The Blues in the Wild Blue: Minor Depression

Everybody gets “down in the dumps” now and then. Marital

or financial problems, a death in the family, job stress,

change of location…you name it. Life can be darn hard and

get the best of you for a while. Fortunately, the FAA realizes

this. They recently gave guidance to us Aviation Medical

Examiners (AMEs) as to how to handle an airman who honestly

reports depression arising from a challenging situation---

minor or situational depression (https://www.youtube.

com/watch?v=FebHBtwezwE). Minor depression has to

be differentiated from chronic recurrent depression. The

latter can come out of the blue. It can be of extended duration

and require anti-depressant medication intermittently

for episodes or chronically for prevention. You can still fly

under Special Issuance (SI) with chronic depression as long

as it is under good control and after you have gone through

psychiatric evaluation to establish this and rule out any

other psychiatric issues.

But let’s suppose life deals you a perfectly valid reason to be

depressed. You indicate this in your flight physical. How

will your AME handle this? First of all she/he will take an

in-depth history. What caused the depression? How long

ago did it start? Have you had to take any medications for

the depression? What do you see happening to you going

forward? Are you still depressed? Your AME is going to be

looking for the following criteria to allow her/him to issue:

1. Did the depression go away within six months of onset?

If it lasts longer than six months you have to ask if your

brain chemistry is a bit off and would benefit from

anti-depressants. Until that question is answered you

shouldn’t be messing around in the cockpit.

2. Has the depression recurred? Again you start to think

about chronic depression, a different duck in treatment

and in how the FAA approaches it.

3. Are there any severe or self-destructive symptoms?

Depression to the point where you can’t get out of bed

and function indicates that more than minor depression

is going on. Likewise any suicidal ideation or acts indicates

that more is brewing that needs to be evaluated.

4. Is there a history of other psychiatric condition(s)?

Depression can be a symptom of many other significant

psychiatric issues that could profoundly affect your

ability to function safely as Pilot in Command.

5. Were any medications used to treat the depression?

Admittedly some well-meaning docs do prescribe

anti-depressants or anti-anxiety medicines quite readily

in hopes of quickly correcting the issue for which the

patient presents. All well and good, but the FAA has

pretty conservative criteria for the use of anti-depressive

medication. They feel that if depression is severe enough

to warrant the use of anti-depressants, we may be dealing

with a more severe chronic depressive state. That

needs to be further investigated.

If you and your AME can answer yes to question 1 and no to

questions 2 to 5 she/he can issue a medical certificate on the

spot. The FAA will review the examination and there is an

outside chance that you will get a follow-up letter requesting

further information. If you did answer truthfully to all

the questions asked, that shouldn’t be a problem (except for

the paper work).

Suppose however, that you were not able to answer “yes” to

1 and “no” to 2-5. What happens then? Your AME should be

consulting the “Psychiatric Conditions Table of Medical

Dispositions” in the AME Guide. You can Google it. The

minor depression we have been talking about would either

fall under “Adjustment Disorders” or “Bereavement or

Dysthymic.” In both categories the Guide advises to defer to

the FAA for further evaluation unless the criteria we talked

about are met. Interestingly, it does allow the AME to issue a

Medical Certificate even if anti-depressants were prescribed,

as long as they were not used for more than six

months and that the airman has been off them for at least

three months without problems. If your case does not fit

into these criteria you will have to be deferred to the FAA. In

some two to six weeks you will get a letter from the FAA

detailing what additional records and/or studies they will

need to make a decision. Almost always if your condition is

under good control and you submit everything that is

requested, you’ll get your Medical Certificate. Sometimes it

takes some doing, but stick with it!

Fly wisely. See you next month!

As always, comments, questions and suggestions are welcome:

jdlakinmd@gmail.com.

Also, we’ve moved our office to Airlake Airport’s FBO (KLVN)!

Call 952-469-4414 or email hannah@wpflights.com for a flight

physical appointment.