Career prospects after antidepressants

[EvilTwinRating]

Hi all,

I have been diagnosed as having severe depression and have been prescribed a lithium based medication (camcolit) as well as undergoing psychotherapy. Thankfully the treatments appear to be having a positive effect, and my Doctor has told me that he is very hopeful for the future.

I've viewed all the threads that I could find that mention depression but could'nt find a defininitive answer to just weather or not having depression means the end of my commercial piloting aspirations.

I would really like to hear from anone who has been on antidepressants either before or during their carrer as a pilot as I am curious about what I should do next.

Cheers All,
ETR

[Loose rivets]

Hi,

A difficult subject. I must be very brief, but some time ago (20th Dec ) I wrote a rather rambling reply to panic attacks / depression which was intended as an argument against taking any form of drug for these conditions unless it was absolutely necessary.

The question was I know, about drugs and flying, but getting well comes first.

One of the most stunning therapy routes taken in the last few years is to assess how many “black thoughts” the patient has in a day. By this I mean creating scenarios in the mind such as accidents to loved ones etc. thinking through, what-if this or that happened, can be useful to a pilot and create a better range of coping with emergencies, but if you carry it home to everyday circumstances it can be very destructive.

Some depressive people do this hundreds of times a day.

Try to asses how you think through day to day problems: make a rough log of negative thoughts. Assess how rational these thoughts have been compared to the normal day to day lives of ordinary people. Then comes the hard part: controlling negative thinking.

There is surprisingly little hard science on chemical recovery and of course I have no knowledge of specifics, but it is my belief that in many people, getting well by therapy and extreme effort on your part, the brain chemistry will take care of it’s self – eventually.

Good luck

[Hawk]

Hello Eviltwin..

Im sorry that your condition has left you a bit up in the air about your commercial aviation future. It sounds like your general practioner is encouraging you to do the right things with the medication and psychotherapy. Depression can sometimes describe a state that is of short term duration and in response to a life crises or loss. As such its a normal response and usually of short duration. Other types of depression are often more serious and have a "biological" basis and respond well to medication and therapy.

Commercial pilots do fly while taking anti depressant medication although this very much depends on your diagnosis and its predicted course. Often there is a period of time of non-flying while you are assessed for side effects.

The medication you are taking is often used to treat a condition called Bipolar Disorder characterised by periods of hypomania and depression and interspersed with periods of wellness. This condition is regarded a little more seriously and as such an AME would request a definite diagnosis rather than the term "Depression" to be able to determine your fitness.

Regardless of the type of depression you have, if you havent already done so it might be worthwhile requesting your doctor refer you to a specialist psychiatrist who will diagnose you with a formal condition from either the ICD-9-CM or DSM IV coding system. Once you have a clear diagnosis you will then be able to do your own research on the various regulatory sites and be in a better position to determine your future.

Its not the medication as such that determines your liklihood of flying commercially but the underlying condition you are being treated for.

Good luck with it all.

Regards
Hawk

[Master Yoda]

Good point raised here, whilst taking the £400 Class 1 Medical, what do they test? Is taking Prozac gonna make you fail the test? (taken just for minor depression), by this I mean traces of the medication in the Blood in accordance to the CAA regulations.

Any info or regulation links would be good.

[twistedenginestarter]

I took some Prozac and Gatwick made me have an interview with their psychiatrist. This was four or five years ago and I think one or two people had dove in airliners so they were a bit nervous.

I would recommend you say on rare occasions you suffer depression and feel the logical thing to do is correct it. Thus you never can envisage yourself getting to the point you would do something dangerous. Obviously you would never consider flying under the influence of medication of any sort. I seem to remember they won't let you fly until X (3?) months after you finish a course of Prozac for example.

As has been discussed before, depression/anxiety often have some specific cause. Examples might be fear of job loss or unresolved conflict with your sexual partner. You may have to explore these sorts of things carefully and face up to fundemental changes to your life in order to free yourself from depression.

[EvilTwinRating]

Thanks for the replies all, very much appreciated.

After weeks of trying to decide whether it was the best thing to do or not , I finally decided to bite the bullet and contact the CAA directly.

I was really quite astonished by their response. I was put in contact with a truly lovely lady who explained to me that my career was in not over at this stage and that the fact that I had been prescribed this medication did not mean that I could never become an airline pilot. She placed me under T/U status and sent me a letter explaining the procedure from here on in.

Basically I had to contact my GP who then referred me to a specialist, they then wrote a report on my condition and what in their opinion my prospects of recovery were. Once this reaches the CAA and I'm off the medication for a reasonable amount of time I will then have to go to Gatwick and have an assesment by a CAA specialist who makes the final call.

At the moment all the professionals I am seeing have told me that my progress is more than satisfactory and they are hopeful about my prospects.

Theres still along way to go, but its a case of so far so good.

Fingers Crossed + thanks again for the advice.

btw, anyone who has found themselves in a similar situation and would like to chat about it feel free to drop me a line.

Thanks all
ETR

[madinthehead]

Hi Eveltwin

Just seen your message re depression and thought I might be of some assistance to you and others re anti depressants.
My tale of woe started in March last year (2002) when I walked of a flight on turnaround because I had had enough. I left work in tears and set of to see my GP. "Ah" he said "you have depression, we’ll send you for counselling and put you on anti depressants." "Well I'll need to check with my AME as to whether I can still fly and take the pills".
“No prob” said the AME (who I have known for 7 years as a GP and AME) “once the pills have kicked in off you go flying again, lots of people are doing it.”
So I started on Prozac, nothing happened I might as well been on Smarties I still felt awful. My company procedure requires that I contact my company doc after 28 days (same as notification to CAA). “You can't take the pills and fly, not allowed” says company doc. “Who says, you or the CAA”, replies I. “The CAA” says she.
Mmmn something not right here. I call back my AME and tell him what I have heard. “Rubbish” says he “I'll contact the CAA now and give you the definitive answer”. He calls me back. “Er looks like I was wrong, you can't fly on anti depressants and once you have stopped taking them you will be unable to fly for a further 3 months, and then you will have to go to the CAA "trick cyclist" to regain your licence.”
“Oh” I said to my former AME, “if I had known that at the start I would have just gone for counselling and then if there had been no improvement I would have considered going on the happy pills. As it is even if I stop today, I will not be allowed to get on an aircraft (at the front) for 3 months.”
I had gone from having a couple of weeks off to de stress to a minimum of three months off, with the associated loss of allowances.
Anyway I continued to take the pills and was referred to a private Psychiatrist. “No probs” he said “take some of this new wonder drug (Venalfaxine) and along with some counselling we'll have you up and running in no time, I treat lots of pilots with depression with great results.”
3 months later (now Sept 2002) I actually feel a bit better, instead of dreading the mention of work, I am now getting back in touch with people and working out a back to work plan.
Psychiatrist agrees that I am showing signs of improvement and wants to just go the extra mile to boost me up. Right stop taking these tablets and start on these. I stop taking the tablets and start on the new stuff (Zispin) two days later my world falls apart as I go into "Cold Turkey", I won’t go into the gory details but it is something that I never want to endure again. To cut a long story short I end up in The Priory (where all the soap stars and footballers wife’s go) on 24 hour observation. I expect to stay for a few days to gain normality; I'm in for a month. I find out later that you do not just stop these pills you must wean of over a period of a week or so.
In all honesty it was the best month that I have spent in a long time, it gives you a chance to re-evaluate your life away from the pressures of every day life. I met some fabulous people there most of whom were like me, stressed out execs, business owners etc. If I had known what it had to offer I would have done it a lot sooner, I guess the negligence of my now former Psychiatrist was beneficial after all.
I still feel unable to return to work and my GP and Psychiatrist won’t let me anyway, after discharge in October I continue on a day patient basis until March 2003, first three days a week cutting down to one day a week.
Before I know it the months that I have been off become a year, my companies patience has now expired and I have just been given six months unpaid (half pay till now) notice of "termination", unless I improve before then (October 2003). Well I have had yet another medication change, they take up to two months to have any effect (can be as short as two weeks). As with any anti depressant once they start to work you must remain on them for some months maybe up to a year to reset your body to a "normal" state that will remain after withdrawal, then of course there is the three month clear of the pills before the CAA will let you have your licence back. So it looks like the end of 22 years flying, what next?
To sum up this ramble
• You can not take antidepressants and fly in the UK.
• Once off the pills you must have 3 months clear.
• When the pills take effect you may well be on them for some time for your body to remain at normal.
• Antidepressants are not happy pills, you will not wake up the next day saying "wow a tree/bird/leaf" etc
• The pills are a stab in the dark, you are trying to find a pill that will adjust your brain chemicals long term, unfortunately who ever is prescribing your pills has no way of knowing what chemicals need adjusting in you.
• It may take some time to find the pill and dose that is right for you (I haven’t)
• They can take up to two months to show any effect
• Make sure that if flying is your income that you have insurance that will pay a monthly sum so that you and your family will not have financial worries as well. (Thankfully I do)
• I am told that the ultimate prognosis is very good in virtually all forms of depression, just wish it would come along a bit quicker some times!
Believe me I was the last person who thought that I would end up like this, my Pyscho tells me that he treats an awful lot of Pilots for depression, now why would that be?

Best wishes to you all

PS I’ll be back!

[twistedenginestarter]

Mad

That was a very informative post. Can I say however that generally speaking SSRI anti-depressants like Prozac and presumably Seroxat do not create dependancy despite what you read. I come from a background of drug development and I can tell you that 600 people will die from doing the Times crossword puzzle etc. In our modern world some drugs actually have virtually no bad effects upon you but if lots of people take them, and quite a few suffer from some medical disaster, then cause and effect are attributed even though there is probably no connection whatsoever.

Prozac for example does not bring noticeable immediate relief although can provide immediate minor side effects eg disturbed sleep. This is their strength. SSRIs increase the level of serotonin which tends to make you feel good about things. Ecstasy works in the same way but floods your brain with the stuff. Unlike Ecstasy, SSRIs build up the level slowly so they don't damage the natural serotinergic system. After a while you realise you feel a bit more positive. It may take many weeks.

The 3 month rule is I believe nothing to do with the effect these drugs have (which is very gentle) but rather with the fact you have said you needed them. Everyone wants to make sure you are balanced before you are let lose with 200 peoples' lives.

The message of the post is valid. Don't take drugs if you think you can get by without. Or, of course, don't let anyone know you are taking them. Get them off the Internet - they are safe. Obviously if you are going slightly bonkers you are best getting it out in the open but if you are just depressed then....

[Flyin'Dutch']

Ahum TES

Think that this last post was less than sound, or more in particular your last paragraphs.

FWIW I think your suggestion for people to selfmedicate and buy serious drugs over the internet verges onto the irresponsible.

Depression is a rather serious condition which needs proper management after a diagnosis is made. The mistake a lot of people make is that they equate their feelings of low mood and having a bad day to those who are suffering a genuine depression.

That is not depression, that is life.

After all we all have times when we get a bit low in mood, suffer moodswings, get tearful, feel got at, lose interest, don't sleep well, have no appetite, don't want sex, think that the world is grey, feel we can not cope etc.

The main reason why people on anti depressants should not and are not allowed to fly is because they are depressed. Not the medication itself.

Your suggestion that people should not bring this out in the open is less than helpful. Not only would it promote dishonesty in an area where this is undesireable; it also inhibits people to seek help for a disease which is already heavily stigmatised in our society.

MITH sorry to read about your predicament and hope you feel better soon. And I would take your old AME of your Xmas card list.

;)

FD

[stagger]

EvilTwinRating,

Lithium salts are indicated for the treatment of mania, bipolar disorder, and for recurrent depression.

Lithium is not generally used as a "first line" treatment for depression because there are potentially serious side-effects - particularly with long-term usage.

Are you having your serum-lithium concentrations monitored?

Have you been given a card describing signs of toxicity to look out for?

[Sick Squid]

Twistedenginestarter, you said, if I may quote the end of your post earlier;
...Or, of course, don't let anyone know you are taking them. Get them off the Internet - they are safe. Obviously if you are going slightly bonkers you are best getting it out in the open but if you are just depressed then....
I think the person who said they can't empathise with the motivation that would lead one to choose to self-medicate would be lying, but really we got to step back from the issue here and think professionally about that issue.

The obvious stance is for us to argue the angle of diagnosis, control, and monitoring here, however as pilots that is beyond our remit; indeed Flying Dutch has very simply and eloquently dealt with that aspect of the argument above already. Simply put, as professional pilots we have a Duty of Care to ourselves and the travelling public, and although it may sound onerous that Duty of Care really has to be faced up to in this instance. If you are unfit to fly, then get the best advice possible, preferably from several sources who are aware of all the downstream consequences, and take the action necessary to attempt to get fit again. Bear in mind that if you choose to go down one's own route, and anything out of the ordinary happens downroute (accident, incident, even these days someone reporting you for stumbling as you leave a bus for gods sake) and they will be taking bloods away for analysis before you can say "Robert is your Father's Brother!"

All companies have a version of the following in their ops manual. Here's the one from mine; usual legal catch-all against even the slightest drug from your GP, but read between the lines carefully, 'cos this is the book they are going to throw at you if you self-medicate..... .
(Reference Number) Use of Drugs: Many drugs lower operational efficiency and impair judgement and reaction time.

It should be noted that drugs and immunisation procedures prescribed for family members and/or passengers may be unsuitable for use by flying crew for safety reasons. Any flying crew member who is being treated with a drug not prescribed by a (company) or (company) appointed doctor who is aware of the operational requirements involved_must not operate or exercise the privileges of his licence until at least 48 hours after such treatment has ended unless cleared by a (company) or (company) appointed doctor

Catch-all indeed, however at least you could plead a degree of mitigation if it had come from a GP's prescription I would have thought. So with the above in mind, your advice can be placed as a gamble, but are the stakes worth it? Is it indeed one we should be willing to take?

Squid