For this week, I thought I may depart from my previous index-finger-waving-in-the-air lecture on fitness and pick one of the fun topics in aviation medicine. You know the ones I mean. Spatial disorientation or G tolerance or something else exciting and dramatic. Preferably something to do with ending up upside down and with a good story afterwards!

Sadly, I’ll have to defer such fun matters for another day. Because, as you know, world events have turned our dear old industry on its own head. The COVID-19, or rather more correctly, the SARS-CoV-2 pandemic, has cast an unprecedented uncertainty on everyone’s employment, with commercial aviation feeling the brunt of the disaster. The recreational pilots aren’t exempt either. Everyone is exposed, irrespective of your chosen profession.

A loss of employment is considered as a top five stressor

A loss of employment, or even the mere threat of it, is considered one of the top five stressors in life. The others are the death of a loved one, divorce, moving and facing a major illness.  Not only is there an upheaval in financial security, but also a loss of status and self-esteem. This tremendous stress easily leads to depression and anxiety.

This is where the waters get muddied. Pilots are usually portrayed as confident problem solvers. They are presented with a hurdle and they respond with a sharp informed decision. It is what is expected. It is what is trained. It is why airline pilots are made to attended CRM lectures repeatedly and demonstrate these skills in a simulator every six months.

But what if there is no obvious answer? I have been inundated during this lockdown period with questions about stress, low mood, anxiety, poor sleep and so on. Often the pilot has by this time already consulted the family physician. The concern then naturally turns to the flying certification and I get the standard question, ‘Doc, how will this affect my flying?’

So with all this in mind, herewith the gist of this complicated matter. Firstly, most of us know by now that pilots are allowed to fly with the diagnosis of depression. This is a delicate but specific process.

The diagnosis is made by both a psychiatrist and clinical psychologist. The pilot must be stable on approved medication for a period of time and there must be absolutely no other psychiatric comorbidities.

 The issue is then reviewed on a case by case basis by the SACAA. We know that the response to modern pharmaceutical therapy can be life changing and we much prefer a well-managed pilot to one that hasn’t sought help. However, the vast majority of pilots do not suffer from clinical depression.

Anxiety – a symptom of depression or a disorder on its own

Anxiety may be a symptom of depression or it may be a disorder on its own. Or it may just be a result of the fact that your job is under threat, which is a rather normal response to a bad situation! Sometimes the depressive episode with all its symptoms is in fact purely due to the situation. We may call this adjustment disorder, which actually responds to the same medication used for depression, even though it is of a shorter duration and goes away eventually.

 If the anxiety is incapacitating and of a long-standing nature, this may be part of what is call general anxiety disorder (GAD.) You cannot be a pilot if you have GAD. I’m not exactly sure why people always find this surprising, but you will have to take my word for it.

Hopefully I haven’t induced anxiety by making you read all this! But the point is that it is complicated. My practice went from having a handful of stressed pilots to having hundreds of stressed pilots almost overnight. And we as AMEs are mandated to screen for mental pathology! Talk about a tall order.

What you can do

When seeking help from a doctor, people generally like to think that help comes in the form of a tablet. Please be wary of self-medicating or GP prescribed medication without consulting your AME first. There is no medication on the market that will ‘take the edge off’ and keep you legally flying at the same time.

There is no approved sleeping tablet for civilian aircrew either (Impossible I hear you gasp! Perhaps a topic for another day?) As mentioned, there are protocols and approved medications in place if and when it is needed, as overseen by the appropriate specialist. Skip the process at your own peril.

It is normal to feel stressed out under the current conditions. It is normal to feel anxious. In fact, it would be pretty weird not to experience these things at the moment!  But it is vital to chat to someone about it when you become overwhelmed.

The human brain is pretty useless when it comes to things like self-diagnosis and honest introspection.  You will be amazed at just how much a session with a trained professional like a clinical psychologist can help keep a healthy mental status. They have tools and skills that can do wonders. And no, the SACAA will not ground you for seeing a psychologist. If you need to get the ball rolling and don’t know where to start, please don’t forget Mayday-SA. It is a peer support group that does amazing work. We are all in this together after all.

I’ll end by quoting my second favourite Beatle. Everything will be okay in the end. If it is not okay, it is not the end!