very common when people are involved in high-stress occupations for years. It has something to do with exhaustion of brain chemicals, specifically serotonin, and exposure to high stress situations on a routine basis.

johns... would you be so self-aware that you would know when you are impaired by endogenous depression? I doubt it. Most self-referrals have a common thread - they have had thier behaviour pointed out by others as having changed, and characteristially the terms used are "flat", "unconcerned" and "indifferent". This condition is very amenable to treatment. Based on statistics from other professions as much as 15% of staff over 40 years of age will be affected by this condition. If treated appropraitely almost all will return to work.

[RatherBeFlying]

With CASA's approach, pilots are more inclined to seek treatment for depression. They lose six weeks of flying going on the drugs and six weeks when the dose is adjusted or ended.

Contrast that with the latest, greatest from the FAA where a pilot is taken off flying status for a year.

That leaves a major disincentive for a pilot to seek treatment for depression unless he has a really severe case, i.e. can't get himself out of bed to report to work.

In that situation many depressed pilots will continue to fly without treatment.

[tarmac-]

Treatment of depression is fixed by taking a step back and adjusting your life. Not taking a chemical expecting it to adjust it for you. It is a drug, which is being used everyday, and like every drug, you become immune over time, to the point it has little effect. Humans were not designed to take a chemical every day, why is it only in the last half century people have been fooled into taking this crap when real health has been mastered by the Chinese for over 3000 years.(Chi Qi-Gong) Get your energy channels flowing. It really does work.

Anti-depressants can often be looked at as the start of a long spiral down. Personally know people on using this stuff who all say it wears off over medium periods or time.

In terms of pilots flying using these pills, it needs to be a case by case basis in which each pilot is researched thoroughly as opposed to a single appointment.


Anti-depressants = sad reality of a not so uncommon modern life for some.

[West Coast]

I wonder how many pilots are out there flying suffering from depression yet still getting the job done. This is a good decision and I applaud the FAA for addressing the situation rather than just sweeping it under the carpet.

I have to believe they are taking a page out of the militaries play book of removing the stigma out of depression and addressing it as a treatable issue.

[Jackdaw]

But if you happen to be one of those pilots on a schedule with irregular hours or minimum turnarounds, you might find yourself hitting the wall while still in the cockpit. Just something to note.


Are there any other schedules?

[Aviast]

Treatment of depression is fixed by taking a step back and adjusting your life. Not taking a chemical expecting it to adjust it for you.

I agree but "taking a step back and adjusting your life" is easier said than done when you are depressed. The medication relieves the depressive moods so that the person can benefit from constructive counselling sessions.

I don't know how common it is for people to be on anti-depressants for extended periods of time but I would suspect that's the exception rather than the rule. Perhaps someone has statistics on that... although we are heading off-topic.

[pattern_is_full]

Jackdaw: Well, I wanted to leave the possibility open - however remote....:ooh:

Psychology is complex - there are many levels of depression and different people react differently to the ailment or to the treatment. So there is room for a variety of approaches.

But for certain types of simple chemical depression, SSRIs are like topping up the oil on an engine. You don't counsel the engine on how to run without enough oil; you don't exhort it to "straighten up and fly right!" - you get out a quart and fill the blerry tank!

[West Coast]

Treatment of depression is fixed by taking a step back and adjusting your life

A bit tougher when your life is adjusted for you. A divorce, a death in the family, losing one house, etc.

You don't have control over everything that ails you.

[Finn47]

Anybody here taken a look at the listed side effects of good old aspirin when taken with caffeine?
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bloody or black stools; confusion; diarrhea; difficulty swallowing; excessive drowsiness; hearing loss; hoarseness; mood or mental changes; ringing in the ears; shortness of breath; sweating... and I left out the more serious ones :} I would not worry too much about listed side effects here. The manufacturers must list them, for legal reasons, I suppose.

[lowcostdolly]

Guys can I add my twopenneth here as someone who has once been refused a job in aviation purely because I had taken, not was taking, anti depressants.

I'm not a pilot but CC so have no where near the responsibilities you guys do. My potential responsibilities were quoted however as a reason for refusing me a position with a certain company.

I'm also a RN so have insight into the actions of SSRI's, tricyclic antidepressant's etc when treating patients but I am no expert. Having taken SSRI's yes I have had side effects whilst getting used to them.

Some people are pre-disposed to depression. I have a family history. My depression was post natal many years ago and since as a loss of job accompanied by bereavement. On both occasions I was treated successfully with drugs (small doses) and counselling.

Unfortunately even in this day and age depression is seemed as a stigma. Some people view sufferers unjustly as potentially suicidal maniacs and in the experience I had aviation was no exception.

I was offered a postion subject to reference and medical clearance so I'd passed all the airlines assesment criteria for CC. I declared I had previously suffered from depression on my med form. Without any further reference to my GP, any interview with me, any psychiatric opinion I was refused my position by the company DR.

I challenged this decision on the grounds of discrimination and lo and behold again without any of the above consults i was given a position!!!. If I was a risk to airline travel the company concerned would never have known either way.

As CC now I could travel with Pilots everyday who are depressed and not seeking treatment. I could also travel with those who have been there as have I and I would never know. Both catergories I'm sure would never admit to this for fear of jeopardising their careers as things seem to stand.

If the FAA are allowing Pilots to fly on anti depressants then good on them :ok:..... providing these Pilots are closely monitored on both medication levels and a proper psychiatric evaluation regularly. Thank God a regualtory authority is recognising this as a treatable illness.

I believe (lurking on another Pilot thread) the CAA are almost there with Pilots as well. It takes a lot of courage however to put this to the test.

[Paul Wilson]

Just something to remember about listed side effects of any drug. They are reported effects that a sample group of patients experienced. Now if you are taking a drug to stop your knee turning green, but it doesn't work for you, your knee will be green. This would be reported as an effect.

Listed side effects are not always SIDE effects, sometimes just uncured symptoms.

[ctrautve]

AIN has a poll (http://www.ainonline.com/poll) about pilots on antidepressants. So far, 20% say they would allow a pilot on antidepressants in the cockpit...

[400Rulz]

Hi All,
Wow, do I have to add my 50c worth here! I was married to my (now ex) wife for 16 years. 10 years ago she was diagnosed with ASD (anxiety stress disorder). She went on Arapax, which was brilliant, but flat lined her emotions. She never had highs, and never had lows. And she never cried (most unusual for a woman). Great for me, but bad news for her. When I went back to long haul (5 years ago), the kids left home, she gave up work and went off her meds. She spiralled back down into depression, met someone on the 'net who had the same problem, and left me because she said "he understood her", and was home every night. He has the same affliction. I have to admit that after I found out she had an affair with him, I thought about antidepressants. But I realised that the only thing that really got me going, was going to work. LOL. Sad but true. But I now know so much about the second and third gen. antidepressants that I would be comfortable flying with someone who was using them.

Further to the above, my current g/f is on them as well (boy, can I pick'em), but for different reasons. Her Mum, brother and Dad died within 3 months of each other. The problem is, that once the emotional dependency is established, there is a general reluctance to come off the meds., and that is where the danger lies. But I am glad the FAA and CAS have seen the light. Divorce and house moving are generally the biggest causes of (temporary) depression. While it is normal for the majority of us "normal" ppl to criticise those who turn to medication to alleviate their problems, not everybody can cope on their own. They need our understanding. I would much rather fly with somebody who is honest about their condition than one who is hiding it.

Food for thought.

400R

[Self Loading Freight]

Mental illness has a special stigma. It's not so long ago in the West - still is, elsewhere - that it was seen as a sign of demonic possession, of moral degradation, of being an irretrievably unstable and untrustworthy person.

A lot of that is still washing around, even in our enlightened society. There has been a sea change in the last twenty years, on the back of better science, better medicine and social changes, and it's now possible to say that you've been clinically depressed (as I have) while expecting it to be seen as any other medical matter. The expectations aren't always met, but things have improved immeasurably.

And so it is possible, and preferable, to regulate employment along those lines. As with everything in aviation, it's risk/benefit analysis to the fore - and I find it very hard to argue against a regime where having depression is seen as no more of a career threat than any other monitorable, treatable and predictable condition. It will encourage honesty and effective management. It's also more humane.

The SSRI antidepressants are very well understood (to a certain extent, but certainly in practical use), and their use in conjunction with other therapies can be limited and safe. The recognition that the state of the art has advanced, together with a regulatory environment where sufferers feel supported, not at extra risk, is a good idea.

In terms of who I'd rather have driving my bones across the sky, I'd have someone with a history of properly treated clinical depression over the roster-fatigued, the hung-over and the work-stressed-to-the-limit, purely because I feel the latter factors are a greater risk - both when things go pear-shaped and when coping with the attention-sapping routine.

R

[jmeagher]

So I've been a reader on these forums for years and have never felt a need to verify my email so I could post until now, since I'm not a pilot and I generally don't feel I have anything of value to contribute -- which should give comfort to the only-professional-pilots-have-anything-worthwhile-to-say crowd (with whom I disagree, for the record).

As I've been reading this thread I've been stunned by the general lack of knowledge on the subject of antidepressants on display by what I generally consider a well-educated, rational group of professionals that are required by the rigors of their jobs to continually question situations and adapt to them as they change -- whether it be a sudden wind shear on approach, or the encroachment of silicone into more and more areas of the aircraft's systems.

So with an amazing capacity for adaption, why this incredible reluctance to re-examine a medical condition that has, over the past ten years, seen an amazing set of leaps both in our understanding of its mechanisms and of its treatment options?

There are a few here who have tried to point out the rational side by explaining how depression works and how the SSRIs treat it, and they've got the right of it in broad strokes, but if the pilot population as a whole is emotionally set against the idea of allowing SSRIs, explaining the mechanisms of depression is a bit like teaching a deaf person the differences between a major and a minor scale. Admirable, but perhaps not the best use of one's time.

Instead, I would ask that those who have a strong negative emotional reaction to this turn of events take a moment to ask themselves if their reactions are based in current facts.

Remember that aviation was once mysterious and unknown and that over a series of decades through the HARD work of pilots, technicians, scientists, mechanics, daredevils, accountants, dreamers, skeptics and many many more, we have come to understand aviation further, define its workings, discover the principles, master all sorts of aspects once considered practically magic. Are there still unknowns? Sure - what the hell did happen with AF in the ITCZ? But we all know that a huge number of people are working to nail down that mystery, and if not solved at least it will most-likely spur innovations that might help future flights (does any pilot out there seriously doubt that in the next twenty years they will not have instantly updated weather at all times in the cockpit -- damn the technical naysayers, I have it now on my $300 cellphone -- global coverage is a logistic, not a technical issue).

Think of the clinical understanding treatment for depression as following a similar course to aviation knowledge, just on a different timescale. The unknowns are being nailed down, just as Yeager proved there was no bogeyman past Mach 1, and millions of safe flights have proven the relative safety of FBW.

All this said, I appreciate the naysayers, for they are the ones who will keep the pioneers honest. They are needed and should be actively involved with any new endeavor. My hope is that the naysayers are as informed as possible, as that is when they are at their most-effective.

So before I go back to my next five years of silent reading of your fascinating forums, I'll tackle a smattering of what's been thrown out there, but really, my hope in writing this is not to answer any one individual voice, but more a call to the profession to shift the attitudes away from a strict rejection of an entire field of inquiry to a more helpful examination of the facts, befitting a group of quite-smart professionals.

Feel free to stop reading here if you are in a hurry.

jm

========

For the record, I'm not an aviator, nor a medical professional, just an ordinary guy with an unhealthy obsession about a few select topics, including aviation and mental health - so if you feel you must ignore or dismiss my points, you have every reason to that you'll ever need.


Shoot me down if I am wrong or exaggerating , but isn't prozac just as much a mind altering substance as alcohol or cannabis ?

Well I won't shoot, but this is wrong. In terms of mind-alteration from a medical perspective, if Alcohol is 100 units of mind-alteration, cannabis is about 65-95 depending on who's research you want to believe and the SSRI class is about 10-30. Caffeine can be higher than SSRIs. Certain cold medications can be 150.


If your depression is severe enough to require use of a substance to alleviate the depression, are you really in the frame of mind to fly ?

Frame of mind and depression are not related. Investigate it further. Common mistake since clinical depression uses the word depression. Most people have an intuitive sense of what depression is and therefore believe they understand it. Then again many people have an intuitive sense that adjusting the throttle should change the speed of the aircraft since that's what happens in their cars. However in truth it's much-more complex. Something about pitch comes into play if I've been following along correctly.

A colleague of my partner is prescribed one of these wonder drugs, she is always a little bit "shiny happy people" bordering on "space cadet" at times.
Regretably humans get emotional for a good reason, sometimes it is adrenalin/emotion that pushes you to take the actions that keep you alive.
Lack of emotion isn't ALL good IMHO

Agree re lack of emotion. Understand SSRIs do NOT inhibit emotion. They actually can increase one's ability to process emotion. I would guess your partner's colleague is either (a) a shiny happy person bordering on space cadet as her normal baseline or (b) not getting the desired results from her current treatment.


so, the airlines have hundreds of guys with depression on their disability lists...paying out money in accordance with contracts

Voila, change the rules and put em back to work!

I think this is a huge mistake, just one more step to weaken the profession.

Does anyone remember the L1011/Delta at DFW that crashed in Microburst? wasn't the pilot taking a drug similiar to an anti depression drug?

And I don't think anyone has studied the side effects of prozac at a cabin altitude of 8000', or during a true emergency regardless of altitude.

Hm. Not sure about this being a concerted effort to weaken a profession. Not familiar with the Delta crash, but as to people studying the effects of antidepressants under emergency/stressful situations there have been plenty of those and while not strictly in a cabin, there are considerable amounts of the world population at high-elevation cities taking these types of medications with no noted special problems.


The downside is that after a good high-energy day thinking clearly, when the time to sleep comes, it comes on fast.

This can happen, but I would argue that within a couple weeks of taking the medication any tendency for this to be a problem larger than any normal fatigue problem is minimal to non-existent. And certainly it is preferable to not getting enough sleep and then dealing with fatigue, which can be, as we all know, worse than a couple beers.

I think the new ruling sets a dangerous precedent as there are many modern non-prescription over-the-counter drugs which are marketed specifically to be "non-drowsy" as compared to their "drowsy" counterparts. Are we saying there ought to be an exemption for such drugs as well ?

Interesting point. There are many drugs available OTC that are MUCH MUCH more powerful and concerning to me than an SSRI. The SSRI by design is administered at incredibly small dosages as the goal is to maintain a absolute minimum effective dosage; wheras many cold medications and painkillers that one would think of as perfectly innocuous work by administering massive doses of quite mind-altering substances as any bored teenager with access to a medicine cabinet can attest to.

After about 18 months I gave the SSRI up under the guidance of my GP, naturally. It needs to be looked at like a broken arm - it needs a "splint" for a while while it heals naturally, then back to normal. Just like me - for those who know me, no smart cracks, OK??

This is a really happy story. However, I'd caution that this is not the case for all people. Think of it more along the lines of insulin for a diabetic. Some people require continued treatment with SSRIs and that is perfectly ok.

This is part of a big (happy) shift in medical thinking. It used to be that Western medicine used prescriptions to treat immediate problems in a massively quick way. Take yer' medicine, grit your teeth and you'll get better. Now, there is recognition that treating things more with more subtlety over a longer period of time might have a better outcome (shifting towards a more eastern philosophy). Hence there are a lot more long-term drugs out there - think of how many of you take meds long-term for cholesterol, cardio issues, etc. This is also explained by big pharma, sure, but there is a medical reason also.


Just what we need...suicidal pilots, now medicated, flying passengers around...

I understand the gut reaction, but cannot agree with the logic behind it.


So we have gone from medicated, suicidal pilots, to unmedicated, suicidal pilots that have no sense of responsibility to their passengers, no sense of professional integrity....thus not seeking help...

I guess I am supposed to dredge up some compassion for these pilots, find some 'heart'?

Situations aren't always as cut-and-dried as you might frame them here. Consider this - most people (and more men, statistically) will not acknowledge, even to themselves, that they suffer from anything like depression, even IF they are aware of it. It is estimated that from 20-40% of cases of depression in men go untreated and the great majority of these untreated cases use alcohol to help cope/avoid. It's even encouraged by most cultures, "have a drink boyo, that'll fix ya up." Unfortunately alcohol actually aggravates the problem. So it may not be a reflection on their professional integrity to not seek treatment -- they might just not know.

Finding some 'heart' doesn't seem like it's your cup o' tea, so instead think of self-preservation and hope the guy/gal sitting to your left or right isn't self-medicating a denied problem with alcohol and may not exactly be in his or her top form.

BTW...thanks for clearing that up...I feel much better knowing my captain is 'indifferent to almost everything' and not 'suicidal'.

This is actually an oversimplification, but it's easy to understand how it comes about. The indifference is actually more likely in regards to things affecting onesself, not in regards to others. This is why you aren't reading headlines about suicidal people taking others to their deaths with great regularity, even though suicide is unfortunately common. The suicidal pilot is more likely to land the plane, go to a hotel room and OD on something than to take all the passengers down with them (sorry for the crudeness).

Endogenous depression is slow onset and is very common when people are involved in high-stress occupations for years. It has something to do with exhaustion of brain chemicals, specifically serotonin, and exposure to high stress situations on a routine basis.

Very interesting point. Further to it, consider that piloting can be both boring, repetitive AND high stress and you have the perfect conditions for the triggers for clinically significant depression. Our ape bodies were designed to run around the Savannah, hunting and running in order to work off excess tension and systemic overloads of our fight or flight systems. When executing a tough crosswind on a slushy runway, those systems are hammered just as hard (or at least I hope to hell my pilot's are) but when the danger has passed, you still have to taxi to stand, perform rote drills, do paperwork and smile to the ungrateful ****s down the back who have no clue how close they all came to death that morning. If you don't exercise afterward and then eat a heavy meal/go to bed, how well is the body coping?

Typically American problem solving; having trouble putting things into perspective, not setting priorities that make sense and only fighting the symptoms i.o. the root cause of a problem! (oh by the way, did anyone say airport security, terrorism and the economy...? )

A quick fix, some high speed tape in the shape of a pill to patch up a broken psyche and off we go again, waiting for the next problem to pop up!

The show must go on...


Got my American hackles up with that, but that's because there is quite a bit of truth in the statement. Touché, and a really interesting topic that could go on and on.

That said, the Freudians/Jungians/Chinese/Hindu/Whathaveyou all have a huge pile of data on the effectiveness of their approaches to treating depression and they all, with a few exceptions, have come around to accept that the physical causes of depression (neurons and such) are real and that treating them with medication has solved more problems and saved more lives and allowed more people to lead normal lives than any of their methods ever came close to doing.

Do Americans think as you outline above? Not all, just as not all Brits are polite tea-sippers, but there IS a tendency to look to the quick-fix. I would point out though, that SSRIs are not a quick-fix. They are long-term, require planning and strategy.

Now in terms of the economy, Christ, look to anyone but us. Our economy relies on constant growth. If we don't get another space race/cold war/tech revolution shot-in-the-economic arm, we're going down in flames and we're taking you all with us.


With CASA's approach, pilots are more inclined to seek treatment for depression. They lose six weeks of flying going on the drugs and six weeks when the dose is adjusted or ended.

Contrast that with the latest, greatest from the FAA where a pilot is taken off flying status for a year.

That leaves a major disincentive for a pilot to seek treatment for depression unless he has a really severe case, i.e. can't get himself out of bed to report to work.

In that situation many depressed pilots will continue to fly without treatment.

Agree. At least it's a step in the right direction.


Treatment of depression is fixed by taking a step back and adjusting your life. Not taking a chemical expecting it to adjust it for you. It is a drug, which is being used everyday, and like every drug, you become immune over time, to the point it has little effect. Humans were not designed to take a chemical every day, why is it only in the last half century people have been fooled into taking this crap when real health has been mastered by the Chinese for over 3000 years.(Chi Qi-Gong) Get your energy channels flowing. It really does work.

Uff. The hard thing about responding to this is that you are partially right. It should often involve taking a step back and adjusting, but it CAN also include using the drug to help. The two are not mutually exclusive nor should they be set up that way. For some, the drug is the only thing that has ever worked for them.

But as to humans not designed to take a chemical everyday? Give me a break, there are plenty of chemicals you need everyday without which you would die. I'm sure you can name a few. Every food we eat is a chemical miracle that science is only now just starting to understand.

Chi Qi-Gong does work for some people and there is an effort to incorporate it into scientific studies. There are people studying it conjunction with drugs. Nothing should be dismissed out of hand until we know for sure. That's how we broke the sound barrier. Since exercise has been shown to be anywhere from 50-100% as effective as SSRIs in treating depression, it would not surprise me if Chi Qi-Gong is quite effective.

However, Chi Qi-Gong has not been around for 3K years unless I'm mistaken. It was accepted in the early 1990s in the Chinese Health system and a lot of traditional Chinese medicine practitioners view it with a great deal of skepticism. Some think the government only accepted it in order to control some ofshoots of the movement it found troublesome, WAY off topic, sorry.

Anti-depressants can often be looked at as the start of a long spiral down. Personally know people on using this stuff who all say it wears off over medium periods or time.
</QUOTE]

Hm. Yes, they can wear off. It is subtle and can be addressed by the ever more-common dosage shifting and combination approaches. However, it is not the case for the majority of people that they wear off or that they are a spiral down. That said, we should wait another 20 years to really say anything concrete about this to get truly long-term data. Maybe you are right. I hope not for many people's sake.

[QUOTE]
In terms of pilots flying using these pills, it needs to be a case by case basis in which each pilot is researched thoroughly as opposed to a single appointment.


Agree wholeheartedly.

I don't know how common it is for people to be on anti-depressants for extended periods of time but I would suspect that's the exception rather than the rule. Perhaps someone has statistics on that... although we are heading off-topic.

It's becoming more common than not as the data show their efficacy and incredibly low-incidence of undesirable side effects.


A bit tougher when your life is adjusted for you. A divorce, a death in the family, losing one house, etc.

You don't have control over everything that ails you.

Agree, but also brings up a larger point. For the most-part, people who suffer from long-term depression have the depression independent of any triggering event. It's endogenous as someone else pointed out. The genetic markers are placed there by your parents and it will manifest or not, usually by early adulthood. We still don't know why at this age, and we still don't know why some people can have the markers and have no problems and others will. Just like we don't yet fully understand how aspirin works or how to cure the common cold. But there are a lot of people hard-working open-minded people at work on these problems.

[johns7022]

I think it would make for an interesting flight if I sat up with a captain that admitted to nibbling on his Glock a week ago, but feels fine now because he's on medication.

[Ptimat31]

I wish you never having some events that puts you into depression.

Otherwise you'd had to face idiotic comments from ignorant guys about your ability to work while under treatment.

Part of the cure could be also resuming flying and enjoying a normal life again.

Pardon me if I'm wrong but you seems like a young unsensitive 'Know it all', and to me, it's far more dangerous than depressive people in a plane.

[b8361811]

Long time reader, not a pilot (IT guy). Had a depressive episode in 1999, been treated, things were well again thereafter for 10 years. In fall last year I felt it started again. Some issues in life (related to money, work or relationship) you normally understand and solve rationally (or just ignore!) start to drag you down. It is as if your 747 is ballasted by 80 tons of lead, and put that either close to the nose gear or the aft bulkhead.

I have been on 20mg/d Citalopram (brand name Celexa) for a few months, and i am in the process of fading it out now. I can assure you that there are virtually no side effects. Modern SSRI's just get your weight and balance right again. You still have to fly (your life) yourself, and all systems work and have to work as before!

[md80fanatic]

Although there appear to be many success stories relating to SSRIs, there are also a few horror stories (Columbine High School for one). Of course the brain is a very complex organ that we know relatively little about. What we know about the brain is equivalent to what could be gained from inventorying a pitch dark warehouse with a flashlight (most items would remain hidden). I feel it's way too soon to trust primitive medications in extreme high stress situations where multiple lives are in the balance. In flight is not the best place to discover a new side effect from SSRIs.

These drugs appear to ease chronic depression in most cases, it is the minority (like the Columbine shooters) that I'd prefer not seeing on the other side of the cockpit door. Until we can get a firmer grasp on precisely who those people are that occupy the minority, SSRIs should not be allowed.

[johns7022]

Funny, not one post in support of a pilot taking professional responsibility and simply quitting, taking a leave of absence, finding another line of work...

[captplaystation]

If you really believe it is that simple (even in a country with a good welfare system) YOU are the one in need of help.

I can't say I find myself totally reassured by this change in policy, but YOU have managed to post the 2 most asinine posts on the whole thread so far within 5 posts.
Open your eyes to the rest of the world, and listen & try to comprehend, rather than just posting provocative nonsense for the sake of it :=

[johns7022]

Captainplaystation: If you want to put a car payment ahead of professional responsibility and the safety of your passengers, go find another proffession where your job performance will not have any effect on people lives.

Seems the only peeps ok with airline pilots being on antidepressents are airline pilots, every 'passenger' I talked to, thought it was nuts.

Oh, well...another rant about what pilots 'should do' vs what they will do.

[M.Mouse]

johns7022

I have a great deal of knowledge on the subject in question. We have several very reasoned and intelligent posts on this thread.

Your posts have that dreadful combination, so often seen, of supreme arrogance coupled with great ignorance. The main reason I have refrained from the debate is because of the inevitable drivel from yourself and a few others and as the saying goes there are none so blind as those that do not wish to see.

...every 'passenger' I talked to, thought it was nuts.

With scientifically sound analytical skills like that we should all sit up and take notice.

[kevinbsmith]

It amazes me to hear so much garbage from people/pilots that have no idea what taking these kind of medecines does to someone.
It actually helps and it has nothing to do with having suicidal thoughts.
captplaystation: you normaly have good ideas but this time you don't know what you are talking about...ask your romanian wife/girlfriend to really question her friend. Personally, working for ryanair itself should be a reason for having suicidal thoughts! Post what you know and just read the things you can't understand.
K

[non iron]

Do you not think that as a non pilot you maybe scaremongering ?

Why bother ?

Explain the buzz please.

PS. if you are taking anything other than authorised drugs whilst flying, plainly non declared, then you ought to be strung up.

And then shot, twice.

[grumpyoldgeek]

If you're talking to me, I'm a little confused. I am a pilot, though not an airline pilot, and I don't take any drugs while flying or for that matter any other time.

I don't understand how quoting an FAA announcement would be scaremongering.

[Global_wanderer]

As a pilot who had to give up flying because the pay at the entry level was too low to support my family, I just wanted to chime in with my $0.02

I think that 28 days is too short to determine whether the medication is actually working or not. I recently went through a bad spell, and spent almost a year on them. I was suffering from depression and anxiety. The first type failed to work effectively, the second type had a wierd side effect (although the missus loved it), and the third type actually worked. Bear in mind it took almost 4 months to establish the correct medication that worked for ME. Not all pills react the same for different people. But the bottom line is, they helped me (and yes I still work in an aviation related role, but in the office, not the air).

If somebody told me that one of the guys in the front office was on antidepressants I truly wouldn't have an issue with it if he had found the right meds etc.

And I'm really sorry to say to those of you that have not suffered this affliction, don't judge those that have and return to their positions. We don't all react the same way, and although you think you have felt the same way as somebody who admits to the medication, maybe you haven't. I lost my wife through suicide and had to ID her body. Tell me that won't impact you!

Anyway, that's my thought process.

[mustafagander]

GW,

First let me say that I am truly sorry for the trauma of your having to identify your wife.

In Oz, the 28 days rule says that you must be stable on your medication and dosage for 28 days. It took me about 6 weeks to first find the right dose, then 28 days to prove to everyone, especially myself, that I was stable. I weaned off the meds after about 18 months.

[Right Engine]

I can think of at least 4 pilots who I have flown with in the last 10 years who exhibited strong symptoms of clinical depression.

Their aloofness played a part in what I would politely call 'Underperformance'.

I can be certain that if they were in a career that did not ground you when admitting to suffering depression, they would probably have got help. 2 of the 4 I flew with, lost their licences permanently a year or so later after I flew with them.

Mental health is not just a stigma in our industry, it is a noose to our careers.

I applaud the FAA for this move and look forward to a similar move by the UK CAA.

[Airbubba]

A story today from CNN:

Under revised FAA rules, 'Prozac Pilot' hopes to fly again - CNN.com (http://www.cnn.com/2010/TRAVEL/04/16/prozac.pilot/index.html?hpt=T2)