The Huffington Post
By Peter Breggin
April 19, 2010
A few years ago I was hired by the FAA to defend the agency against a suit brought by a pilot who wanted to fly while taking a prescription antidepressant. I helped the FAA formulate its defense of the agency’s ban on pilots using antidepressants and, as a result, the ban remained in effect. Pilots remained unable to fly while taking antidepressants, including the newer ones such as Prozac, Paxil, Zoloft, Celexa, Lexapro and Effexor.
How times have changed. Ignoring the scientific data on adverse drug effects that the agency and I generated and evaluated for the earlier case, the FAA is lifting its 70-year-old ban on allowing pilots to take antidepressants. Has the science changed–improving the adverse reaction profile of these drugs? To the contrary, since that time my most dire observations have been confirmed in the FDA-approved label for all antidepressants. Now there is not only a Black Box Warning for suicidality in children, youth and young adults, but also a lengthy Warnings section about a variety of extremely dangerous abnormal behavioral reactions in all ages including aggression, hostility, disinhibition, impulsivity and mania. Even when not severe, these reactions impair judgment and increase the likelihood of accidents and violence.
According to the FDA-approved guidelines, prescribers are supposed to give a special Medication Guide to patients and their families that warns about dangerous drug-induced reactions including suicide, violence and a variety of unexpected negative behaviors. Originally intended for children and youth, the Medication Guide is now expanded to cover all age groups, including adults. The Medication Guide for all ages can be found at the conclusion of each FDA-approved label for antidepressant drugs in the 2010 Physicians’ Desk Reference.
Why did the FAA lift the ban on pilots using antidepressants? According to FAA statements to the media, depressed pilots sometimes kept on flying while secretly taking antidepressants. “Our concern is that they haven’t necessarily been candid,” FAA Administrator Randy Babbitt reportedly told the press on a conference call. They were flying below the radar of drug testing, so to speak. The new policy not only allows pilots to use antidepressants, it grants a degree of amnesty to those who have been using them illegally in the past.
The FAA feels it’s safer to allow the use of antidepressants because it will make it easier for pilots to obtain needed treatment for depression. It supposedly will also make it easier to monitor their use of these dangerous drugs. If we accept this argument, why not legalize stimulants such as amphetamine as well? They would help keep the overworked pilots awake. And while the FAA is at it, why not let them use marijuana, since they may be doing it illegally on their own without anyone monitoring them.
Unfortunately, monitoring pilots on antidepressants won’t work nearly as well as might be hoped. Many severe emotional and behavioral reactions occur in the first one to three days of antidepressant dosing, or shortly after dose changes, either up or down–long before the next scheduled appointment. Although close monitoring and informing the family to be on the alert can be helpful, and should be done, it won’t prevent many of the drug reactions that occur abruptly and without warning. In addition, doctors too often fail to warn the patient and the family about the risks. As a medical expert, I’ve learned how cavalier some prescribers are in regard to warning patients about the adverse effects of any psychiatric drugs.
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