Ask the Flight Surgeon / By CPT Frank C. Stafford, D.O.: Q: Lately, I have been having problems sleeping, staying motivated and coping with stress. At times I feel hopeless and I wonder if I am depressed. Can I get the help I need and still fly?
FS: Thank you for this important question. Symptoms of depression are common, rarely permanent and affect most people at some time in their lives. You may have depressive symptoms for many medical reasons and it does not necessarily mean you have a diagnosis of clinical depression or that you require medication or duty limitations. Know that you are not alone and you are encouraged and supported in seeking assistance.
Clinical depression is defined as a depressed mood over two weeks or more that can cause negative changes in sleeping and eating habits, decreased enjoyment of hobbies and recreational activities, difficulty concentrating, decreased reflexes, or thoughts of death. If a particular stressor, or set of stressors, is the source of these negative emotions, behavior and/or physical well-being, you may have an adjustment disorder. With this condition, once the stressor is removed, symptoms generally resolve. Stressors can be negative as with the death of a loved one, marital strife or financial problems. Stressors can even be life events that are considered to be positive like the birth of a child or a promotion. Both depression and adjustment disorders can be treated with counseling and lifestyle modifications that include improved sleep habits, exercise, diet changes, and relaxation techniques. Medications can also be a viable treatment option.
Why is it important to be aware of my mood?
Moods are more than just the way a person feels. Our state of mind can impact how we perceive the flight environment and process information. Our mood can adversely affect the ability to concentrate, retain important information, or how we interact with others. A depressed mood may lead us to feeling “down”, “angry” or “frustrated” and can distract us from recognizing problems in flight and taking appropriate actions. Mood and behavioral changes are complex. Their effects can hide from us even when others have already expressed concerns for our well-being.
What are my treatment options?
Behavioral health experts like therapists and social workers are locally available for most soldiers. The steps of seeing a behavioral health provider generally includes an assessment, treatment plan, and evaluation of progress. The behavioral health provider will give the crewmember an opportunity to discuss their concerns. The behavioral health provider and crewmember will jointly develop strategies to help minimize the severity, longevity, and intensity of symptoms while addressing core issues that are likely causing the symptoms.
As a part of the treatment plan, a consultation with a provider who prescribes medication may be considered. The most common type of medication for depression are Selective Serotonin Reuptake Inhibitors (SSRIs). Also, some behavioral health providers use non-pharmaceutical treatments like cranial electrotherapy stimulation (Alpha Stim) to treat depression. While treatments like this are not explicitly addressed in aeromedical policy, AR 40-8 states that crewmembers will discuss any treatments given by a behavioral health provider with their flight surgeon. The flight surgeon, along with the behavioral health provider, will decide if the symptoms will affect your flight status.
Can I fly if I’ve been diagnosed with depression or an adjustment disorder or if I’m being treated for them?
Due to increased risk when flying with behavioral-health related symptoms, initial grounding may occur depending on the severity of the symptomology. With adjustment disorder, if symptom severity is relatively low and symptoms resolve within 90 days, the crewmember may continue flying. If symptom resolution requires more time or medication treatment, then flight status will be affected. Once treatment is complete and symptoms have resolved, the flight surgeon may submit a waiver to return the crewmember to flying.
A diagnosis like major depression will result in restricted flying duties. Neurocognitive testing is also required if any medications have been used. A crewmember should be on a stable dose of SSRI for four months with remission of symptoms before waiver submission. However, after 3 months of a stable dose, the flight surgeon may recommend a temporary up-slip while the waiver is being processed if symptoms are well controlled with minimal medication side effects.
CPT (Dr.) Frank C. Stafford is a flight surgeon at the U.S. Army School of Aviation Medicine, Fort Rucker, AL.