SPECIAL ISSUANCE for ANTIDEPRESSANTS

[My Flight Surgeon]

Your cost figures are off, the actual cost is around $2000.

The issue is that the use of these medications and their potential adverse effects has never been approved in the past. The Federal Air Surgeon made the decision to have some sort of process to evaluate airmen on these medications and insure aviation safety - the primary reason the FAA exists. As time goes on and more data is gathered, I suspect the criteria will be relaxed.

 

[exneophyte]

Hey Doc,

While we're on the topic. For someone getting a new medical under this special issuance, would you recommend completing the psych tests before your appointment with your AME so you can have all of the paperwork ready to go.

Or would it be better to see your AME so he/she can "order" them and then take the tests afterward.

 

[timotb]

Your cost figures are off, the actual cost is around $2000.

The issue is that the use of these medications and their potential adverse effects has never been approved in the past. The Federal Air Surgeon made the decision to have some sort of process to evaluate airmen on these medications and insure aviation safety - the primary reason the FAA exists. As time goes on and more data is gathered, I suspect the criteria will be relaxed.

If the actual costs is around $2000, I must have been taken to the cleaners because I already paid $3000 for everything less Cogscreen. My AME says she can administer that for $1000. 3000+1000=4000. I am cognizant enough to know that.

Can you tell us how many Medical waivers have been issued for anti-depressants and of today?

 

[My Flight Surgeon]

You need to go to a HIMS AME and it is best to work with the HIMS AME to get the right psychologist to keep te costs down.

 

[timotb]

You need to go to a HIMS AME and it is best to work with the HIMS AME to get the right psychologist to keep te costs down.

That wasnt a very helpful answer. I did go to a HIMS AME that recommended the wrong and expensive psychologist.

I assume nobody knows how many anti-depressant special waivers were issued to date. My suspicious is probably few to none. The process is complicated, tricky, expensive and someone flying for a living would have to stop working for 12 months to show stability.....not very practical.

 

[exneophyte]

I don't think anyone knows how many people have done it, but you are probably correct that it is very few.

While the new process may be tricky and certainly isn't perfect, it's a dramatic step forward towards ensuring healthy pilots.

 

[pppatacki]

That wasnt a very helpful answer. I did go to a HIMS AME that recommended the wrong and expensive psychologist.

Hey, Take it easy on the Doc. He is volunteering his time.....

 

[timotb]

Pardon me, Don't take me wrong.....I mean no disrespect to the Doc.....and very much appreciate his help and time. I also believe a process to allow some pilots to fly on anti-depressants is one small step for pilots.

....but Im not sure it these bureaucrats have their heads screwed on straight.

 

[SpiraMirabilis]

I think that once there has been a history of pilots flying uneventfully while taking these medications the requirements that are in place now will get less onerous. I don't know how long that will take though.

 

[exneophyte]

I have a feeling it will take quite a long time until the restrictions are relaxed based on how long it took to ease off the automatic disqualification policy.

Being someone who will have to take these tests to start flying(a lifelong dream), I actually don't have a problem with being required to take additional tests, but have two major concerns about it:

a.) the cost of the tests - It is unfortunate that people trying to get the special issuance will have to incur several thousand dollars in extra tests to fly, but hey...no one ever said flying was cheap. I think the ideal situation would be to have the FAA or some other organization create a hybrid test that incorporates the elements of each of the required tests. This way we could test all of the attributes(concentration, critical thinking, etc) that the FAA wants and make sure that the pilots are safe, but it could require less time and less money by creating this new test especially since it will need to be repeated for each renewal. So now for a class A, the pilot will incur these expenses each year which leads me to my next question.

b.) the accuracy of repeated tests - So let's say a pilot gets the special issuance on a class A medical. They now take these mental tests each year. There are plenty of studies that debate the effectiveness of any test that is repeated many times with the idea being that you can "game the system." I'm not an expert in psychology or research by any means, but that kind of makes sense to me. It kind of reminds me of the pilots that used to memorize the eye chart. They couldn't see anything, but could recite the eye chart as if they had better than perfect eye sight. Probably a little different since they can now change the eye chart with the click of a mouse, but the idea still stands.

I still think the special issuance situation has its weaknesses, but it's a step in the right direction. I think there is value in lobbying to the FAA and the rest of the government to make the process easier, but still effective.

 

[My Flight Surgeon]

You are only tested once. The repeat evaluation is from your psychiatrist which is not testing.

 

[exneophyte]

Hey Doc,

Your latest post said you do not have to retake the tests. I certainly am not questioning your knowledge or authority on the subject. I am eternally indebted for your input on the subject, but I'm confused.

On May 18, I asked:

Has there been any indication if the FAA is going to require the psychological tests to happen every time you renew your medical certificate?

And you responded:

Yes they are.

Is this new information or did i completely misunderstand? Based on this new information, I pay the $2-4000 to take the test once. Then on any renewals, my psychiatrist just has to attest that I haven't changed meds and appear stable?

Just trying to understand the cost ramifications of this whole thing based on your knowledge. Again, not trying to get you into a trap...just trying to make sure I understand what lies ahead for me.

 

[My Flight Surgeon]

AH, A Senior Moment

Here is the correct answer:

1. Current status report from treating physician at the time
of application for Special Issuance medical certificate.
2. Psychiatric consultation status report every 6 months for
all classes of medical certificate holders.
3. Letter from airline management every 3 months for firstand
second-class medical certificate holders flying under
FAR Parts 121 or135, forwarded to the HIMS AME.
After initial Special Issuance Authorization, psychometric
testing will be required.
1. Annually for first- and second-class medical certificate
holders flying under FAR Parts 121 or135.​

2. Every 2 years for third-class medical certificate holders.

 

[exneophyte]

Thanks for the clarification doc. Just so I understand, when you refer to "psychometric testing", that is the $2000-4000 battery of tests(COGSCREEN AE, Trails A/B; Stroop Test; CCPT, PASSAT, Wisconsin Card Sorting Test) right?

Sorry for asking so many questions. It's all so confusing!

 

[My Flight Surgeon]

Correct. In Phoenix these tests run $1500 to $2000.

 

[timotb]

You are only tested once. The repeat evaluation is from your psychiatrist which is not testing.

This assumes you are being treated by a psychiatrist. What about the large and probable majority that gets their med from a family doctor that offers it like candy? Now, we have to start seeing a psychiatrist?

I wish I knew the tests in Phoenix were 1500-2000. I would have flown out to take them instead of paying 4000 here in NE Ohio. Not that I'm doubting you, but could we see some invoices so to use to negotiate with in the future?

Also, we should consider how tests are scored. Who is in the pool of people/pilots that we are going to be compared to on a percentile basis? Are they astronaut applicants, naval aviators, supermen?

I want to argue the average private or commercial pilot does not take these tests on a regular basis and are not supermen with genius IQ's, hence there will be a poor comparison.

 

[My Flight Surgeon]

Also, we should consider how tests are scored. Who is in the pool of people/pilots that we are going to be compared to on a percentile basis? Are they astronaut applicants, naval aviators, supermen?

I want to argue the average private or commercial pilot does not take these tests on a regular basis and are not supermen with genius IQ's, hence there will be a poor comparison.

Professional pilots are certainly not used to taking these types of tests and are probably more anxious than the non-professional pilot about them.

 

[timotb]

Professional pilots are certainly not used to taking these types of tests and are probably more anxious than the non-professional pilot about them.

Yes sir! ...and still nobody knows who we are being compared to.

 

[timotb]

I have been in contact with Gary Crump, head of the medical division AOPA regarding this anti-depressant special waiver policy. He replied:

If you can discontinue the meds, that is by far the best way to go. The SSRI policy is intended for consideration of people who are chronically treated for depression with long term medications. The SSRI policy is new and we have not yet seen anyone complete the application process and testing for a special issuance. My understanding of the new policy is that all testing is forwarded to the HIMS-AME who then reviews the package and makes a recommendation to the FAA for issuance of a medical under the policy guidelines.

I am concluding it is best NOT to go the special waiver route. Go off the med or quit flying.

 

[timotb]

While Im on the subject of going off the med for 90 days then showing stability to make application. Who do we need to show/prove stability? Will a family doc suffice assuming he is the treating physician?