Office of Aerospace Medicine SSRI Requirements Presented to: HIMS AME

Office of Aerospace Medicine SSRI Requirements Presented to: HIMS AME Basic Seminar Denver, CO By: Penny Giovanetti, DO, MSPH Director, Medical Specialties Division Date: September 24, 2019 Federal Aviation Administration

Safety of the National Air Space is Job #1 PSA flight 182 San Diego, CA 9/25/78 Cessna 172 HIMS AME Basic Seminar – Denver, Colorado September 24, 2019 Federal Aviation Administration 2

History General observation that pilots on antidepressants were doing well General awareness that mild/moderate depression is very common Publication in Federal Register April 5, 2010 4 approved medications chosen for most favorable side effect profile HIMS AME Basic Seminar – Denver, Colorado September 24, 2019 Federal Aviation Administration 3 3

Why HIMS AME? Interest in mental health issues Familiar with other mental health professionals and their reports Experience addressing more complicated follow up and administrative processes HIMS AME Basic Seminar – Denver, Colorado September 24, 2019 Federal Aviation Administration 4 4

Antidepressants Mild/moderate depression or other diagnosis Stable 6 months No history psychosis, suicidal ideation, multiple meds, electroconvulsive therapy Use of fluoxetine, sertraline, citalopram or escitalopram only HIMS AME Basic Seminar – Denver, Colorado September 24, 2019 Federal Aviation Administration 5

Antidepressants Ongoing monitoring by: – – – – HIMS AME Psychiatrist Neuropsychologist Treating physician Changes in condition must be reported to HIMS AME and FAA immediately HIMS AME Basic Seminar – Denver, Colorado September 24, 2019 Federal Aviation Administration 6

Antidepressants (CY 2018) Class 1 Class 2 Class 3 Total SI 179 40 202 421 Deny 17 9 37 63 Processing 4 3 9 16 200 52 248 500 Totals HIMS AME Basic Seminar – Denver, Colorado September 24, 2019 Federal Aviation Administration 7

Diagnoses Depression Anxiety Major depression Obsessive/compulsive PTSD Dysthymia HIMS AME Basic Seminar – Denver, Colorado September 24, 2019 61% 39% 12% 0.05% 0.02% 0.02% Federal Aviation Administration 8

SSRI Follow Up Path HIMS AME Basic Seminar – Denver, Colorado September 24, 2019 Federal Aviation Administration 9

Your Best Friends Authorization Letter AME Guide: www.faa.gov/go/ssri HIMS AME Basic Seminar – Denver, Colorado September 24, 2019 Federal Aviation Administration 10

AME Guide HIMS AME checklist – SSRI Initial FAA Certification Aid – SSRI Initial HIMS AME checklist – SSRI Recertification FAA Certification Aid – SSRI Recertification Specifications for Neuropsychological Evaluations Airman Information Air Traffic Controllers HIMS AME Basic Seminar – Denver, Colorado September 24, 2019 Federal Aviation Administration 11

FAA Certification Aid Cog screen results – – – – Specify norm used and session number Address LRPV, Taylor factors, base rates Submit entire (approx 13 pages) report Submit results and rationale for any additional testing done Clinical neurocognitive evaluation – Overall neurocognitive status **Agree to notify FAA/AME immediately for adverse changes in condition HIMS AME Basic Seminar – Denver, Colorado September 24, 2019 Federal Aviation Administration 12

Problems AMEs sending cases to the wrong place MISSING DOCUMENTS!!!! Inappropriate level mental health care practitioner Inadequate specialty evaluation i.e. psychiatry, neuropsychology – Omitting critical items of history – “rule outs” – What’s really the diagnosis HIMS AME Basic Seminar – Denver, Colorado September 24, 2019 Federal Aviation Administration 13 13

The “Rule Outs” Psychosis Suicidal ideation History of electroconvulsive therapy (ECT) Concurrent use of multiple antidepressants History of use of antidepressant plus other psychiatric drugs Psychiatric hospitalizations Bipolar spectrum disorders Affective instability HIMS AME Basic Seminar – Denver, Colorado September 24, 2019 Federal Aviation Administration 14

Cautions Dosage changes invalidate authorization Change of medical monitors must be preapproved Report changes in condition immediately to HIMS AME and FAA Issue only if all checklist items are green (renewal only) Send all reports to FAA, issued or not Recurrent depression must be treated HIMS AME Basic Seminar – Denver, Colorado September 24, 2019 Federal Aviation Administration 15

QUESTIONS? HIMS AME Basic Seminar – Denver, Colorado September 24, 2019 July 29, 2010 Federal Aviation Administration 16