Here is a risk matrix that shows percentages across the top. The percentages at the top are the probability of a medical event occurring within the next year.  So something like a seizure, which as was discussed in the last two posts has a 36% chance of occurring in the next year, would be in the middle column of 10-60%.

The severities are seen along the side and are as follows: a Fatal event would be something like a plane crash in which someone in the plane or on the ground dies, a Really Bad event would be like the plane crash landing in a way that causes significant injuries, but no one dies, a Bad event would be like something that causes an inflight emergency that requires immediate landing, but no significant injuries, and lastly a Not Too Bad event would be like a medical event that doesn’t cause any changes to the flight, but needs to be taken care of as soon as they land

The intersection of the 5 probability ranges across the top and the 4 severities along the side lead to 20 boxes numbered 1 through 20 with the most risk being attributed to box 1 as it has an almost 100% chance of occurring and if it did it would be fatal.  And then the numbers are color coded with 1 through 5 being red indicating a high risk, 6 through 9 are orange indicating a serious risk, 10 though 17 are yellow, a medium risk, and 18 through 20 are green, a low risk.

To read the full transcript go to The Flight Shrink substack at https://flightshrink.substack.com

DISCLAIMER:

The views expressed in The Flight Shrink are those of the author and do not reflect the official policy or position of the Department of Defense, The United States Air Force, or any other organization with which Dr. Heacock is associated.  The content of The Flight Shrink is not medical advice.  The Flight Shrink is for informational purposes only and may not be applicable to all situations.  Use of the information is at the reader’s own risk.  Any recommendations of treatments, products, or services are made in general and may not apply to a specific person, situation, or illness.  Please seek care from a medical professional if you have concerns for any physical or mental health symptoms.

If you or someone you know is experiencing a mental health, suicide, or substance use crisis or emotional distress, reach out 24/7 to the 988 Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) by dialing or texting 988 or using chat services at suicidepreventionlifeline.org to connect to a trained crisis counselor. You can also get crisis text support via the Crisis Text Line by texting NAMI to 741741.  For those in countries other than the U.S. here is a Google site with helplines:https://support.google.com/websearch/answer/11181469

A comparable mental health concern is a history of a suicide attempt.  To understand the topic a little more, let’s look at some statistics.  In the U.S. general population, there are about 45,000 suicides per year or about 15 per 100,000 people.  A very low risk of dying by suicide at 0.02% per year.

But if you look at suicide attempts, about 1.4 million American adults attempt suicide each year, which means there are about 30 attempts for every death by suicide.  Still a pretty low risk of attempting suicide at 0.6% per year.

But when you’re thinking about the aeromedical safety of someone who has already attempted suicide, you’re not concerned with just anyone’s risk of attempting suicide, but the risk of another suicide attempt in someone who has already had a failed attempt.  How often do they die by suicide on a subsequent attempt?  One study showed that one out of every 100 who previously attempted, will die by suicide within one year.

To read the full transcript go to The Flight Shrink substack at https://flightshrink.substack.com

DISCLAIMER:

The views expressed in The Flight Shrink are those of the author and do not reflect the official policy or position of the Department of Defense, The United States Air Force, or any other organization with which Dr. Heacock is associated.  The content of The Flight Shrink is not medical advice.  The Flight Shrink is for informational purposes only and may not be applicable to all situations.  Use of the information is at the reader’s own risk.  Any recommendations of treatments, products, or services are made in general and may not apply to a specific person, situation, or illness.  Please seek care from a medical professional if you have concerns for any physical or mental health symptoms.

If you or someone you know is experiencing a mental health, suicide, or substance use crisis or emotional distress, reach out 24/7 to the 988 Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) by dialing or texting 988 or using chat services at suicidepreventionlifeline.org to connect to a trained crisis counselor. You can also get crisis text support via the Crisis Text Line by texting NAMI to 741741.  For those in countries other than the U.S. here is a Google site with helplines:https://support.google.com/websearch/answer/11181469

Pilots probably understand a lot of the risks involved with flying when it comes to the mechanical function of aircraft as well as training standards for pilots.  If parts on the plane are not functioning properly, they are unsafe to fly.  If a pilot has not had the proper training, whether that be flying in general or aircraft specific, then they are unsafe to fly.

Some level of risk IS accepted though.  If a part is not likely to fail or if it does fail and it’s function is not critical to flight then you can accept that level of risk.  If a pilot has not had all the training needed then they are more likely to fail and this would be critical to the success of the flight and so you would not accept that risk.  But if that pilot is flying with another qualified pilot, then the likelihood of a critical event occurring has been reduced, and then you can accept that risk.

To read the full transcript go to The Flight Shrink substack at https://flightshrink.substack.com

DISCLAIMER:

The views expressed in The Flight Shrink are those of the author and do not reflect the official policy or position of the Department of Defense, The United States Air Force, or any other organization with which Dr. Heacock is associated.  The content of The Flight Shrink is not medical advice.  The Flight Shrink is for informational purposes only and may not be applicable to all situations.  Use of the information is at the reader’s own risk.  Any recommendations of treatments, products, or services are made in general and may not apply to a specific person, situation, or illness.  Please seek care from a medical professional if you have concerns for any physical or mental health symptoms.

If you or someone you know is experiencing a mental health, suicide, or substance use crisis or emotional distress, reach out 24/7 to the 988 Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) by dialing or texting 988 or using chat services at suicidepreventionlifeline.org to connect to a trained crisis counselor. You can also get crisis text support via the Crisis Text Line by texting NAMI to 741741.  For those in countries other than the U.S. here is a Google site with helplines:https://support.google.com/websearch/answer/11181469

The last mindfulness practice I shared had a lot of instruction.  Just like when you’re learning to fly it can be helpful for beginners to have someone guiding them regularly throughout the session.  Mindfulness can be even more powerful with less guidance so you can really watch what your mind does and practice refocusing over and over without judgement.

The “without judgement” is the hard part for me.  But it’s important to recognize the catching yourself not focusing is the goal of mindfulness.  So each time you find yourself refocusing it’s important to not judge yourself for failing to stay focused, but rather look at this positively for having become mindful again.

To see more from The Flight Shrink, visit the substack at https://flightshrink.substack.com

DISCLAIMER:

The views expressed in The Flight Shrink are those of the author and do not reflect the official policy or position of the Department of Defense, The United States Air Force, or any other organization with which Dr. Heacock is associated.  The content of The Flight Shrink is not medical advice.  The Flight Shrink is for informational purposes only and may not be applicable to all situations.  Use of the information is at the reader’s own risk.  Any recommendations of treatments, products, or services are made in general and may not apply to a specific person, situation, or illness.  Please seek care from a medical professional if you have concerns for any physical or mental health symptoms.

If you or someone you know is experiencing a mental health, suicide, or substance use crisis or emotional distress, reach out 24/7 to the 988 Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) by dialing or texting 988 or using chat services at suicidepreventionlifeline.org to connect to a trained crisis counselor. You can also get crisis text support via the Crisis Text Line by texting NAMI to 741741.  For those in countries other than the U.S. here is a Google site with helplines:https://support.google.com/websearch/answer/11181469

Today with it being a holiday week we’ll be taking a break from some of the technical mental health discussions and focusing on some self-care with a mindfulness practice you can use if you’re feeling a little stressed over Thanksgiving and other upcoming holiday activities.

This post’s voiceover (at the top of the Email or webpage) and the podcast feed is a chance for you to do some chair flying.  For our non-pilot readers and listeners, chair flying is a technique used by pilots for mental rehearsal and practice while sitting in a stationary chair. However, with this mindfulness practice, rather than mentally simulating flight procedures, maneuvers, or emergency scenarios, and going through the motions of making decisions as if actively flying, imagine your instructor pilot or CFI has taken over controls and told you to just take in your experience.

To see more from The Flight Shrink, visit the substack at https://flightshrink.substack.com

DISCLAIMER:

The views expressed in The Flight Shrink are those of the author and do not reflect the official policy or position of the Department of Defense, The United States Air Force, or any other organization with which Dr. Heacock is associated.  The content of The Flight Shrink is not medical advice.  The Flight Shrink is for informational purposes only and may not be applicable to all situations.  Use of the information is at the reader’s own risk.  Any recommendations of treatments, products, or services are made in general and may not apply to a specific person, situation, or illness.  Please seek care from a medical professional if you have concerns for any physical or mental health symptoms.

If you or someone you know is experiencing a mental health, suicide, or substance use crisis or emotional distress, reach out 24/7 to the 988 Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) by dialing or texting 988 or using chat services at suicidepreventionlifeline.org to connect to a trained crisis counselor. You can also get crisis text support via the Crisis Text Line by texting NAMI to 741741.  For those in countries other than the U.S. here is a Google site with helplines:https://support.google.com/websearch/answer/11181469

Continuing with the theme of the last several flights, I will be talking about antidepressant medications and the aeromedical acceptance of those treatments.  Flight #18, discussed the first four antidepressants approved by the FAA for use in pilots, the SSRIs (Selective Serotonin Reuptake Inhibitors):  Prozac, Zoloft, Lexapro, and Celexa.  And Flight #19 talked about the most recent addition to the FAA approved list of antidepressants, Wellbutrin.  Today I’ll discuss other antidepressants that may be used in general clinical practice, but are NOT currently approved by the FAA for use in pilots.

Since the 4 SSRIs were the first antidepressants approved by the FAA, I’ll start with the other SSRIs that are not approved: Paxil and Luvox.  As you can see from the chart, they have a similar side effect profile as the approved SSRIs, with the addition of some potential for sleepiness.  As you might imagine, a pilot taking a pill that can make them sleepy is probably not the best idea.  But this is probably not the main reason they have not been approved.

To read the full transcript go to The Flight Shrink substack at https://flightshrink.substack.com

DISCLAIMER:

The views expressed in The Flight Shrink are those of the author and do not reflect the official policy or position of the Department of Defense, The United States Air Force, or any other organization with which Dr. Heacock is associated.  The content of The Flight Shrink is not medical advice.  The Flight Shrink is for informational purposes only and may not be applicable to all situations.  Use of the information is at the reader’s own risk.  Any recommendations of treatments, products, or services are made in general and may not apply to a specific person, situation, or illness.  Please seek care from a medical professional if you have concerns for any physical or mental health symptoms.

If you or someone you know is experiencing a mental health, suicide, or substance use crisis or emotional distress, reach out 24/7 to the 988 Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) by dialing or texting 988 or using chat services at suicidepreventionlifeline.org to connect to a trained crisis counselor. You can also get crisis text support via the Crisis Text Line by texting NAMI to 741741.  For those in countries other than the U.S. here is a Google site with helplines:https://support.google.com/websearch/answer/11181469

Many note that Wellbutrin has been used for quite some time to treat several mental health conditions.  So why did it take so long for the FAA to approve Wellbutrin?  I’ve heard some people claim this is because the pilot who crashed the Germanwings plane in 2015 was taking Wellbutrin.  But I haven’t found evidence for that.  A New York Times article https://www.nytimes.com/2016/03/14/world/europe/germanwings-crash-inquiry-urges-stricter-oversight-of-pilots-mental-health.html# says, “Toxicological examination of Mr. Lubitz’s remains found traces of the antidepressants mirtazapine [Remeron] and citalopram [Celexa] as well as zopiclone, an insomnia treatment [similar to Lunesta].

And besides, the FAA approved the SSRIs 5 years before the Germanwings crash, and the U.S. Air Force has been allowing pilots to fly while taking Wellbutrin since 2013, 2 years before the Germanwings crash, and they did not stop allowing after this crash.  So, I ask again, why did it take so long for the FAA to approve Wellbutrin?

To read the full transcript go to The Flight Shrink substack at https://flightshrink.substack.com

DISCLAIMER:

The views expressed in The Flight Shrink are those of the author and do not reflect the official policy or position of the Department of Defense, The United States Air Force, or any other organization with which Dr. Heacock is associated.  The content of The Flight Shrink is not medical advice.  The Flight Shrink is for informational purposes only and may not be applicable to all situations.  Use of the information is at the reader’s own risk.  Any recommendations of treatments, products, or services are made in general and may not apply to a specific person, situation, or illness.  Please seek care from a medical professional if you have concerns for any physical or mental health symptoms.

If you or someone you know is experiencing a mental health, suicide, or substance use crisis or emotional distress, reach out 24/7 to the 988 Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) by dialing or texting 988 or using chat services at suicidepreventionlifeline.org to connect to a trained crisis counselor. You can also get crisis text support via the Crisis Text Line by texting NAMI to 741741.  For those in countries other than the U.S. here is a Google site with helplines:https://support.google.com/websearch/answer/11181469

On this flight, I’m going to actually talk about the 5 antidepressants approved by the FAA for use in pilots.  They are Prozac, Zoloft, Lexapro, Celexa, and the most recent one added in May 2023, Wellbutrin.

Prozac, Zoloft, Lexapro, and Celexa are classified as Selective Serotonin Reuptake Inhibitors (SSRIs).  Since they were the only approved antidepressants when the FAA first started allowing their use in pilots in 2010, much of the FAA guidance refers to an SSRI Decision Path or SSRI Certification.  But even though Wellbutrin is classified as a Norepinephrine and Dopamine Reuptake Inhibitor (NDRI) you can follow all the same FAA guidance for SSRIs.  Before we get to Wellbutrin though, let’s talk about the antidepressants that the FAA has been allowing the longest, the SSRIs.

To read the full transcript go to The Flight Shrink substack at https://flightshrink.substack.com

DISCLAIMER:

The views expressed in The Flight Shrink are those of the author and do not reflect the official policy or position of the Department of Defense, The United States Air Force, or any other organization with which Dr. Heacock is associated.  The content of The Flight Shrink is not medical advice.  The Flight Shrink is for informational purposes only and may not be applicable to all situations.  Use of the information is at the reader’s own risk.  Any recommendations of treatments, products, or services are made in general and may not apply to a specific person, situation, or illness.  Please seek care from a medical professional if you have concerns for any physical or mental health symptoms.

If you or someone you know is experiencing a mental health, suicide, or substance use crisis or emotional distress, reach out 24/7 to the 988 Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) by dialing or texting 988 or using chat services at suicidepreventionlifeline.org to connect to a trained crisis counselor. You can also get crisis text support via the Crisis Text Line by texting NAMI to 741741.  For those in countries other than the U.S. here is a Google site with helplines:https://support.google.com/websearch/answer/11181469

Now, it's time to explore why such careful consideration goes into deciding to start an antidepressant and what it means to be taking one.

First, to understand the history of antidepressants in aviation, let’s talk about what it was like before antidepressants were approved for use in pilots.  Back in 2010 there were four SSRIs (Prozac, Zoloft, Celexa, and Lexapro) that were the first antidepressants approved by the FAA for pilots to take and still be allowed to fly.  Prior to this, if your mental health condition was so severe that it required treatment with an antidepressant it was felt flight safety could be compromised.  And so, since it was such a new policy 10 years ago, when pilots needed to take an antidepressant they were not allowed to fly unless they had thorough evaluation and documentation from mental health providers that they were stable enough to do so.

To read the full transcript go to The Flight Shrink substack at https://flightshrink.substack.com

DISCLAIMER:

The views expressed in The Flight Shrink are those of the author and do not reflect the official policy or position of the Department of Defense, The United States Air Force, or any other organization with which Dr. Heacock is associated.  The content of The Flight Shrink is not medical advice.  The Flight Shrink is for informational purposes only and may not be applicable to all situations.  Use of the information is at the reader’s own risk.  Any recommendations of treatments, products, or services are made in general and may not apply to a specific person, situation, or illness.  Please seek care from a medical professional if you have concerns for any physical or mental health symptoms.

If you or someone you know is experiencing a mental health, suicide, or substance use crisis or emotional distress, reach out 24/7 to the 988 Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) by dialing or texting 988 or using chat services at suicidepreventionlifeline.org to connect to a trained crisis counselor. You can also get crisis text support via the Crisis Text Line by texting NAMI to 741741.  For those in countries other than the U.S. here is a Google site with helplines:https://support.google.com/websearch/answer/11181469

In this edition, we'll take flight into the world of antidepressants and their aeromedical approval by the FAA. Managing mental health is paramount in the aviation industry, and for some, antidepressants are a crucial part of that journey. We'll look into the details of how antidepressants can be used by pilots and what that means for their medical certificates.

For pilots, the decision to start an antidepressant is a big deal because the FAA has a specified process of how to return to flying once stable on an antidepressant.  This unfortunately has led some pilots to not seek help for their mental health concerns.  In the worst case scenarios, this has sadly resulted in suicide.

To read the full transcript go to The Flight Shrink substack at https://flightshrink.substack.com

DISCLAIMER:

The views expressed in The Flight Shrink are those of the author and do not reflect the official policy or position of the Department of Defense, The United States Air Force, or any other organization with which Dr. Heacock is associated.  The content of The Flight Shrink is not medical advice.  The Flight Shrink is for informational purposes only and may not be applicable to all situations.  Use of the information is at the reader’s own risk.  Any recommendations of treatments, products, or services are made in general and may not apply to a specific person, situation, or illness.  Please seek care from a medical professional if you have concerns for any physical or mental health symptoms.

If you or someone you know is experiencing a mental health, suicide, or substance use crisis or emotional distress, reach out 24/7 to the 988 Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) by dialing or texting 988 or using chat services at suicidepreventionlifeline.org to connect to a trained crisis counselor. You can also get crisis text support via the Crisis Text Line by texting NAMI to 741741.  For those in countries other than the U.S. here is a Google site with helplines:https://support.google.com/websearch/answer/11181469