EASA allows medication for mood disorder

[RRR69]

New in EASA is that it allows psychotropic medication in case of a mood disorder whereas JAR-FCL states that a fit assessment may only be considered after all psychotropic medication has been stopped for an appropriate period. Because of this change some pilots will be back in business when JAR changes to EASA. Does any of you already have experience with this or know someone who does? The country from which I operate will change to EASA in april 2013.

[Robot1]

Hi RRR

Are you referring to EASA's 'Acceptable Means of Compliance and Guidance Material to Part-MED1' which states....

Mood disorder
An established mood disorder is disqualifying. After full recovery and after full consideration of an individual case a fit assessment may be considered, depending on the characteristics and gravity of the mood disorder. If a stable maintenance psychotropic medication is confirmed, a fit assessment should require a multi-pilot limitation.

It certainly seems to be a step forward

[Robot1]

Given the history of interest in anxiety / depression on this site, I find it strange that nobody has anything to add to this thread ;););) :oh:

[RRR69]

Dear Robot,

Hopefully some pilots will still share there experience. We have only started this thread recently but you are right. Let's wait and see. So again, does anyone have experience within EASA's new policy on mood disorders?

[Dan Winterland]

Yes. I'm in a bad mood just having read CAP 804, the new EASA regs!

[zero1]

Ladies and gentlemen

This information was available a couple of years ago in the proposal for comment, which I and I believe the UK CAA commented on. Before EASA took over the UK CAA were very close to allowing the use of SSRI drugs based a draft protocol. However, politics kicked in and they lost their nerve despite only needing one more committee to approve the change.

As for EASA Med Part 1, it is true that the proposal will provide some flexibility in the use of SSRI drugs and is likely to follow the protocol proposed by the CAA, which in turn was developed from the experience gained from our friends down under who have allowed the use of these drugs for over 10 years. Now for those who are really interested there is a long term study, which reports little or no difference in accidents rates by pilots who take these drugs to those who do not. Hence the US FAA has also recently agreed to relax the rules, all be bit with a few more restrictions.

Assuming the CAA protocol will be followed in some form, you will need to meet a number of obvious criteria to regain your medical certificate (class 1 or 2). These include a suitable report(s) on your condition, restricted to using specific SSRI drug types (I believe there are four or five approved) and also provide follow up evaluations depending on the medical certificate.

Now for the sad bit.... I recently wrote to the CAA again on the subject and their position with the EASA rules, plus I also followed up with a phone call with them to discuss the matter further and unfortunately they refused to provide any advice until the EASA rules come into force in July... :ugh:

Something to do about local interpretation of the rules (i.e. one country might allow one thing and another might not...). This seems a little strange to me because these medical standards are meant to be common to all.
So like the rest of us I still need to wait until July/August before I know if I can regain my full medical back.

Don't you just hate red tape.... :mad:

[Robot1]

At least you got a reply,, my 'Authority' didn't even bother to reply to my enquiry :confused:

[zero1]

Robot1

I have a lot of letters on this subject believe me... It is a subject that I have followed for sometime after losing my class 1 medical following my declaration that I was on the SSRI for a mild form of GAD.

The medical people do like their rules and boy do they stick to them.

I also tried the approach of asking them (CAA) if I could fly on an Austrian medical but the rules kick in again stating I can't fly a UK aircraft without a UK medical... Hopefully we will have an answer in a couple of months, one way or the other.

[RRR69]

Dan, can you please be a little more specific about what you found in CAP 804?

[zero1]

Just had some news from the CAA and Sept looks positive for a change in policy. However, they were not committing to anything more than that. :ok:

[Robot1]

Great News Zero

Wondering if you got any idea if there's anything in the pipeline for ATCOs. New rule seems to only apply to old Class I & II. Ironic that the lesser Class III should still be bound by the old restrictions.

[zero1]

Hi Robot1

I suspect as the class 3 is technically a lower medical standard then the rules may also apply to that as well. Remember that the NPPL medical, which is also a lower medical standard will allow the use of SSRI drugs even now.

I must stress the acceptance of the condition and medication will need to conform to the EASA/CAA protocol. Specifically there will be only 4-5 SSRI drug types allowed, which are the 1st generation drugs. In other words, those that the medical people have statistical data on in a flying environment.

The likes of Venlafaxine, which is a SNRI (serotonin and norepinephrine reuptake inhibitor) and Duloxetine have not been proven and therefore will unlikely be included. Some time ago I did discuss this with the CAA as to how they will include newer drugs in the protocol but at the time this had not been fully considered. Still we have to be thankful that some common sense has finally come to the medical people on this subject.

The question I always asked is if the statistics say that 1 in 4 people in the general population will at sometime suffer a mental health problem then what are the CAA medical people seeing in the pilot/ATCO population... It should be the same or near it but I bet it is not the same... In fact I seem to have read that in some career roles, which suffer high stress (production workers, teachers, farming) the statistics are worst with 1 in 3 having problems.

[RRR69]

Did anyone get his licence back yet? Or does anyone have new information upon this matter? I would like to know if the authorities have mentioned what medication will be admitted or will they look at the individual person. My situation is probably worse than most of you since I am declared a form of bipolarity.

[marioair]

Whatever happens it looks as if the regulation will still limit to multipilot operation, which isn't very helpful for GA.

[zero1]

This might be the case for Class 1 but as most of the aircraft are twin crew this should not be a major problem. As for GA crew (class 2) I am not sure if there is a limitation for twin crew as it was not in the original protocol.
Some people have asked about the approved SSRI drugs, the protocol will likely state the following as acceptable but you will need to wait until Sept for confirmation:
Fluoxetine (Prozac) - This might be included in the protocol based on the FAA recommendation
Escitalopram (Lexapro) - Already approved by US, Australia, New Zealand and Canada
Sertraline (Zoloft) - Already approved by US, Australia, New Zealand and Canada
Citalopram (Celexa) - Already approved by US, Australia, New Zealand and Canada

You will note that the drugs are perhaps the 1st generation SSRIs, the decision to approve these is based on the report from the Australia study. As you might be aware there are a lot of more modern 2nd generation drugs available based on SNRI or SSNRI formula but these were not included in the study and therefore not included in the approval list.
Assuming the proposal is approved for September it is a positive move forward despite the limitation the protocol might impose. I must stress this is just a guess, based on what I have seen and despite the proposed limited approved drugs the individual’s condition would need to be assessed on a one to one bases.

[marioair]

This might be the case for Class 1 but as most of the aircraft are twin crew this should not be a major problem. As for GA crew (class 2) I am not sure if there is a limitation for twin crew as it was not in the original protocol.

So the new wording say's that

a fit assessment should require a multi-pilot limitation

but its not clear if this applies to all Class'???

[zero1]

Sorryto say we need to wait for the issue of the protocol.

[mjd1]

Is there any further update on this?

I went through a very rough patch 15 years ago (reactive depression due to circumstances), and was prescribed venlafaxine which I came off about 12 years ago.

I started on my PPL(H) about 8 years ago, and got my class 2 medical (needed a GP note that I was now fine, and had a proviso on the license that I ground myself if I had a re-occurrence, which I thought was slightly unfortunate wording!) For various reasons, I didn't complete at that time, and the medical has expired.

I'd like to work on the PPL(H) again (time is pressing on etc.), but I'm also going through a rough patch (again external triggers). Not as bad as last time, but the GP has suggested various options such as CBT and citalopram, which I'm currently considering.

I'm wary of the latter due to the side effects and withdrawal symptoms which may be associated with it, but also the impact it may have on (re)obtaining a class 2 medical.

Ironically, I think that working towards a PPL(H) would help pull me out of the current patch.

[marioair]

is their any updates on this, there must be a protocol available for GPs now?

[marioair]

Is a qualified AME able to advise whether SSRI's (specifically escitalopram) is permitted under a class 2 ?

[Robot1]

I've been advised by AME in Europe, that the 'new rules' will not be applicable until 2015...,

[marioair]

Having said that, these are now published on the CAA website:
Psychiatry Guidance Material | Medical | Personal Licences and Training (http://www.caa.co.uk/default.aspx?catid=2499&pagetype=90&pageid=13853)

so it looks like good news?

[zero1]

The first thing to note is that the CAA is implementing the rules ahead of some EU countries, the 2015 timeline is to ensure all countries have completed the implementation. An example is the issue of new EASA pilot licences has started in September.
The next step is to contact your AME or the CAA and ask them to confirm the start date, followed by advice on how to proceed.
Finally you need to note the protocol the CAA have published, specifically the how to comply with the rules they have set out, acceptable treatments and required medical reports. Not all medical conditions or severity will be acceptable or suitable for flying, remember mental health will be assessed on a case by case basis.
Note to mjd1, as you believe the condition is classed as reactive then try the CBT route first. This group of depression illnesses is quite responsive and will help. Unfortunately it is perhaps not as effective on endogenous forms of the illness, which are more related to mood hormone imbalance