Prozak Pilot may fly again

[Hawkerflyer]

http://www.cnn.com/2010/TRAVEL/04/16/pr ... =allsearch

"Under the new FAA policy, pilots with mild to moderate depression will be allowed to fly while taking antidepressants if they can demonstrate that they have been satisfactorily treated for at least 12 months."

Times are changing!

[200hr Wonder]

I do not think that it is as cut and dry as yes you can fly with depression or no you can't. Lets face it, as any career pilot knows the industry puts a tremendous amount of stress on ones personal life. I am sure that the number of depressed pilots is significant and untreated/self medicated. What would you rather have a pilot who is getting treatment and being monitored very closely while on SSRIs (Prozac family of antidepressants) OR one who copes by getting loaded every night in the crew hotel? Certainly you can't just go handing out pills like candy and saying here feel better as seems to be the case with the general population these days. I personally have a friend who was handed quite strong doses of SSRis by his GP and had little to no follow up oversight to ensure correct usage. 20min a week with a GP is not follow up. Needless to say I don't think they helped a hell of a lot and made things worse. With that said I also have another friend who was seeing a psychiatrist, and with careful supervision and follow up the SSRis did great amounts to help him. So SSRIs can be a great tool in treating depression. What needs to be done before a pilot or anyone in a similar situation can perform their job on them is that they must be prescribed and followed by an approved FAA psychiatrist, and certainly a temporary suspension of their medical while everything settles out. Also a restriction to 2 crew would be prudent.

Neither of my friends on SSRIs are/where pilots.

[r22captain]

bring this back from the dead....anyone fly with someone who's on prozac?
We have a guy who had his medical pulled a while back, when it came out at his medical that he was on prozac for like 6 months, and didn't feel the need to report that.

[justwork]

//off topic post removed by Sulako. Not appropriate.//

[crazycanuck]

It seems that Transport Canada and the FAA have had archaic and offensive attitudes towards mental health issues in the past. Fortunately things appear to be changing ever so slowly. By their attitudes one might think that those who suffer from mental illness just sit at home in a state of indecision, or lethargy, or chaos, or are perpetually suicidal. In actual fact many people who suffer from mental illness manage or treat it very successfully and consistently perform at very high levels in their professional lives. At the very least it is reasonable to believe that in some cases mental illness could be treated sufficiently such that one could reliably perform the tasks required to fly an aircraft safely. Some of the best and brightest minds in history have suffered from significant mental illness. Here are a few well known examples but there are many more.

Winston Churchill
Isaac Newton
Abraham Lincoln
Buzz Aldrin

[Tim]

...In actual fact many people who suffer from mental illness manage or treat it very successfully and consistently perform at very high levels in their professional lives. At the very least it is reasonable to believe that in some cases mental illness could be treated sufficiently such that one could reliably perform the tasks required to fly an aircraft safely. Some of the best and brightest minds in history have suffered from significant mental illness...

the trouble with your post is that flying isn't just a matter of intelligence. sure that's part of it, but the decision making and physical coordination between hands and feet while on prozac is the part that worries me.

[crazycanuck]

...In actual fact many people who suffer from mental illness manage or treat it very successfully and consistently perform at very high levels in their professional lives. At the very least it is reasonable to believe that in some cases mental illness could be treated sufficiently such that one could reliably perform the tasks required to fly an aircraft safely. Some of the best and brightest minds in history have suffered from significant mental illness...

the trouble with your post is that flying isn't just a matter of intelligence. sure that's part of it, but the decision making and physical coordination between hands and feet while on prozac is the part that worries me.

The physical side effects of modern SSRIs are usually minimal. By minimal I mean less than the side effects of drinking one or two cups of coffee and pilots do consume that all the time. The side effects that sometimes do occur normally subside after the first few weeks. The trouble with the ignorant and uninformed attitude that you have expressed is that it creates an industry where pilots are afraid to seek treatment for a condition that is very treatable. Up until recently even breathing the words depression to a doctor could ruin an aviation career. Therefore pilots simply did not seek treatment. Untreated depression is far more dangerous than being concerned about the medical side effects that likely won’t be present or could at least be recognized and addressed prior to flying.

Also, I think you are being a little melodramatic about the physical skill or coordination required to fly an aircraft. A simple flight test could address that concern. If you one can pass the same test flights while on an SSRI then what is the difference? There are overweight pilots, old pilots, stupid pilots, tired pilots and the test for all of them is whether they demonstrate the ability to perform the tasks required. Why should it be any different for a pilot on an SSRI?

[CFR]

...In actual fact many people who suffer from mental illness manage or treat it very successfully and consistently perform at very high levels in their professional lives. At the very least it is reasonable to believe that in some cases mental illness could be treated sufficiently such that one could reliably perform the tasks required to fly an aircraft safely. Some of the best and brightest minds in history have suffered from significant mental illness...

the trouble with your post is that flying isn't just a matter of intelligence. sure that's part of it, but the decision making and physical coordination between hands and feet while on prozac is the part that worries me.

The physical side effects of modern SSRIs are usually minimal. By minimal I mean less than the side effects of drinking one or two cups of coffee and pilots do consume that all the time. The side effects that sometimes do occur normally subside after the first few weeks. The trouble with the ignorant and uninformed attitude that you have expressed is that it creates an industry where pilots are afraid to seek treatment for a condition that is very treatable. Up until recently even breathing the words depression to a doctor could ruin an aviation career. Therefore pilots simply did not seek treatment. Untreated depression is far more dangerous than being concerned about the medical side effects that likely won’t be present or could at least be recognized and addressed prior to flying.

Also, I think you are being a little melodramatic about the physical skill or coordination required to fly an aircraft. A simple flight test could address that concern. If you one can pass the same test flights while on an SSRI then what is the difference? There are overweight pilots, old pilots, stupid pilots, tired pilots and the test for all of them is whether they demonstrate the ability to perform the tasks required. Why should it be any different for a pilot on an SSRI?

The problem is that both society and the medical profession for years only had two diagnosis "nuts" and "not nuts". It has taken a while, some changes in thinking and some court action to move towards an understanding that not all mental illnesses are debilitating and not all sufferers should be treated the same! While the CARS themselves have not changed, the medical guidance to CAME’s and RAMO's has - http://www.tc.gc.ca/eng/civilaviation/p ... u-2187.htm

SSRI’s have come a long way and as you note can have few if any side effects (one of the most common is sexual dis-function, hardly an issue in the cockpit I would think) especially on a maintenance dose. Plus other actions in combination have shown to be helpful, exercise, blue light therapy, etc, and depending on the cause, removing or managing the “triggers” can completely resolve the issue. As well GP’s may jump to the depression diagnosis/medication when it may be something else that is responding to the SSRI but could be treated differently.

While I consider COPA to be a relatively progressive organization, until recently they had mis-information regarding SSRI’s on their site. To their credit, when I pointed this out to them they quickly approached the head of Civil Aviation medicine, who updated their info to the following:

"Did you Know…About SSRIs?
SSRI stands for Selective Serotonin Reuptake Inhibitors. These are drugs that are normally prescribed for depression, although they can also be prescribed for social phobias and anxiety as well.

(updated 2011) - From Transport Canada, Director Medicine Civil Aviation

For some ten years Transport Canada Civil Aviation Medicine (TC CAM) has been allowing select Canadian pilots to fly while taking certain Selective Serotonin Reuptake Inhibitors (SSRIs) as treatment for depression. TC CAM initially started this practice as a research project but it has progressed to the point of being standard practice. It is important to note, that it is not simply the medication that determines whether or not someone may fly or not. The underlying diagnosis is also important, as is the response to therapy. A depressed pilot treated with an SSRI who is still depressed is a risk to flight safety. Similarly, some conditions currently treated with SSRIs are not sufficiently well managed with the medication to lessen the aeromedical risk. In some cases this risk can be mitigated by restricting the pilot to fly with another qualified pilot but in other cases that is not so.

The reason for our policy change some years ago, similar to that of the FAA, is that treatment of simple depression with an SSRI known to the regulatory authority is safer than allowing depressed pilots to fly untreated or worse on an inappropriate medication. It is also important to note that not all SSRIs are similar in side effect profile and some can be quite sedating. Unlike the FAA, TC CAM will accept more than four specific SSRIs. Canada does not have the same regulatory framework as the US but our policies are very similar. For example, we do not have such a thing as a Special Issuance. Instead we exercise “accredited medical conclusion” under the flexibility clauses of the CARs to allow exceptions to the existing regulations. In keeping with the demands of our legal system our analysis of medical flight safety risk is based on a personalized assessment of the individual pilot, their underlying condition and their response to treatment (including the side effects experienced) Further details of our practice can be found on our web site at http://www.tc.gc.ca/eng/civilaviation/p ... u-2187.htm

I urge you for your own safety, the people who fly with you as passengers and the rest of the flying public to be up front and professional about your medical status with your Civil Aviation Medical Examiner (CAME) and your Regional Aviation Medical Officer (RAMO). Our goal is to keep people flying safely with the medical conditions they have. May I suggest your first step should be to contact your local RAMO to discuss your situation and appropriate next steps. You may do this anonymously if you wish.

D.A. Salisbury MD MHSc FACPM FRCPC CD
Director Medicine/Civil Aviation

Medical research has shown that the best therapy for depression is a combination of anti-depressants and counseling and that neither one of those individually is as effective as both are together. In general terms the same goes for social phobias and anxiety as well. See your CAME for more information on this condition and the use of SSRIs."

Finally it is interesting to note that the subject of the original post is "Prosak" as it is both mis-spelled and currently is not likely to be one of the SSRI's prescribed to a pilot.

[wotai139]

They may be allowed to fly, but think of the passengers. Would you feel comfortable putting your child or your mother on a plane if you knew the pilot was being treated for depression?

[Apollo]

Given what you know about what pilots do 'the night before' would you put your family on any aircraft?


Come on buddy.

[CFR]

They may be allowed to fly, but think of the passengers. Would you feel comfortable putting your child or your mother on a plane if you knew the pilot was being treated for depression?

If I was ignorant of what a broad spectrum "depression" covers and if I thought "treatment" was invariably mind-numbing medications then I would be worried ... otherwise I would not since the treated one is monitored on a six month basis and must meet certain criteria. I would be far more worried about the pilot who is untreated (estimates are that there are a significant number of untreated pilots out there) or in denial for this illness or who may have a whole host of other ailments left undiagnosed or unchecked.

[Tim]

The physical side effects of modern SSRIs are usually minimal. By minimal I mean less than the side effects of drinking one or two cups of coffee and pilots do consume that all the time.

here's what my "ignorant uniformed attitude" told me about SSRIs and their side effects:

anxiety
headache
nausea
diarrhea
drowsiness
insomnia
decreased appetite
increased sweating
decreased sexual drive
ejaculatory and orgasmic delay or impairment
agitation or irritability
restlessness
impulsiveness
hyperactivity
tremors
rash
Allergic reaction - difficulty breathing; swelling of your face, lips or tongue or difficulty swallowing.
Seizures
Problems with balance or coordination
Suicidal thoughts

they get really good towards the end of the list huh. hey if passing a flight test while on medication is the litmus test for it being safe, can i go drink a 6 pack and give it whirl? if i pass ill be safe to get drunk before i fly from now on!!

[CFR]

The physical side effects of modern SSRIs are usually minimal. By minimal I mean less than the side effects of drinking one or two cups of coffee and pilots do consume that all the time.

here's what my "ignorant uniformed attitude" told me about SSRIs and their side effects:

anxiety
headache
nausea
diarrhea
drowsiness
insomnia
decreased appetite
increased sweating
decreased sexual drive
ejaculatory and orgasmic delay or impairment
agitation or irritability
restlessness
impulsiveness
hyperactivity
tremors
rash
Allergic reaction - difficulty breathing; swelling of your face, lips or tongue or difficulty swallowing.
Seizures
Problems with balance or coordination
Suicidal thoughts

they get really good towards the end of the list huh. hey if passing a flight test while on medication is the litmus test for it being safe, can i go drink a 6 pack and give it whirl? if i pass ill be safe to get drunk before i fly from now on!!

No ... that's what an Internet search told you - your "ignorant uniformed attitude" led you to assume that any or all of them are present in everyone. Every prescription drug and most over the counter remedies have side effects. Most often you hear the term "may suffer from side effects". My doctor told me that he once stated to his fellow doctors that he has never had a patient who "suffered" side effects since if they showed any he changed the dose or medication. This is why doctors are supposed to see patients who are on prescription medication regularly rather than simply renew prescriptions over the phone, to see if they are having any trouble. And this is why doctors must see pilots every 6 months who are on SSRI's.

You can't fly after consuming 6 beers because there is a law against it, however there is no law against flying while suffering the side effects (hangover) but I sure wouldn't want you up front! Same if you OD'd on Aspirin (ringing in the ears) or cough syrup. Taken correctly and monitored nothing wrong with aspirin; cough syrup and other cold remedies talk to your CAME.

[Canuck223]

The physical side effects of modern SSRIs are usually minimal. By minimal I mean less than the side effects of drinking one or two cups of coffee and pilots do consume that all the time.

here's what my "ignorant uniformed attitude" told me about SSRIs and their side effects:

Most people prescribed these drugs experience few of the listed symptoms. Most find that the few noticeable side effects taper off to almost nothing.

The drugs work by increasing the regulation of and breakdown of neurotransmitters. It's a balancing act and titration can take weeks. Once stable, I would not object to a medicated pilot.

[crazycanuck]

The physical side effects of modern SSRIs are usually minimal. By minimal I mean less than the side effects of drinking one or two cups of coffee and pilots do consume that all the time.

here's what my "ignorant uniformed attitude" told me about SSRIs and their side effects:

anxiety
headache
nausea
diarrhea
drowsiness
insomnia
decreased appetite
increased sweating
decreased sexual drive
ejaculatory and orgasmic delay or impairment
agitation or irritability
restlessness
impulsiveness
hyperactivity
tremors
rash
Allergic reaction - difficulty breathing; swelling of your face, lips or tongue or difficulty swallowing.
Seizures
Problems with balance or coordination
Suicidal thoughts

they get really good towards the end of the list huh. hey if passing a flight test while on medication is the litmus test for it being safe, can i go drink a 6 pack and give it whirl? if i pass ill be safe to get drunk before i fly from now on!!

Yeah, I can also selectively use the copy and paste function. Here are some side effects of common Tylenol.

“Acetaminophen side effects, which are serious consist of nausea, vomiting, sweating, appetite loss, irritability, pain in abdomen centered in the part near the liver, diarrhea and yellow skin or eyes. In some worst case scenarios, these also include liver and kidney failure coma, problems in the heart, coma and even death. Sometimes, people may also have problems in ulcer and bleeding problems.”

The side effect for Asprin (the famous wonder drug) are also fun.

“The most common side effects of aspirin involve the gastrointestinal system and ringing in the ears. With respect to the gastrointestinal system, it can cause ulcerations, abdominal burning, pain, cramping, nausea, gastritis, and even serious gastrointestinal bleeding and liver toxicity. Sometimes, ulceration and bleeding can occur without any abdominal pain. Black tarry stools, weakness, and dizziness upon standing may be the only signs of internal bleeding.
Should ringing in the ears occur, the daily dose should be reduced. Rash, kidney impairment, vertigo, and dizziness also can occur. Aspirin should be avoided by patients with peptic ulcer disease or poor kidney function, since this medication can aggravate both conditions. Aspirin may exacerbate asthma. Aspirin can raise the blood uric acid level and is avoided in patients with hyperuricemia and gout. Children and teenagers should avoid aspirin for symptoms of the flu or chickenpox because of the associated risk of Reye's Syndrome, a serious disease of the liver and nervous system that can lead to coma and death.”

I was on an SSRI for a few years but am no longer. I can only tell you that in my case there were zero side effects beyond the first two weeks. I also have friends and family on SSRIs and they also indicated that they have zero side effects. Now that I no longer require the SSRI the only remaining side effect is a very low tolerance for idiots. Unfortunately there is no cure for stupid.

[old_man]

You can't fly after consuming 6 beers because there is a law against it, however there is no law against flying while suffering the side effects (hangover) but I sure wouldn't want you up front! Same if you OD'd on Aspirin (ringing in the ears) or cough syrup. Taken correctly and monitored nothing wrong with aspirin; cough syrup and other cold remedies talk to your CAME.

602.03 No person shall act as a crew member of an aircraft

(a) within eight hours after consuming an alcoholic beverage;

(b) while under the influence of alcohol; or

(c) while using any drug that impairs the person's faculties to the extent that the safety of the aircraft or of persons on board the aircraft is endangered in any way

Being hungover could be considered 'under the influence of alcohol'

and I think (c) covers ODing on drugs.

602.02 No operator of an aircraft shall require any person to act as a flight crew member and no person shall act as a flight crew member, if either the person or the operator has any reason to believe, having regard to the circumstances of the particular flight to be undertaken, that the person

(a) is suffering or is likely to suffer from fatigue; or

(b) is otherwise unfit to perform properly the person's duties as a flight crew member.

(b) could also cover being hungover.

Just my 0.02

[CFR]

You can't fly after consuming 6 beers because there is a law against it, however there is no law against flying while suffering the side effects (hangover) but I sure wouldn't want you up front! Same if you OD'd on Aspirin (ringing in the ears) or cough syrup. Taken correctly and monitored nothing wrong with aspirin; cough syrup and other cold remedies talk to your CAME.

602.03 No person shall act as a crew member of an aircraft

(a) within eight hours after consuming an alcoholic beverage;

(b) while under the influence of alcohol; or

(c) while using any drug that impairs the person's faculties to the extent that the safety of the aircraft or of persons on board the aircraft is endangered in any way

Being hungover could be considered 'under the influence of alcohol'

and I think (c) covers ODing on drugs.

602.02 No operator of an aircraft shall require any person to act as a flight crew member and no person shall act as a flight crew member, if either the person or the operator has any reason to believe, having regard to the circumstances of the particular flight to be undertaken, that the person

(a) is suffering or is likely to suffer from fatigue; or

(b) is otherwise unfit to perform properly the person's duties as a flight crew member.

(b) could also cover being hungover.

Just my 0.02

Point taken. I suspect under the influence might not fit, but "otherwise unfit" likely would.

[CFR]

... I was on an SSRI for a few years

Been there!

but am no longer.

Done that!

... Unfortunately there is no cure for stupid.

Got the T-shirt!

[SYT_YYZ]

I find it a little shocking that people have compared a pilot who is contending with depression to a pilot who has been drinking.
If we are going to be talking about mental states here, what about fatigue.
I am way more concerned about the guy who has been up all night trying to get sleep on a crew room chair then the guy who is on anti depressants.

You can't take a pill for fatigue yet we are resigned to it being a part of the job.

Also it is incredibly true about what this industry demands of a pilots personal life.

Unless you have reached the cushy top, you are likely:

- an overworked zombie which lead to a poor ability to maintain other aspects of your life in any normal way
- underpaid, which means the guy who collects your garbage each week is better off that you are
- unappreciated by your employer
- in the dog house with your girlfriend/wife/kids/etc because you are so fucking tired
- very good at compartmentalization and thus emotionally out of touch or unavailable because if you werent, you'd want to walk into a prop after every flight.

If you arnt depressed at some point in this career, you are either in denial, exceptionally fortunate, so used to everyone you socialize with having the same standard of living thus you've mistaken it for the norm, or simply so used to it it just never occured to that there was anything else.

[kevind]

What I find interesting... If you are depressed and dont get medical help you are "legal" to fly. But if you admit you have a problem and seek help you can lose you medical and this may mean your job.

A truely depressed pilot is probably more dangerous than a pilot properly supervised on proper medication.

But since TC can only regulate after the person admits the problem, they go after that person.

I believe that transport would rather have a depressed pilot than a medicated pilot because if the pilot is not on medication then if something ever does happen, they can say "I seeeeee nothing.... I know noooothing"