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3/31/2016 by Chris McCleskey BOS ALPA Aeromedical Representative Feeling Low? Mental health is an issue rarely discussed by aviators. Most of us would rather take a check ride at 2 a.m. than visit the doctor for any reason, especially for a possible mental health concern. In the past, mental health issues were often considered a career killer. However, the FAA has modified its approach to addressing mental health needs in the last decade and is now focused on helping pilots who face a variety of health concerns, including those related to mental health. The FAA wants pilots who need help to get help. The sooner a depressed pilot gets help, the less time he or she will be out of the flight deck. More importantly, getting help early can shorten the length and severity of any mental health conditions. There are many types of depression; I will cover three in this update. The first one is the mood disorder, dysthymic disorder. While dysthymic disorder is not technically depression, those with the disorder can be at a higher risk for developing depression. Experts describe the symptoms of this disorder as persistent melancholy. The patient with dysthymic disorder may not recognize these symptoms—even his or her family members may not notice. Individuals suffering from this type of mood disorder are often subject to an increased risk of developing exogenous depression. Exogenous (caused by outside factors) depression arises when someone encounters an event such as the loss of a family member, problems at work, a troubled or unhappy marriage, divorce, alcoholism, drug abuse, financial problems, job loss, etc. By no means is this a comprehensive list of the causative factors in developing exogenous depression. It is often labeled an adjustment disorder with depressed mood. The final type of depression I will touch on is endogenous depression, also termed major depressive disorder, which may be inherited and chemical in nature. Endogenous depression may also develop at any time without an apparent reason. Think of it as a glitch that shows up in a computer that has been working fine for years. Some of the signs and symptoms of depression are: Feeling depressed all day long Loss of interest in activities that you usually enjoy Social withdrawal Fatigue Tearfulness A pervasive feelings of sadness, grief, or helplessness Changes in appetite Irritability Feelings of guilt, worthlessness, or sinfulness Inability to concentrate or think clearly Illogical thought patterns Agitation Physical symptoms such as stomachaches, headaches, and backaches The good news is that there are options for anyone needing help that generally do not require notification to the FAA: Give up alcohol consumption, it will always make depression worse. Start exercising or exercise more, it releases endorphins and can release pent-up feelings of frustration, anger, or hostility. Forgive yourself and forgive others. Remember no one is perfect—do not expect it from yourself or others. Open up more. Most of us are not “touchy feely” by nature, but in this case, talking to your spouse, significant other, or a close friend may help. The next rung on the ladder is talking to a professional. (Slow down, breathe, no one mentioned a psychologist or psychiatrist.) Talk to a member of your clergy or someone referred through an Employee Assistance Program (EAP). (JetBlue’s EAP is administered through Life Solutions, username Blue) Under most circumstances EAP representatives have no requirements to report to the FAA and they may be beneficial in righting the ship before the next rung is required. Finally, we reach the medical professional level. Psychologists and masters-level mental-health professional visits are required to be reported, with a few exceptions such as marriage counseling, family counseling, counseling for a family member’s drug or alcohol addiction, or other family issues. Many times receiving counseling may prevent the condition being treated from affecting the status of your medical certificate. Now for the psychiatrist, the professional who may prescribe medicine to help combat depression. While many medications may be used to counter depression, the FAA will only consider issuing a special issuance for those taking one of four allowed SSRIs (selective serotonin reuptake inhibitors) while being treated. There is the requirement to be on a stable dose and symptom-free for six months, as well as neurocognitive testing the FAA will require. The FAA may also issue a medical after the successful treatment and discontinuation of other antidepressants, again with a six-month stable period. I know that a special-issuance medical certificate concerns many pilots, don’t let it. Any time a pilot seeks a special issuance of a medical it is on a case-by-case basis, regardless of the medication or the condition being treated. In many cases, after the initial approval from Oklahoma City, the regional flight surgeon will be able to issue subsequent medical certificates. (Note—this is not true for pilots taking SSRIs; all special issuances in these cases must go to FAA HQ in Washington, D.C.) Don’t let the fear of being temporarily grounded keep you or someone you know from seeking help. It is far better to lose six months or a year in the air than to be permanently grounded. Depression can be successfully treated with over an 85 percent success rate. Getting treatment if you suffer from depression no longer means trading in your wings for another profession. The bottom line is that if you feel that you are too far below the glide slope, get help. Questions can be directed to your Aeromedical Committee or by calling ALPA’s Aeromedical professionals (AMAS) at 303-341-4435. Resources: ALPA Aeromedical AMAS FAA specifications for neuropsychological evaluations for treatment with SSRI medications FAA Guide for Aviation Medical Examiners