SSRI's
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SSRI's
I'm a pilot myself and have been suffering, for quite some time, from a mild (to worser) case of chronic hyperventilation/anxiety disorder. I haven't been flying commercially for some years now (just keeping the licence valid) but now I want to get out of a vicious circle. Psychotherapy and Physiotherapy (breathing techniques) helped me out for a while but didn't solve the problem (to an acceptable level - that is capable of flying commercially again).
Since I am suffering from a relapse at the moment, my psychotherapist suggests that i should consider takintg an SSRI (Cipralex) to get over this. I am not agoraphobic but being plagued by nausea, dizzyness, light-headedness,... just makes it very hard to function. I am getting a lot of exercice as well, but I am really considering to follow his advice. Any pilots having experience with SSRI's (or Cipralex) as a relief for anxiety problems? Many thanks
Since I am suffering from a relapse at the moment, my psychotherapist suggests that i should consider takintg an SSRI (Cipralex) to get over this. I am not agoraphobic but being plagued by nausea, dizzyness, light-headedness,... just makes it very hard to function. I am getting a lot of exercice as well, but I am really considering to follow his advice. Any pilots having experience with SSRI's (or Cipralex) as a relief for anxiety problems? Many thanks
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As far as I know non of the SSRIs is allowed by the FAA or CAA.
They can however be very effective in treating anxiety and/or depression.
I think you need to discuss your particular case with your healthcare professional and your ame.
Best of luck.
FD
They can however be very effective in treating anxiety and/or depression.
I think you need to discuss your particular case with your healthcare professional and your ame.
Best of luck.
FD
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Olaf,
If your therapist is recommending SSRIs that means, to me, a failure of psychotherapy for anxiety disorder.
As I see it, the key to therapy for anxiety is insight. People with panic attacks need to understand the cycle: anxiety leads to minor physical symptoms, which reinforce the anxiety, which leads to more symptoms, etc.
Breaking the cycle requires the insight that the symptoms are not independent, but are generated entirely by the anxiety. It is perhaps one illness in which the Nancy Reagan therapy is appropriate: "Just Say No".
If a patient with anxiety disorder can't 'say no', SSRIs may not help. In fact, they may be a reinforcement of the disorder, rather than a step towards resolution. The logic is as follows: Patients think that SSRIs will help them to break the cycle by helping them to 'say no' to the rising anxiety, however, they miss the point that since SSRIs are a real, physical treatment, they may reinforce the notion that the symptoms are 'real' also. This is a step in the wrong direction.
That said, SSRIs may be used in panic disorder because they provide symptomatic relief, improve quality of life and for many other reasons. That does not mean, however, that they ameliorate the underlying illness. They may do so, and there is some evidence to support the idea that a short course of SSRIs can lead to 'remission' of the illness, even after therapy is discontinued, but it is not very strong evidence at this point.
SSRIs are trendy. Trendy drugs get studied a lot, and they get prescribed for a lot of things. The perspective of time usually reveals that trendy drugs aren't as great as we thought they were. Though this may seem harsh, it usually doesn't matter that trendy drugs are widely (and inappropriately) prescribed because most people who take them are not in occupations that have strict measurements of performance.
Pilots are different. There are specific expectations and requirements of performance, and reasonably regular objective measurements of that performance. Quite reasonably, use of an SSRI may be seen as a negative when evaluating fitness to fly. SSRIs may also quite legitimately adversely affect objective measures of performance.
It may be fair to require a pilot to have control of the symptoms of anxiety through insight alone. During critical moments in flight, heart rate and contractility may increase, and sweating, nausea and vertigo (and contraction of a particular smooth muscle) may occur through normal physiological means - the stimulation of the sympathetic nervous system. These are the same symptoms that feed the panic cycle in people with anxiety disorder. Pilots understand (either consciously or unconsciously) that these symptoms are normal and focus their attention on solving the problem that is causing the anxiety. People with anxiety disorder do not - they focus inward and the cycle begins.
My treatment for acute anxiety is invariably as follows: Tell the patient that they are suffering from anxiety, assure them that I have exhausted every other possibility for physical illness, explain that no harm can possibly befall them under my expert medical care, and insist that they may now relax, slow down their breathing, and feel better. This is a bluff - there could be any number of things wrong with them that I have missed, and anyone in hospital is probably more at risk than they are at home - but, if they are suffering from anxiety, it works.
In other words, I give them a dose of, "The Right Stuff". If you saw me talking to someone with acute anxiety, you might think that I was pompous, egotistical, and overconfident, and you would be right - for the moment. Some patients with acute anxiety have white faces and claw-hands (from blowing off CO2 - it causes constriction of blood vessels) and agitated to the point of climbing the drapes. My little talk works better than deep sedation and quicker.
Pilots must be able to give themselves a dose of this stuff when things get hairy. They must put aside any irrational fear that the pounding in their chest might indicate an impending heart attack (or whatever) and manage the situation. The goal of insight psychotherapy for anxiety disorder is to enable patients to do exactly the same thing.
One last thing: The biggest mistake I ever made was assuming that an illness was purely psychiatric when there was a physical cause. Adrenal and pancreatic tumours (Steve Jobs just had one) among many other things can cause the symptoms of anxiety disorder. I like to make sure there was some justification for my pomposity, egotism and overconfidence.
If your therapist is recommending SSRIs that means, to me, a failure of psychotherapy for anxiety disorder.
As I see it, the key to therapy for anxiety is insight. People with panic attacks need to understand the cycle: anxiety leads to minor physical symptoms, which reinforce the anxiety, which leads to more symptoms, etc.
Breaking the cycle requires the insight that the symptoms are not independent, but are generated entirely by the anxiety. It is perhaps one illness in which the Nancy Reagan therapy is appropriate: "Just Say No".
If a patient with anxiety disorder can't 'say no', SSRIs may not help. In fact, they may be a reinforcement of the disorder, rather than a step towards resolution. The logic is as follows: Patients think that SSRIs will help them to break the cycle by helping them to 'say no' to the rising anxiety, however, they miss the point that since SSRIs are a real, physical treatment, they may reinforce the notion that the symptoms are 'real' also. This is a step in the wrong direction.
That said, SSRIs may be used in panic disorder because they provide symptomatic relief, improve quality of life and for many other reasons. That does not mean, however, that they ameliorate the underlying illness. They may do so, and there is some evidence to support the idea that a short course of SSRIs can lead to 'remission' of the illness, even after therapy is discontinued, but it is not very strong evidence at this point.
SSRIs are trendy. Trendy drugs get studied a lot, and they get prescribed for a lot of things. The perspective of time usually reveals that trendy drugs aren't as great as we thought they were. Though this may seem harsh, it usually doesn't matter that trendy drugs are widely (and inappropriately) prescribed because most people who take them are not in occupations that have strict measurements of performance.
Pilots are different. There are specific expectations and requirements of performance, and reasonably regular objective measurements of that performance. Quite reasonably, use of an SSRI may be seen as a negative when evaluating fitness to fly. SSRIs may also quite legitimately adversely affect objective measures of performance.
It may be fair to require a pilot to have control of the symptoms of anxiety through insight alone. During critical moments in flight, heart rate and contractility may increase, and sweating, nausea and vertigo (and contraction of a particular smooth muscle) may occur through normal physiological means - the stimulation of the sympathetic nervous system. These are the same symptoms that feed the panic cycle in people with anxiety disorder. Pilots understand (either consciously or unconsciously) that these symptoms are normal and focus their attention on solving the problem that is causing the anxiety. People with anxiety disorder do not - they focus inward and the cycle begins.
My treatment for acute anxiety is invariably as follows: Tell the patient that they are suffering from anxiety, assure them that I have exhausted every other possibility for physical illness, explain that no harm can possibly befall them under my expert medical care, and insist that they may now relax, slow down their breathing, and feel better. This is a bluff - there could be any number of things wrong with them that I have missed, and anyone in hospital is probably more at risk than they are at home - but, if they are suffering from anxiety, it works.
In other words, I give them a dose of, "The Right Stuff". If you saw me talking to someone with acute anxiety, you might think that I was pompous, egotistical, and overconfident, and you would be right - for the moment. Some patients with acute anxiety have white faces and claw-hands (from blowing off CO2 - it causes constriction of blood vessels) and agitated to the point of climbing the drapes. My little talk works better than deep sedation and quicker.
Pilots must be able to give themselves a dose of this stuff when things get hairy. They must put aside any irrational fear that the pounding in their chest might indicate an impending heart attack (or whatever) and manage the situation. The goal of insight psychotherapy for anxiety disorder is to enable patients to do exactly the same thing.
One last thing: The biggest mistake I ever made was assuming that an illness was purely psychiatric when there was a physical cause. Adrenal and pancreatic tumours (Steve Jobs just had one) among many other things can cause the symptoms of anxiety disorder. I like to make sure there was some justification for my pomposity, egotism and overconfidence.
Psychophysiological entity
Olaf. In the dozen or so posts that I have made on the subjects of depression and classical migraine, I have had to state that I am a pilot and not a doctor. My comments have been made as a layman, but with the best intention and a tad of skilled back-up.
FD makes two succinct statements specific to aviation, you have to be guided by them.
Daina has put into one post, probably everything that I have tried to say over the last two years. I would however, ask one question. Are you currently, or have recently, taken any other type of drug that has not been discussed? You have some skilled people listening, now would be a good time to really thrash through this. The ultimate aim must be to be free of any drugs of this kind while flying.
FD makes two succinct statements specific to aviation, you have to be guided by them.
Daina has put into one post, probably everything that I have tried to say over the last two years. I would however, ask one question. Are you currently, or have recently, taken any other type of drug that has not been discussed? You have some skilled people listening, now would be a good time to really thrash through this. The ultimate aim must be to be free of any drugs of this kind while flying.
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sorry for the late reply... In the meantime i am on cipralex... and i guess i am feeling a bit better already. I do realise that the SSRI's won't solve the problem. As said before, it is important to get out of this vicious circle by understanding the mechanics of an anxiety problem. I have been coping with the problem rather well in the last two years but i suffered relapses from now and then, and these got me back where i started. Maybe it's my own mistake. I followed cognitive behavourial therapy when things were bad, but as soon as it got better, i stopped with this therapy. My psy told me that this was the biggest mistake i could make since i have to contiune working on this "understanding" process even if everything is allright.
Therefore i decided to really try to do somethig about this problem for good. I see this SSRI as a little push in the back, which simply restores the imbalance of serotonine and as a support for the cognitive "mind tuning" techniques i have to practise right now. actually i am against meds, but a friend of mine (an airliner pilot) admitted to me that he suffered from the same problem and that he took the same meds with a lot of success (of course in combination with CBT therapy) and without any side effect while flying. as my psy said as well: CBT combined with SSRI's are supposed to give the best result, and that's what i am trying right now. and i have this gut feeling that i will succeed in beating the problem.
untill now, nobody ever noticed that i have this problem and i have a normal life (at work or in social activities), but just not good enough for commercial flying. i was just getting tired of always having this "sword of damocles" over my head, especially when suffering from relapses. once more, i am not seeing SSRI's as a miracle cure, they are merely a "push in the back" to help me getting out of the problem. it seems that i just needed this, i was getting tired of "thinking too much"...
just another small reply: i know that the symptoms are not "real" but its damn hard to "flow" through it when i am suffering from anxiety symptoms again. i can cope with them while on the ground, but while flying is still a problem. it once happened to me: dizzyness and numb feeling in the arms. I was of course not alone on board (i always fly with a "safety pilot" or instructor since it all started...). It felt terrible, but i do know that it is not dangerous and that my mind is just playing tricks on me with feelings that are not harmful and actually innocent. and i do know that i can continue functioning... My safety pilot knever knew, and i made an uneventful landing, just functioning like every other pilot, but it did scare me! i just need some time to regain confidence...
Therefore i decided to really try to do somethig about this problem for good. I see this SSRI as a little push in the back, which simply restores the imbalance of serotonine and as a support for the cognitive "mind tuning" techniques i have to practise right now. actually i am against meds, but a friend of mine (an airliner pilot) admitted to me that he suffered from the same problem and that he took the same meds with a lot of success (of course in combination with CBT therapy) and without any side effect while flying. as my psy said as well: CBT combined with SSRI's are supposed to give the best result, and that's what i am trying right now. and i have this gut feeling that i will succeed in beating the problem.
untill now, nobody ever noticed that i have this problem and i have a normal life (at work or in social activities), but just not good enough for commercial flying. i was just getting tired of always having this "sword of damocles" over my head, especially when suffering from relapses. once more, i am not seeing SSRI's as a miracle cure, they are merely a "push in the back" to help me getting out of the problem. it seems that i just needed this, i was getting tired of "thinking too much"...
just another small reply: i know that the symptoms are not "real" but its damn hard to "flow" through it when i am suffering from anxiety symptoms again. i can cope with them while on the ground, but while flying is still a problem. it once happened to me: dizzyness and numb feeling in the arms. I was of course not alone on board (i always fly with a "safety pilot" or instructor since it all started...). It felt terrible, but i do know that it is not dangerous and that my mind is just playing tricks on me with feelings that are not harmful and actually innocent. and i do know that i can continue functioning... My safety pilot knever knew, and i made an uneventful landing, just functioning like every other pilot, but it did scare me! i just need some time to regain confidence...
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Daina,
Your post makes it clear that you think that all people with depression and stress related problems are suitable candidates for counselling and or CBT.
It is my experience that there are a lot of folks out there for whom this is definitely not the case.
You may well be correct for those with a bit of a neurosis, but if you think that you can cure people with a severe depression or other serious mental health disease by just telling them to 'Say No' to their symptoms you have obviously had little exposure to these patients.
Your post makes it clear that you think that all people with depression and stress related problems are suitable candidates for counselling and or CBT.
It is my experience that there are a lot of folks out there for whom this is definitely not the case.
You may well be correct for those with a bit of a neurosis, but if you think that you can cure people with a severe depression or other serious mental health disease by just telling them to 'Say No' to their symptoms you have obviously had little exposure to these patients.
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I know this matter was discussed some time ago. However, it would be interesting to learn what pilots in general feel about "mental" problems such as anxiety/depression and flying.
I'm not a pilot now, but I'm considering starting my flight training.
To me, the view has always been that pilots must be absolutely, totally 100% mentally focused. I have never heard about pilots taking SSRIs, but maybe there are hidden numbers? Are pilots allowed to have these kind of problems while acting as a professional pilot?
Having said that, I really admire people who dare to go to the core of their problem in order to feel better. It must be tough.
I hope you're feeling better.
I'm not a pilot now, but I'm considering starting my flight training.
To me, the view has always been that pilots must be absolutely, totally 100% mentally focused. I have never heard about pilots taking SSRIs, but maybe there are hidden numbers? Are pilots allowed to have these kind of problems while acting as a professional pilot?
Having said that, I really admire people who dare to go to the core of their problem in order to feel better. It must be tough.
I hope you're feeling better.
Last edited by pgpilot; 1st Jul 2005 at 04:12.
