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Can I get Class 2 Medical if I use Mirtazapine (tetracyclic anti-depressant)

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Can I get Class 2 Medical if I use Mirtazapine (tetracyclic anti-depressant)

Old 7th Apr 2024, 00:24
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Can I get Class 2 Medical if I use Mirtazapine (tetracyclic anti-depressant)

Hello,

Several years ago I got my PPL and accumulated approximately 130 hours. In 2020 I unfortunately got sick with Covid and subsequently developed Long Covid (or Post-Covid Syndrome), so I have not flown for the last 3-4 years.

Now that I am getting slightly better I want to pick up flying again.

Unfortunately one on-goings symptom of Long Covid is that I have trouble sleeping, as a result on most nights I take a low 7.5mg dosage of Mirtazapine to aid sleep. Mirtazapine is technically an anti-depressant (tetracyclic type), but it is often prescribed off-label to help with sleep. At a very low dosage it acts as a sleeping aid, at a higher dosage (at least 15mg) it acts as an anti-depressant.

Would this completely disqualify me from getting a pilot medical? I only want a Class 2 medical at this stage.

I do not nor have I ever suffered from depression. It is only used to help me sleep.

Just wondering if anyone has any experience with this?

Many thanks
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Old 7th Apr 2024, 00:43
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Honestly, your best bet is to talk to a DAME before booking your medical - Even ask if you can have an appointment to discuss the medication prior to booking a medical (then it doesn't show as a refused or cancelled medical). CASA can be a bit iffy with any medication linked to depression and also with sleep issues - so if they are ok with it you are likely going to have to jump through some hoops to get your class 2 issued.

Unfortunately, there is nothing listed on the CASA DAME Clinical Practice guidelines page indicating that the use of Mirtazapine is ok or not.
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Old 7th Apr 2024, 03:35
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Originally Posted by mkqq
Hello,
I do not nor have I ever suffered from depression. It is only used to help me sleep.
Many thanks
why take it then? there are literally thousands of other ways to try and improve your sleep than take a drug that's going to complicate your medical.
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Old 7th Apr 2024, 04:31
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Tell the DAME nothing.
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Old 7th Apr 2024, 04:33
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Yes, there are certain anti depressants permitted by CASA after a certain grounding period. I cannot speak for that specific drug.
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Old 7th Apr 2024, 04:46
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Unfortunately sleeping problems due to Post-Covid syndrome is not like your average sleeping problem where "good sleep hygiene" can help. It's hard to explain unless you are suffering from it yourself. Without medication I might only get 3-4 hours of sleep a night, no amount of good sleep hygiene helps.
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Old 7th Apr 2024, 04:47
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I don't ever intend to lie to the DAME but let's for argument's sake that I tell them nothing, wouldn't they be able to pick up traces of the drug in my blood/urine anyway?
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Old 7th Apr 2024, 06:40
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Better to first go speak to the doc who prescribed you the medication and ask him/her about the implications and whether there may be alternate medication available.

I’m no expert but if you’re permanently depending on this particular medication to sleep, then you may be considered as being addicted. Your GP is the go to person for advice, not Pprune.
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Old 19th Apr 2024, 21:57
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Don't know about CASA, but for the UK CAA, Mirtazapine is disqualifying, even if its intended use is as a sleep aid and not anti-depressant. Your story pretty much mirrors mine. Awful insomnia and nothing apart from Mirtazapine had any effect. 3-4 hours sleep per night and 5-6 wakings during that time. Prior to Covid I had no sleep issues, despite the rigours of a short haul airline roster. I took 7.5 mg for six months and came off it at Christmas. The medics were adamant that I took it constantly for that six months and not intermittently. Sleep has been normal ever since.

My AME does not see any reason why I shouldn't regain my Class 1 after the medics finally sign me off next month. I had some respiratory and blood issues as well but these have now resolved. For me regular bedtimes, no alcohol and swimming really helped and apart from not flying I lead a normal life now, after a pretty grim 2.5 years. With perseverance it is possible. Having taken it, I can see why the CAA do not allow it. Yes I slept really well but was very groggy until 10 in the morning. Coming off it has been like waking up.
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