Many people have walked into this trap. Things like Zoloft and Xanax are handed out left, right and center these days for anyone who just feels a little stressed or has unhappy. What many don’t know is they are disqualifying for a medical. And to get rid of them and expunge your record once you’ve just been prescribed it (even if you didn’t take it), is almost impossible. And very costly. So here’s a little subversive/anarchist tip for anyone that needs alternates to SSRI’s that are not prohibited (as they are natural), but have similar effects as SSRI’s:
1. Kava.
2. Rhodiola.
3. Valerian root.
4. Ashwaganda.
5. Passionflower.
6. Lemon Balm.
7. Phenibut.
They all are well documented as anti-anxiety and stress relief. This is not just hippie stuff – they’re proven clinically. So if you have to use drugs and can’t cope without, these could be an alternative. Non-addictive and FAA friendly.
But you didn’t hear it from me – nor do I endorse or condone their use. 
Um, Phenibut. Really? I’ll confess I’ve only ever seen it as a drug of misuse but my patient was in quite a bad way with agitation and hallucinations and hadn’t slept for several days. The problem is that you develop tolerance to it, so you have to have ‘drug holidays’ in order to retain the effects.
Our handbook of toxicology gives a case report:
“A 40-year-old man reported using phenibut for its psychoactive properties for months prior to his presentation with agitation, psychosis, hallucinations and a complaint of insomnia. He used 250 mg 3-4 times a day, and denied the use of any other medications or supplements. Three days prior to his hospital visit, he discontinued phenibut because cyclic use is recommended to decrease tolerance. He required endotracheal intubation and sedation with benzodiazepines (lorazepam) for behavioral control. He was extubated on day 4 with a normal mental status and his psychosis had resolved. He never developed seizures (Odujebe et al, 2008).”
As for when you’re taking it,
“Clinical features of intoxication are likely to be similar to baclofen. Generalised muscular hypotonia, areflexia, drowsiness, dilated pupils, coma, respiratory depression, bradycardia, hypotension and hypothermia may occur.
Phenibut will potentiate the effects of other CNS depressants, including alcohol, taken at the same time."
My patient got to the stage where he had alternating periods of drowsiness/agitation depending on when he’d last taken a dose. He wasn’t in a fit state to cross the road much less fly a plane. And he had no insight.
Kava:
“Acute toxicity may cause numbness of the mouth and tongue, vomiting, sweating and dizziness, dilated pupils, blepharospasm, urinary retention, muscle weakness, ataxia, acute dystonic reactions, choreoathetosis, tremors, slurred speech, reduced level of consciousness and diminished motor reflexes. Transient liver enzyme elevation (GGT and ALP) may occur.”
Valerian
Mild drowsiness is likely to be the only feature in most cases of acute ingestion.
Fatigue, hypotension, mydriasis, abdominal pain, tremor and light-headedness have been reported.
Agitation and insomnia may occur on withdrawal from chronic use. Chronic ingestion may cause hepatotoxicity.
hepatotoxicity = liver toxicity.
Passionflower:
Liquid extracts/tinctures typically contain 20-60% ethanol (check packaging)
As for the others, my ‘bible’ of drug overdoses doesn’t know enough to tell you what the effects are likely to be with any certainty so I find the idea that they’re ‘proven clinically’ a bit hard to believe.
Personally I’m more sympathetic to herbal medicines than many doctors: after all, most medicines are derived from herbal medicines – they’ve just been purified, the concentration and therefore dose carefully controlled, and they’re studied extensively for safety at a cost of hundreds of millions of pounds per drug. But at least there are chemicals in them that have a theoretical possibility of doing something which is more than can be said for many ‘alternative’ therapies.
That said, when I was at university a girl I knew slightly died after using Chinese medicine for her acne. She had a horrid time writing up her PhD and the stress caused a flare-up so she went to the herbalist. She passed her viva then went down to London and got her dream-offer of a post-doctoral position. On the train home she felt a bit queasy and noticed her eyes were slightly yellow. A few days later she died of fulminant liver failure.
Liver failure is a known rare and idiosyncratic side-effect of many prescription drugs for acne, which is why if a doctor had prescribed any of them without monitoring her liver function, they’d have been struck off. The reason a doctor couldn’t prescribe her herbal remedy is that it hasn’t been made into a prescription medicine because it is known to be more dangerous and no more effective than the existing drugs. Also, many Chinese remedies have been adulterated with strong prescription steroids. I very much doubt she had her liver function monitored. As far as I’m aware, no action was taken against the herbalist who doled out her medicine – I’m not sure that anybody was even sure who it was.
~~~~~~~~~~~
I’m afraid I really have to regard this list as very ill advised, especially given that there are antidepressants such as Zoloft that you can take whilst acting as a pilot.
Here’s the FAA guidance on antidepressants:
I’m not familiar with UK guidance but was under the impression that pilots could fly whilst taking, and certainly after, certain SSRIs.
The possibility your suggestion raises is that perhaps the FAA guidance is inadvertently encouraging people to self-medicate with prescription and non-prescription drugs in order to avoid being lumbered with a diagnosis of depression. Now, it’s a while since I looked at that page but it seems stricter than I remember – perhaps there have been changes since the Germanwings suicide. If the result is people advocating self-medicating with Phenibut then we’re in a dire place indeed. On the other hand, 6 months without being PIC, and an extended medical is the sort of thing that most of us could probably countenance. Particularly those of us who don’t have an ATPL/CPL and who frankly won’t cause their AMEs as many sleepless nights as those who do.
My disclaimer is that I’m not an AME or perhaps even a doctor. But take it from me: herbal medicines may be ‘natural’ but so are butterflies, sunsets and Ebola. They may or may not be innocuous – some of those on the list above certainly aren’t. Phenibut isn’t even natural – at least no more so than epoxy resin.
Medical students soon learn that anyone who practices self-diagnosis has a fool for a doctor. This is doubly, quadruply true for psychiatric conditions. My advice for anyone who is feeling down, anxious or depressed would first of all be that there is hope. It generally gets better but from the depths of the pit, the thought that you will be well again challenges the imagination. If you can manage it by talking to friends, family, strangers on a train then do so. If you still need help, go see a professional such as your GP. Try and fix things before they get out of hand. Drug treatments such as SSRIs are a ‘convenient’ solution to jump to, and doubtless the correct solution for some patients. But there are other approaches such as talking therapies. Different people have different needs. If you’re at rock bottom, phone the Samaritans or go to the emergency department: they’d rather see you before you take an overdose or otherwise harm yourself rather than after, and they’re open 24/7.
I believe there are also confidential schemes available to support aviation professionals – outside of my sphere of knowledge and probably different for every company/country – perhaps someone could post some links.
All antidepressants are disqualifying from a routine issuance of medical viewpoint. UK CAA will look at pilots on an individual case basis and make a decision. 4 different antidepressants are allowed by the UK CAA but again, only if a psychiatrist with an interest in aviation says so, and only with careful and regular review.
Events after GermanWings have made this a hot topic amongst aviation authorities.
What is true is the number of people being put on these medicines, sometimes for very valid reasons, but sometimes for the flimsiest of reasons.
Those of us in the UK might have to accept seeing a frazzled GP in a 10 minute appt. may not be the best way to diagnose any mental health problem, as there isn’t enough time, and the temptation to medicate is all too real – GPs are not happy with this either, but we as a country voted for a party which intends to make it worse not better, until they can privatise it.
All antidepressants are disqualifying for a pilot until seen by a psychiatrist, so the best practical advice I can offer would be:
1. get help if you are depressed- you’re a person first and a pilot second, make sure you get what you need and if things are bad enough to warrant treatment, take it, and accept the hassle of getting your license back
2. If your problem is more of a minor nature, think about counselling and psychology as treatment options, they seem to be as effective as ADs-you are likely still to be regarded as unfit until you have a satisfactory report from your treating clinician
3.Its good to talk and it works.
Afsag wrote:
Events after GermanWings have made this a hot topic amongst aviation authorities.
And not just antidepressiva. Every holder of a medical (especially class 1) should be highly alerted when a doctor prescribes anything. Better double check with the AME before taking the pills… A colleague has just returned to flying after 6 months of forced “ground time” for being treated against back pain. After administering the injection the orthopaedist remembered “Oops, this guy is a pilot – let’s better inform someone…” and on the same day he received a phone call from his AME who told him that he had to hand in his medical immediately. There might have been nothing wrong with that painkiller drug, but it was not on the list of approved medications (just like the MEL – if something is not on the list, the aircraft stays on the ground…). Luckily for him he is an employee, so the health insurance and social security took care of him and the company paid what was necessary to revalidate his lapsed license and type rating (he lost on of the two he previously held in the process). For a freelance pilot, this could well be the end of his career.
Any regular medication terminates a Part-MED medical, Class 1 or 2, until you get AME approval. It doesn’t matter what it is.
Of course many (most?) people just don’t tell the AME…… In Germany, I am told, this is standard because the AME has no authority to get your medical record. Accordingly, post-Germanwings, the UK CAA is refusing to accept German medicals.
I don’t think not telling the AME is wise because in theory it voids your insurance.
The UK has an AMC on this which alleviates it for e.g. the contraceptive pill, IIRC. Some previous threads; I recall @Jacko said something…
Peter wrote:
Of course many (most?) people just don’t tell the AME…… In Germany, I am told, this is standard because the AME has no authority to get your medical record.
The problem is that the doctor who treats you might feel compelled to inform either your AME or the aviation authority directly. Part of the blame for the Germanwings crash was attributed to the psychiatrist who had treated the pilot but did not tell anyone (he didn’t have to and wouldn’t be allowed to without the patient’s consent). No doctor wants to get himself into that position now. So either you tell the doctor that you are a bricklayer (if that’s your first visit with him) or you begin the treatment with a telephone conference between yourself, the doctor and the AME…
Peter wrote:
Any regular medication terminates a Part-MED medical, Class 1 or 2, until you get AME approval. It doesn’t matter what it is.
Surely not – e.g. surely something like over-the-counter athlete’s foot treatment isn’t going to terminate a Part-MED medical?
MED.A.020 Decrease in medical fitness
[my bold]
Obviously (b) is a real catch-absolutely-everything, including the common cold…
The FAA doesn’t have this; well not so strictly. It publishes the self-grounding conditions instead.
kwlf wrote:
especially given that there are antidepressants such as Zoloft that you can take whilst acting as a pilot.
Hmmmm:
“Patients who take selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine), Paxil (paroxetine) or Zoloft (sertraline) may experience side effects such as violent behavior, mania or aggression, which can all lead to suicide.”
https://www.drugwatch.com/ssri/suicide/
Also “care less syndrome” is also a common side effect of anti-depressants and yet another reason it shouldn’t be mixed with flying.
