Suicidal Ideation

[hopeful2122]

I have a past voluntary hospitalization that ended in getting diagnosed with depression/suicidal ideation. Am I completely screwed? I am working with a psychiatrist and working on a board-certified psychiatrist to prove that am stable without medication. I was on Wellbutrin for approximately 2 months and then 1 month non-consecutively. Is there a possibility of cognitive/psychiatric testing to further prove that I am fit to fly or am I grounded for 10 years just due to that one incident. The only thing I want to do is potentially get my first-class medical. I am successfully off medication and have been managing with diet and exercise and I have past counselor visits to help teach me how to deal with situations.

 

[PeterNSteinmetz]

I intended my comment to underline that people with suicidal ideations have no business carrying passengers for hire.

If the FAA never gives you a medical, they could be saving the lives of 100+ innocent passengers.

Therein lies the problem with this whole aeromedical business. It is likely nearly impossible to predict with any accuracy who is going to have a psychiatric problem across the entire population of pilots.

In hindsight, one can identify problems like Lubitz, but I don’t think most psychiatrists or psychologists think it is an exact enough science to make these kind of predictions.

Take for example the OP here, who said he was admitted to the hospital but wasn’t that seriously suicidal. Suicidal thoughts come on a spectrum, from sort of casual wondering to actually having a plan and the means to carry out it.

Yet the FAA just throws everyone with a note about “suicidality” in the same boat.

https://www.statnews.com/2016/12/14/depression-pilots/

The linked study showed that “Researchers also found that 4.1 percent of pilots reported having thoughts of being better off dead or self-harm within the past two weeks.” Yet we don’t have a huge rash of pilots crashing planes in murder suicides.

If the numbers in this study are true, it strongly suggests that the FAA’s policy may then discourage pilots from obtaining treatment and thus actually INCREASE the risk of such events.

This is the sort of unintended consequence that can be produced when trying to screen for extremely rare events. So I don’t think there is any good evidence that the FAA’s policies here have any predictive value or improve the safety of flight.

It sounds like the OP will obtain the advice of a senior HIMS AME and that he can potentially be able to obtain a medical but it will require a forensic psychiatrist evaluation and an SI.

 

[PeterNSteinmetz]

Can’t predict it from just those kind of descriptions or simply the note in the chart. There is no statistical evidence that can be done.

So I personally would not make judgements about individuals based simply on that. Fortunately the FAA, while throwing everyone in the same boat initially, does have a process for careful review and decisions if the OP wishes to pursue that.

 

[PeterNSteinmetz]

How funny, people admitted to the hospital for suicidal ideations, decide they weren't really THAT BAD. Uh huh....

More precisely the OP said that he was voluntarily admitted then was diagnosed with depression / suicidal ideation. It is not clear from that statement what actually brought him to the hospital. It may have been suicidal ideation, but it may not have.

Sometimes people are admitted for depression because of very low energy or mood, then when asked the screening question about having thoughts of hurting yourself, state they have wondered about that. This is then recorded as “suicidal ideation”.

Normally in more serious cases of suicide attempts or strong thoughts of self harm, it is an INvoluntary admission, which suggest something else was going on with the OP. But of course we really don’t know.

That is the advantage of the forensic psych evaluation, it will look very carefully at all this. Though I am still not sure there is any evidence that even with that the FAA can successfully predict which ones of the 4% of the pilot population who have had suicidal/self harm thoughts in the last 2 weeks will kill themselves / murder others with an airplane.

 

[PeterNSteinmetz]

Thank goodness for the FAA with guidelines to protect the public from that 4%.

If you have a look at the study, it is 4% of active airline pilots in an anonymized survey. Hard to see how the FAA’s policies have any protective effect at all as they are likely still flying.

But if you want to support the assertion that the FAA’s policies somehow improve the safety of flight, please cite to the primary literature. Without looking at the actual data, this is just an unsupported assertion.

 

[PeterNSteinmetz]

And here is another question to think about which I find is often useful in this type of discussion.

What evidence or reasoning would persuade you that the FAA’s policies of excluding medicals for persons with a history of suicidal ideation do not improve the safety of flight? Is there any conceivable or possible which you would find persuasive?

 

[PeterNSteinmetz]

So, thank you rbeard for you outdated view on psychiatry, however I am seeking the advice of my Senior HIMS AME and will explore my options for potential medical clearance whatever it may take. I am not a threat to others, and I will work to prove that to the FAA

Initial consult on whether this is possible should cost around $1k. A good AME will not have you do all the testing and send the app unless they believe it will be issued. Figure $5-$10k and 6-18 months to get it done if possible, then every 4-6 month checkups for some years.

The risks of lying under penalty of perjury on an FAA medical form are severe so the product of the cost x probability of being caught is still rather high, which sounds like you have factored in.

Good luck on your pursuits. And bear in mind that even if you decide you can’t get a medical, both light sport and gliders are open to you if you and your doctors decide you can fly safely.

Indeed, I might suggest learning to fly gliders in the meantime. It does not require a medical and is an excellent way to learn how a set of wings and controls handles in the air. The training can be later extended to powered flight.

You might even learn to enjoy soaring for its own sake -

Disclaimer - I am now happy to report that I recently completed my CFI-G — though don’t teach that for a living. :emoji846:

 

[PeterNSteinmetz]

Perhaps useful to remember that the prior Federal Air Surgeon apparently had an attitude about psychiatric illness summarized by an AME as “You can’t fly if you’ve got something wrong in your head”. Thus SSRI’s were not allowed at all for many years so we had professional pilots going to Canada to obtain them.

 

[PeterNSteinmetz]

I just find it so interesting that I never had any suicidal thoughts until while on the beta blockers and haven’t had any since getting off them.

Depression is listed as a common side effect of some beta blockers. That suggests the depression / suicidal ideation may have been caused by the drugs you were prescribed. This will factor into the forensic psychiatric evaluation, which hopefully you have started working on.

 

[PeterNSteinmetz]

Vs maybe, just maybe having a case by case basis instead of a blanket ban. No SI for ADHD, No SI for a suicide attempt in the last 10 years. Ect.

If you can convince a senior HIMS AME based on an examination and history to attempt a submission, I believe they can submit for an SI. For example, if a person never actually had ADHD but was diagnosed. So in a sense it is on a case by case basis functionally. It will cost money and time though, and there are cases where the history or exam indicate a very low likelihood of success so probably not worth it to try.

 

[PeterNSteinmetz]

Unfortunately I do have a diagnostic history of ADHD and Aspergers, however I have not being on ADHD medication for more than a two week trial, as it caused headaches/irritability. That was over 3 years ago.

Well if you want to really know the answer on the possibilities, best to consult with one of the senior HIMS AMEs about it. If they say you have a good shot with the history and testing, then you have a path forward, albeit probably an expensive and time consuming one.