Ask the Flight Surgeon / By CPT Laura Ball, DO: Q: Recently I have been experiencing nightmares, and I feel anxious and on guard most of the time. My wife says that I am moody and we have been arguing more frequently. I think I might have PTSD from my deployment 2 years ago. What can I do to get better and will I have to be grounded?
The Army’s Post Traumatic Stress Disorder and Mild Brain Injury Program (Photo Credit: U.S. Army Medical Department)
FS: Post-traumatic stress disorder (PTSD) is a mental disorder characterized by nightmares, flashbacks of traumatic events, hypervigilance (i.e. “being on guard”), sleep disturbances, avoidance of activities that act as reminders, and emotional detachment. We frequently see military personnel with PTSD from combat. However, it can occur after a number of traumatic events including motor vehicle accidents, sexual violence, domestic violence, natural disasters, or life-threatening illnesses. People who are afflicted by PTSD may also have other behavioral disorders, such as depression, anxiety, or substance abuse. Often people with PTSD find themselves using substances such as alcohol or drugs to self-medicate and cope with their symptoms. A history of a traumatic brain injury increases the risk for developing PTSD. Unfortunately PTSD tends to be a chronic condition with one-third of patients continuing to experience symptoms at 10 years; meanwhile, another third of patients will recover within a year.
PTSD is a treatable medical condition with various readily-available treatment options. Treatment typically consists of cognitive behavioral therapy, medication, or both. Cognitive behavioral therapy that focuses on trauma is considered the first-line treatment. This therapy can be done through individual counseling or in a group setting. Selective serotonin reuptake inhibitors (SSRI’s) or serotonin-norepinephrine reuptake inhibitors (SNRI’s) are frequently used medications that have proven beneficial in the treatment of these patients. Simply put, these medications increase the levels of chemical neurotransmitters in the brain.
Most of the time treatment begins with behavioral health evaluation. You may see several different medical providers to include a psychiatrist for medications, a counselor or psychologist for cognitive behavioral therapy, and an aeromedical psychologist. Ultimately aeromedical psychology will complete an evaluation that typically includes an evaluation of your response to treatment, current symptoms and, in some cases, psychological testing. Based on that evaluation, the aeromedical psychologist will make a recommendation to your flight surgeon regarding your flight status. Follow up with your flight surgeon during the full treatment course. Keep them involved in the process because your flight surgeon will eventually complete the aeromedical summary and submit a waiver request when you meet the requirements, which are mentioned below.
Can I Still Fly?
The big question on the mind of most aviators is, “Can I still fly?” Unfortunately, during initial diagnosis and treatment, aviators are usually grounded. If your provider starts you on medication, you will have a minimum of four-month grounding period to ensure you have a good response to treatment and no side effects from the medication. Both the medications and the diagnosis of PTSD are considered disqualifying and will require a waiver. The following criteria must be met for a waiver request to be submitted: 1) you are free of symptoms that would impair your ability to be a crewmember; 2) your medication dose is stable for a four-month time period (if applicable); 3) aeromedical psychology has cleared you to return to flight; and 4) you are able to complete an in-flight performance evaluation. An in-flight performance evaluation is done to demonstrate that you have recovered and are able to function and perform your duties in the stressful environment of the aircraft. A temporary upslip may be given during the waiver process if your flight surgeon feels that you are ready to return to flight duties. Once the waiver request is received at the Army’s Aeromedical Authority (AAMA), it may take four months before a final decision is made by your waiver-granting authority.
Many aviators may avoid seeking treatment due to grounding requirements and the stigma that is unfortunately often associated with mental health disorders. It is a personal decision to seek treatment and an important one. PTSD is a treatable medical condition. However, if left untreated, it may affect the quality of life not only for the patient, but also for the family. An individual suffering with untreated PTSD is most likely not functioning at the optimal level. Considering that the majority of aviation mishaps are due to human error, it is important to ensure that we address any medical issues that can degrade human performance. If you are struggling with PTSD, remember that treatment is important not only to improve quality of life but also to mitigate potential safety risks.
CPT (Dr.) Laura Ball is a flight surgeon at the U.S. Army School of Aviation Medicine, Fort Rucker, AL.