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Depression case-based scenario

(Not so) high anxiety

After a messy divorce knocked James for six he started drinking heavily, slept very little and began a low spiral into depression.

Although recovered by the time he saw his Designated Aviation Medical Examiner (DAME), he feared his history of mental illness might disqualify him from receiving a medical certificate. Those fears proved entirely unfounded.

A 35 year old businessman, James has worked in IT since graduating university. James' father was a pilot in the Air Force and he used to take James flying when he was a child. James always promised himself he would get his pilot's licence one day, but hadn't found time to pursue his dream until recently.

Always a hard worker, James typically works 12 hour days and through the weekends. He blames his divorce five years ago at least partly on the demands of his work. 

"Mind you, in hindsight I really wasn't taking good care of myself for most of my married life. I was away from home a lot, and used to drink heavily on business trips," James says. "I wasn't exercising, and by the time the end came, I was much heavier than when my wife met me.

"In retrospect, I can see why she was so unhappy."

Medical history

James had always been a bit anxious growing up. His father was a heavy drinker and was extremely strict.

"Because I was chronically anxious, I was away from Primary School so much with one illness or another that my parents took me to see a paediatrician. He did lots of tests, but couldn't really find much wrong with me and had no useful advice to offer my parents. I just seemed to recover over time, and I did really well at high school."

Emerging symptoms

James' marriage to a girl he met at university started so well that he was shocked when his wife finally demanded a divorce, fed up with the long hours and the drinking. In the months following the divorce James found himself drinking even more heavily. He also began to have more and more trouble sleeping. The sleeping tablets his GP prescribed weren't working and he stopped seeing his family and friends and spent all his time at work or watching TV.

Things came to a head one morning when he tested positive at a roadside breath test and had his driving licence suspended.

When his mother found out about the driving under the influence charge she pleaded with him to see a doctor about his mental health. She had noticed that James had not been himself for more than a year since the divorce, she told him.

His GP diagnosed major depression, recommended treatment with an anti-depressant, and referred James to a psychiatrist. The psychiatrist agreed anti-depressants might be useful.

"I hated the idea at first, so I only started taking medication very reluctantly," James says." I was really surprised how effective the anti-depressant proved to be. Within a couple of months I was feeling much better. I could concentrate better at work and also started back windsurfing, a favourite hobby from years ago."

In the five years after the divorce James tried several times to wean himself off the medication under the supervision of his GP, but found his symptoms would return every time. At least James was alert to the symptoms by then and would return to the GP before they got too bad.

Visit to DAME

By the time James decided to go for his pilot's license things were going well. His business was booming; his work/life balance was much better, and he was taking the time to pursue a range of recreational activities.

"Even so, I was really nervous when I showed up to the local DAME for my first medical assessment," he says. "I didn't know how the doctor would react to my history of depression and I was afraid it would prevent me from getting my licence."

After questioning him in detail about his medical history and mental illness, the DAME explained that a diagnosis with depression need not be disqualifying from flying, but that AvMed would need more supporting information before considering his application.

AvMed asked James to provide reports from his treating GP and psychiatrist. Because of his history of driving under the influence they also asked him to provide a copy of his national police certificate and to undertake a blood test. These were satisfactory.

James was subsequently issued a class 2 medical certificate with a requirement that he provide a report from his treating doctor on the progress of his depression each year. He was reminded that if his condition or treatment changed that he needed to ground himself and present to his DAME for review.