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SAM has no known toxicity but should be used with caution in bipolar (manic-depressive) syndromes as it may provoke a manic episode.The FAA will consider certification for all classes for individuals diagnosed with depression and successfully treated with electroconvulsive shock therapy on a case by case basis. Once the symptoms have developed, a variety of treatments exist including counseling and medications are available.The FAA policy on counseling for possible PTSD through airline pilot unions or corporate Employee Assistance Programs (EAP) is that the counseling is not reportable on FAA medical applications unless the diagnosis if formally made. They include alprazolam (Xanax), oxazepam (Serax), temazepam (Restoril) and lorazepam (Ativan). Most antidepressant medications take several weeks to reach their full effect. Sources of stress vary widely ranging from arguments with family members, pressure from bosses and management, urgent deadlines to meet, unrealistic workloads, financial difficulties or the prolonged illness or death of a loved one. *This list is not intended to replace the advice of your physician nor should it be considered as medical or legal advice. This is a serious step that pilots understandably resist.What many do not recognize is that the use of medications in the early stages of a significant psychiatric condition may actually DECREASE the time they are grounded. Several in this class carry an increased risk of seizures in high dosage ranges according the Physician’s Desk Reference. Some studies have shown beneficial effects using SAM in chronic liver diseases, chronic fatigue syndrome (CFS) and fibromyalgia, a condition of chronic muscle pains often associated with depression and CFS. The usual dose in depression is 100 mg daily.In 1989, a world-wide epidemic of eosinophilia-myalgia syndrome (EMS) was observed in users of artificially produced L-tryptophan. Peer counselors and stress debriefers are ready to respond to any potential PTSD provoking situation. Also, counseling services are readily available.On the negative side, insurance companies are reluctant to pay for extended counseling. The usual course of treatment is 6-12 months in typical cases. SSRI Pathway II requires a FAA specifically trained AME to monitor the individual, with Psychiatrist updates twice yearly, and cognitive testing. The use of medication is temporarily disqualifying for flying duties. Because it is an herbal compound, it is not regulated by the FDA.
This is to establish a side effect profile beyond the manufacturers published material and does not include herbal preparations or supplements. Now effective treatment exists for conditions from grief and anxiety to psychoses and schizophrenia.For the pilot and controller, the widespread use of medications for mental health issues is a double edged sword. Sometimes, people experience these physical and emotional disturbances for no readily identifiable reason. Contact Pilot Medical Solutions for the most current information concerning FAA medication approval.New medications usually require a 1-year review hold beginning on the date of FDA approval. It may also relieve some cravings of tobacco withdrawal and food cravings in people on a diet. Again, reporting to the FAA may not be reportable depending on the condition (e.g. For specific requirements and assistance contact an AMAS physician (See the section below on FAA reporting requirements for more specifics).What should pilots and controllers who feel they have a need for counseling or mental health evaluation do? Anti-anxiety medications may exert their effect in minutes to hours.Antidepressants in widespread use today include the SSRIs (selective serotonin reuptake inhibitors) which exert their effect by changing the levels of certain chemicals in the brain called neurotransmitters. They include diazepam (Valium), chlordiazepoxide (Librium), Flurazepam (Dalmane), clorazepate (Tranxene), halazepam and prazepam. Next, is a move of psychiatric care and psychiatrists/ psychologists from the hospital setting to the community office.The rise of well trained and qualified para-medical mental health professionals such as licensed counselors and social workers has made mental health services available for the entire range of psychological problems, not just the most severe “crazy” ones. Major depression is generally treated with one of four types of medication: SSRI’s, TCA’s, second generation antidepressants and rarely with MAOI’s. Even the military is instituting a system of buddy care for suicide prevention backed up by medical and chaplain resources. In addition to the required waiting period for stabilization, the FAA requires cognitive testing and oversight by a psychiatrist. Any nutritional supplement should be ground tested for at least several days before flying to determine that there are no adverse side effects.Tryptophan is an amino acid which serves as a key building block for chemicals in the brain.
They are very inexpensive and have measurable levels in the blood defined for treatment responses. John’s wort (hypercium) is an herbal preparation used for many years for depression. Longer acting forms may result in sedation, impaired thinking and delayed reaction times. The question of treating the condition with medication is of secondary concern.
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