SSRI ANTIDEPRESSANTS AND THE SPECIAL ISSUANCE

PROCESS UNDER THE HIMS/IMS PROGRAM

 RB “Doc” Hecker

 FAA HIMS/IMS Senior AME 20969

 

Aeronca

1943 Aeronca O-58B / L-3B  USAAF 43-26975  NC47185  Based at 1T8 Bulverde, TX 

The FAA is currently limiting consideration of Special Issuance Medical Certificates to only four (4) medications used as single therapy agents; not used in combination.  These four medications are:

Fluoxetine (Prozac), Sertraline (Zoloft), Citalopram (Celexa), and Escitalopram (Lexapro).  

As these medications are becoming increasingly accepted by the FAA and are commonly used within the medical community, these four antidepressants have been safely prescribed in appropriate aeromedical cases with proper oversight by specifically trained AMEs who act as Independent Medical Sponsors (IMS).  These medications have fewer side effects than previously used generations of antidepressants.  While the focus of the current policy statement is on individuals being treated for depression, the FAA realizes that these four medications may be used to treat conditions other than depression.  It should be noted, therefore, that in all instances, the FAA will continue to consider pilot applicants and make determinations on a case-by-case basis under the special-issuance process just as it always has.  In addition to treating psychiatrists, AMEs who have specialized training under a program called the Human Intervention and Motivation Study (HIMS) also will assist the FAA by making recommendations about certification cases to be considered under this present policy.  The HIMS program is a safety-critical aviation program that was established nearly 40 years ago.  The original program, developed specifically for commercial pilots, was designed as an alcohol and drug assistance program to coordinate the identification, assessment, treatment, and medical certification of pilots in need of help with their addiction or dependence problems.

Under HIMS, pilots who successfully meet rigorous FAA protocols for alcohol abuse, drug abuse, depression and other mental health disorders requiring single dose medication, may be returned to duty in accordance with 14 CFR § 67.401. The FAA will apply the basic HIMS evaluation and monitoring approach to this new policy and HIMS/IMS AMEs will participate in a specialized training program tailored to evaluating and monitoring applicants who wish to be considered for Special Issuance under this policy.

CONSIDERATION FOR PILOT APPLICANTS WHO DESIRE SPECIAL ISSUANCE OF A MEDICAL CERTIFICATE WITH REGARD TO DEPRESSION TREATED WITH SINGLE AGENT MEDICATION

This protocol applies to considerations for Special Issuance medical certification for airmen requesting First, Second, or Third Class special issuance medical certificates, for the exercise of privilege under
14 CFR Parts § 121, § 135, or § 91, who are being treated with certain approved antidepressant medications.

CRITERIA TO BE CONSIDERED WITH APPLICATION FOR A SPECIAL ISSUANCE UNDER HIMS PROGRAM

Diagnoses:

Mild to moderate depressive disorders, such as:

1.       Major Depressive Disorder (mild to moderate) either single episode or recurrent episode

2.       Dysthymic Disorder

3.       Adjustment disorder with depressed mood

Pharmacologic Agents Considered (single-agent use only):

1.       Fluoxetine (Prozac)

2.       Sertraline (Zoloft)

3.       Citalopram (Celexa)

4.       Escitalopram (Lexapro)

Specifically Unacceptable Diagnoses and or Symptoms:

1.       Psychosis

2.       Suicidal ideation (thoughts)

3.       History of electro convulsive therapy (ECT)

4.       Treatment with multiple concurrent antidepressant medications

5.       History of multi-agent drug protocol use (prior use of other psychiatric drugs in conjunction with antidepressant medications)

Psychiatric Status:

1.       All symptoms of the psychiatric condition for which treatment is indicated must be ameliorated by the single medication and the condition must be stable with no change in or exacerbation of symptoms for 12 months prior to certification

2.       Airman must be on a stable dosage of medication for a minimum of 12 months prior to certification

3.       Airman must have no aeromedical significant side effects of prescribed medication.

Required Reports and Consultations for Initial Consideration:

1.       A consultation status report (and follow-up reports as required) from a treating psychiatrist attesting to and describing the applicant's diagnosis, length and course of treatment, dosage of the antidepressant medication taken, and presence of any side effects from the antidepressant the applicant takes or has taken in the past

2.       A written statement prepared by the applicant describing his or her history of antidepressant usage and mental health status

3.       A report of the results of neurocognitive psychological tests with provision of the raw test data: This includes, but is not limited to:  COGSCREEN AE, Trails A/B; Stroop Test; CCPT, PASSAT, Wisconsin Card Sorting Test

4.       An evaluation and a written report from a HIMS-trained AME who has reviewed items 1, 2, and 3 above, and who makes a recommendation for a Special Issuance Medical Certificate

5.       Any additional information the Federal Air Surgeon may require to make a determination under the provisions of this program

I currently provide Special Issuance services for pilots who are taking any of the four approved SSRI antidepressants, or who require HIMS evaluation and monitoring for drug or alcohol problems in order to remain in compliance with the current FAA standards.  I am available for discrete consultation at:  This email address is being protected from spambots. You need JavaScript enabled to view it. .

 

December 20, 2014

 

RB “Doc” Hecker (SRA 5171) is a FAA Senior HIMS/IMS AME (20969) who retired from the US Army Medical Department in 1997 after 26 years of service.  He holds certificates for CFI Single Engine Land & Sea, Commercial Pilot ASEL, ASES, AMEL, AMES, Glider, B-17 SIC and Instrument Airplane along with an A&P Mechanic Certificate.  He has logged over 2,500 hours and prefers small, intimate airparks.  He has restored a 1965 Cessna C210E (N4904U), a 1946 Taylorcraft BC12-D (NC43306),a 1946 Aeronca 7AC (NC2241E), refurbished a 1943 Aeronca O-58B / L-3B (NC47185), 1945 Stinson L-5CVW Sentinel (N178) and a 1947 Taylorcraft BC12-D (N43928).  He is currently refurbishing a, and assisting the restoration of a 1947 Aeronca 7BCM / L-16 (N119TX).  His other projects include maintaining a 1942 Boeing A75-N1.  He has previously owned a Cessna C-172 (N61785), a Grumman AA-5B (N74447) and a Mooney M20C (N10AD).  In his free time, Doc practices medicine in San Antonio, TX.  He is a member of EAA Chapter 35 of San Antonio, TX, EAA Chapter 92 of Orange, CA, and is an EAA Technical Counselor and Flight Advisor.  In addition, he is a Life Member of the Commemorative Air Force and affiliates with the Houston Wing (Houston, TX), Centex Wing (San Marcos, TX), and is an active member of the Gulf Coast Wing (Houston, TX) where he crews as a Co-Pilot, Flight Engineer and member of the maintenance team doing sheet metal and fabric repair work on that magnificent 1945 B17-G war bird “Texas Raiders” (N7227C).