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FAA allows pilots to take antidepressants

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FAA allows pilots to take antidepressants

Old 2nd Apr 2010, 16:07
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FAA allows pilots to take antidepressants

The Associated Press: FAA: Pilots allowed to take antidepressants on job

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 Federal Aviation Administration officials said the old rule was based on outdated versions of antidepressants that could cause drowsiness and other side effects.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.
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Old 2nd Apr 2010, 18:32
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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

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.
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Old 2nd Apr 2010, 18:42
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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.
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Old 2nd Apr 2010, 18:47
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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.
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Old 2nd Apr 2010, 18:52
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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
drowsiness 17
anxiety 15

If we include rare but possible side effects such as

suicidal thoughts or behaviour
anxiety or panic attacks
hostility or aggresiveness
restlessness or inablity to sit still
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
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Old 2nd Apr 2010, 19:27
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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.
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Old 2nd Apr 2010, 23:29
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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.
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Old 3rd Apr 2010, 00:18
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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
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Old 3rd Apr 2010, 00:31
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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 ?
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Old 3rd Apr 2010, 00:34
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Interested parties should read this document:

http://www.casa.gov.au/avmed/downloa...depressant.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:
  1. not seek treatment for his/her depression; or
  2. covertly take SSRIs, perhaps obtained over the internet and/or without seeking counselling; or
  3. 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
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Old 3rd Apr 2010, 05:04
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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...suicide
These 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.
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Old 3rd Apr 2010, 09:02
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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.

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.
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Old 3rd Apr 2010, 17:56
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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.
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Old 3rd Apr 2010, 19:48
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Any chance of a beer sometime soon?
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Old 4th Apr 2010, 01:37
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More 'dropping of the standard' in pilots...

Just what we need...suicidal pilots, now medicated, flying passengers around...
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Old 4th Apr 2010, 04:30
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Just what we need...suicidal pilots, now medicated, flying passengers around...
I take it you would prefer suicidal pilots, unmedicated, flying passengers around?
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Old 4th Apr 2010, 10:01
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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.
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Old 4th Apr 2010, 16:18
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How about paying pilots a living wage? I bet that would cure most cases of depresion!
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Old 4th Apr 2010, 17:30
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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.
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Old 4th Apr 2010, 20:02
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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'.
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