The FAA has expanded the list of antidepressants potentially allowed for pilots with three relatively common drugs. Now on the “conditionally approved” list are duloxetine (Cymbalta), venlafaxine (Effexor) and desvenlafaxine (Pristiq). A special issuance is required for active pilots to maintain their medicals. The change took effect April 24 and was covered in an update to the AME Guide.
All three drugs are serotonin and norepinephrine reuptake inhibitors and all are prescribed for depression and anxiety. The work by increasing the activity of serotonin and norepinephrine in the brain.
Given the potential side effects such as dizziness, fatigue, visual disturbances, and mood fluctuations, how will the FAA ensure that these risks are adequately managed?
Raf, the choice is not between accepting potential side effects versus not accepting potential side effects of antidepressant medication (that is an easy choice). The real choice is between accepting potential side effects of medication versus accepting the known adverse effects of untreated (and typically, undisclosed) mood disorder.
The vast majority of people who take an antidepressant medication experience no adverse effects that impair the ability to fly a GA airplane. Further, millions of Americans take an antidepressant, including many we routinely trust for assistance with health, legal, financial, and other major concerns.
When the choice is clinically defined depression or the side effects of brain medication; honestly both should disqualify someone sitting in the left seat when carrying trusting passengers.
AJF – when you have some epidemiological or clinical evidence to back up your biases get back to us.
Should “clinically defined depression” (an episodic condition, BTW) or antidepressant use disqualify someone from being your doctor? Guess what, 50 out of 50 medical boards in the United States have decided that neither is disqualifying from licensure or any medical practice.
So, the people who prescribe mind/mood altering drugs say they are fine? Of course they do.
And more to the point, the efficacy of these meds!
I’m a 25 year AME and internist. I agree with these recommendations and know these are decent medications with a favorable efficacy to side effect ratio.
As far as side effects, Raf, when you have a chance look up the side effects to the most benign medicines you can think of. From Tylenol to Pepto-Bismol. They would all kill you with just a sniff. The side effect lists are not written by physicians or [pharmacologists but by lawyers to cover the drug company.
I was waiting for your comment, Dr. William, as I value it. Thanks.
Last year I saw first hand a loved one take just ONE mild “anti-depressant pill while in the hospital.
Seeing the bad results first hand, we called back in the doctor immediately and demanded that he take her off the drug. These are NOT something where you can make a blanket statement that they are all “benign”. Sure this was just one observation BUT it was enough to let me know that physicians saying “these are all benign” is a load of dingo’s kidneys.
Sadly not for ATC’s