Wednesday, August 26, 2009

Pilots and depression revisited

In a previous post I brought up some questions about the FAA rules and pilot mental health. I personally feel that there is a lot of misinformation floating around about how nosy the FAA is about what type of counseling a person receives and what it is for and any retribution that might happen because of it. But right now I don't have the time to look further into it (I'm waiting for the opportunity to do it under the guise of a research paper and kill two birds with one stone actually...). My interest was more along the lines of getting short term counseling to help one deal with financial, parenting, or relationship stress and how even needing that can be perceived as a weakness making one unfit to fly not so much on full on diagnosed depression. It bothers me that ANY kind of counseling, by anyone, is perceived as a negative when in reality it could help one do ones job even better.

To that end, I came across a post in A's company forum that talked about pilots and depression and highlighted an Australian study regarding pilots who do fly while under care for depression. Here is the poster's summary of the study-

"Most air-safety authorities around the world ban pilots from flying while on antidepressant drugs citing safety reasons. Now the results of an Australian study suggests that taking the drugs does not increase the risk of accidents, while banning them could increase risks by encouraging depressed pilots not to seek treatment.

A team led by aviation medicine specialist James Ross, who ran the study while a consultant at Australia's Civil Aviation Safety Authority (CASA), scrutinised Australian pilot safety records spanning from 1993 to 2004.

Unlike most air safety authorities around the world, CASA allows Australian pilots to fly while on antidepressant drugs, under tightly controlled conditions.

For example, the pilot must have taken the drugs for at least a month before flying. This is to ensure that he or she is not suffering side-effects such as fatigue or nausea that could affect performance. Depressed pilots are also not allowed to fly if they have suicidal tendencies, pathological anger, or abnormal sleep patterns associated with the disorder.

General ban
Over the 12-year study period, 481 pilots who were prescribed antidepressants had 11 accidents due to pilot error and 22 near misses. The researchers say this was not significantly different to the five accidents and 26 near misses of the similar number of pilots who did not take antidepressants, but who were matched by age, sex, and flying experience.

The results will be presented by team member Kathy Griffiths of the Centre for Mental Health Research at the Australian National University in Canberra today at the World Psychiatric Association annual congress in Melbourne, Australia.

Most aviation safety authorities, including the US Federal Aviation Authority, and the European Joint Aviation Authority, ban pilots from flying while on antidepressants because of concerns about the effect of treatment and the underlying depression on a pilot's performance.

That might not be wise, says Ross. He points out that the Australian study suggests that using antidepressants in a carefully managed, structured environment is safe, and that rules or regulations that encourage pilots not to seek treatment, or not to declare it, could backfire.

"Antidepressants can be prescribed for years, so that means you are asking people to give up their livelihoods, or leave their depression untreated," notes Griffiths.

Reluctant reporting
The Australian study also found that only 1% of pilots admitted to taking antidepressants, compared to 4.5% of Australians in the general population.

That suggests that even under the Australian rules, which allow pilots on antidepressants to continue flying, the increased scrutiny by CASA could encourage pilots to avoid seeking medical help or to keep it secret when they do.

US pilots taking medication for psychological conditions such as depression who were involved in fatal accidents had also rarely reported either the medication or their underlying condition to the FAA, according to two recent studies (see Aviation, Space and Environmental Medicine, vol 77, p 1171, and vol 78, p 1055, for the most recent).

"Many aviation doctors have maintained that the side effects of antidepressants present far less risk to aviation safety than the problem of untreated or undeclared depression. It's encouraging to see that the Australian evidence supports this," says David Powell of the Occupational and Aviation Medicine Unit at Otago University in Wellington, New Zealand.

"Depression is common and treatable, so surely the best way to manage it in aviation is to bring it out of hiding," he says."

A comment made by the poster that reflects what I was thinking as well when I made the first posts- "I guess we would rather have depressed pilots flying, who don't want to report it, than pilots who are being treated and fully able to fly competently while on medication."

A later poster commented that pilots hiding depression do self medicate- with alcohol.

Sadly, the poster of the study did not give any citations for the study so I can't give any info about where to find this study or where/when it was published. Requests for that information further into the post did not receive a response. I feel kind of dirty posting what is said to be research without a citation, must the the honest student in me, but I felt the information was important.


Anonymous said...

I too think this is grossly unfair, it encourages a very treatable illness to be either ignored or to self medication. I am a Pychiatric ARNP and have treated several pilots most suffer needlessly secretively. My fiance recently confided in me, he is torn and has basically withdrawn from me and the ones who love him. It is torturous to see someone in such pain when you know it is treatable. The FAA guidelines are outdated and preposterous. Their guidelines encourage people to hide their illness and to be ashamed of something that is beyond their fault.

Anonymous said...

I am a mental health professional and prescribe medication, counseling and alternative treatments every day. I monitor the effects of these treatments. It was amazing for me and my physician colleagues most recently to find out that the FAA bans pilots from taking antidepressant agents. These regualtions need to be updated to the 21st century. This type of regulation encourages pilots to keep secret their mental health problems, it also makes them feel like it is a sign of weakness, they get punished for seeking out professional help, this only perpetuates the problem. The FAA needs to look into what they are doing, the regulations are in dire need of revision. What can be done to open there eyes? Is it better to hide a medical condition that frequently causes decreased ability to concentrate, psycho-motor slowing, difficulty in decision making skills, dulls ones cognition to fly a plane or to have a one taking an antidepressant or herbal supplement. Or encourage self medication with alcohol?

Anonymous said...

I know this post is a few years old but I'm grasping at straws for anything relevant.
My husband has recently confessed to being depressed for years. He says he just feels sad all the time and very few things help keep those feeling at bay. He won't get help because then he won't be allowed to fly and the thought of that depresses him further. He retreats from the people who love him when it gets to be too much and it's very hurtful for those closest to him.
Has anyone found any alternative treatments for depressed pilots? Is there something I can do to better help him through all of this? He has hidden this for a very long time and says he doesn't even know who he is. His one love outside of our home is flying, he can't lose that.