Psychotropic Drugs Kill 150 People

March 29, 2015 permalink

On March 24 Germanwings Flight 9525 crashed near the village of Barcelonnette France, killing all 150 people on board. Once the voice recorder was recovered, investigators found that co-pilot Andreas Lubitz locked the captain out of the cockpit during a washroom break, then took the plane into a ten minute descent into the French Alps.

The world's most authoritative news sources are corroborating what the fringe press has been saying for days. Andreas Lubitz had antidepressant drugs in his apartment. So either he was on psychotropic drugs at the time of his suicide, or even worse, had withdrawn from drugs. During withdrawal, the patient experiences the opposite of the intended effect of the drug. That would have made Lubitz more depressed, and more suicidal, than before starting his treatment.

For two decades there have been regular mass shootings by deranged killers. The common element in most is the use of psychotropic drugs by the shooter. In previous incidents the psychotropic drug connection has been downplayed. The excuse of patient confidentiality has kept the details of drug use out of the press. But how can the airline industry avoid exposing the full details this time? Anything less would risk repeated murder/suicides of hundreds of passengers at a time.

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Germanwings Crash Raises Questions About Shifting Ideas of Pilot Fitness

By ERICA GOODE and JAD MOUAWADMARCH 28, 2015

Aviation agencies in Europe and the United States once banned all pilots from flying if they disclosed a mental illness to their employers.

But in recent years, bowing to advances in scientific understanding and a growing public awareness that common mental disorders like depression are treatable, regulators loosened those restrictions, allowing the use of certain antidepressants for a small number of pilots and permitting some pilots whose illnesses were mild to stay on the job. In doing so, agency officials said, they hoped to encourage pilots who were experiencing problems to come forward and seek treatment.

Now the crash of Germanwings Flight 9525 on Tuesday has raised questions about how well those policies work and whether airlines and regulators are doing enough to detect pilots who are too mentally ill to fly.

The authorities have said that Andreas Lubitz, the co-pilot who is believed to have intentionally crashed the German aircraft, killing himself and the other 149 people aboard, had a mental illness and hid the diagnosis from his employer. The exact nature of his disorder remains unknown, but Mr. Lubitz apparently sought treatment for vision problems that may have jeopardized his ability to work as a pilot. Still uncertain is whether there is a link between Mr. Lubitz’s vision problems and his psychological issues. On Saturday, an official said that the police had found antidepressants during a search of his apartment in Düsseldorf.

Here’s what we know (and what we don’t) about Andreas Lubitz, the pilot believed to have crashed a Germanwings plane in the French Alps, according to investigators:

What We Know

• The French prosecutor in charge of the case has said that Mr. Lubitz, the co-pilot, was alone at the controls of the Airbus A320 in the ten minutes before the crash. Mr. Lubitz did not respond to pleas from the captain to be readmitted to the cockpit and set the plane on a descent course that took it into the mountains, the prosecutor said.
• Mr. Lubitz had been receiving treatment for a psychological or psychiatric condition that he did not disclose to his employer.
• He had also sought treatment for a vision problem.
• He had doctors’ notes in his apartment in Düsseldorf excusing him from work, including one good for Tuesday, the day of the crash.
• His pilot’s license included a designation indicating that he had a medical condition.
• Antidepressants were found in his apartment.

What We Don’t Know

• When his psychological problems began, their severity and precise nature, or when he began treatment.
• The severity of his eye problems, when they first occurred or whether they could have been psychosomatic and related to his psychological problems.
• What antidepressants he might have been prescribed, at what dose and whether he was taking them.
• Whether any family members, friends or colleagues were aware of his problems and raised any flags with the airline about his suitability to fly.
• Whether an interruption in his pilot training was related to any psychological or medical problems.

Since the crash, European airlines have scrambled to require that two people be present in the cockpit at all times, a rule already in place in the United States. But many experts said the focus should now be on improving the process of hiring and screening pilots to better guard against someone like Mr. Lubitz getting into the cockpit in the first place.

The programs currently used by airlines and regulators on either side of the Atlantic, aviation experts and psychiatrists said, leave much to be desired. Screening exams are given on a yearly basis and often merely nod to mental health issues, including only a few questions about depression or other illnesses. The exams are often conducted by general practitioners with no psychiatric expertise.

In addition, most programs are based on an honor system, relying on pilots to volunteer information about problems they might have. And to do that, several psychiatrists said, they must overcome the stigma that still clings to mental illness, one that remains strong in commercial aviation, a profession with deep roots in the military that values a cool head and steady hand under pressure.

The screening process for pilots “really falls short for people who are involved in the public’s safety,” said J. Reid Meloy, a forensic psychologist who consults on threat assessments for corporations and universities.

The practice of screening only once a year is a particular problem, he said, because any number of life events — the breakup of a relationship, the death of a loved one or other setbacks — can affect mental functioning. Rather than coming out of nowhere, suicide often represents a convergence of troubled strands. Investigators who delve into a suicide victim’s background — interviewing relatives, co-workers and friends in what is called a psychological autopsy — almost always find a troubled history and often uncover hints about suicidal intentions that were overlooked or ignored by others.

A study of eight deliberate airplane crashes from 2003 to 2012, for example, found that five of the general-aviation pilots had intimated their plans to others beforehand.

But while suicide is rare, depression is one of the most common mental disorders: Government surveys suggest that one in 20 American adults have an episode of major depression each year and one in 10 take antidepressant medications.

And identifying a person whose condition poses a threat to public safety is not always easy, said Dr. Andrew Brown, president of the Academy of Organizational and Occupational Psychiatry.

“You have to get a sense of who this person really is, of what their coping mechanism is, of what their defenses are, in terms of how they characteristically deal with adversity,” Dr. Brown said. “It goes without saying that you have to ask them specifically if they have ever had thoughts of suicide.”

Screening systems in Europe closely mirror those imposed by regulators and airlines in the United States, aviation experts said, and in most cases, the tests that would-be pilots must pass to be licensed are focused far more on physical than mental health.

Crashes caused intentionally by pilots are very rare but not unheard of.

Dr. Warren Silberman, a former manager of aerospace medical certification for the Federal Aviation Administration, said that in the United States, pilots applying for a license must fill out an online medical questionnaire. Only three questions on the form deal with mental health, he said.

“There is no specific psychological testing,” he said.

Before they are licensed, pilots must undergo a medical exam, conducted by a doctor trained and certified by the aviation agency. Some airlines impose additional screening procedures, but they vary from company to company. Active pilots are required to have a medical screening once a year until they turn 40 and then twice a year after. Only when pilots are found to have mental health problems are they sent to a psychiatrist or psychologist for evaluation or treatment.

But the system, Dr. Silberman and others said, leaves pilots on an honor system, albeit one reinforced by penalties to discourage them from concealing any health issues that could affect their fitness to fly, including mental illness. Pilots who falsify information or lie about their health face fines that can reach $250,000, according to the F.A.A.

But Peter Goelz, a former managing director of the National Transportation Safety Board, said the system left a lot of wiggle room for pilots. For example, pilots are allowed to choose doctors, and can pick someone who might be less likely to report any difficulties.

“They know which guys are more cordial to their concerns and which are not,” Mr. Goelz said. “My guess is that the industry and the F.A.A. will look at this closely.”

Martin Riecken, a spokesman for Lufthansa, the parent company of Germanwings, said that airline’s screening procedures were similar to those in Europe and the United States.

Pilots are rigorously screened for physical problems before they are hired and fill out a questionnaire intended to vet their psychological fitness. Examination by a psychologist or psychiatrist is not a routine part of screening, he said.

As in the United States, pilots are required to report to the company any medical or psychiatric condition that might make them unfit to fly, Mr. Riecken said. But he added that in Germany, a private doctor who is consulted by a pilot is under no legal obligation to inform the airline about the pilot’s physical or mental state.

Seeking help from outside doctors is a common practice among pilots in Europe, said Dr. Alpo Vuorio, a researcher at the Mehiläinen Airport Health Center in Finland who has studied depression in pilots and pilot suicides. And few pilots inform the airlines that they have done so.

Without a strict reporting system, accountability suffers, he said. “People start to find services all around the country and even from different countries, and then it’s lost,” he said.

In Mr. Lubitz’s case, the Düsseldorf University Hospital said in a statement that he had been seen at their clinic in February and a final time on March 10 for what it called a “diagnostic evaluation.” The hospital refused to give further details, citing Germany’s privacy laws for medical records, including those of the dead, but denied reports that the co-pilot had been treated for depression. Prosecutors said that several doctors’ notes stating that Mr. Lubitz was too ill to work, including on the day of the crash, were found at his home; one of the notes had been torn up.

Because pilots and flight crews spend so much time working together in close quarters, airlines often rely on employees to monitor their colleagues’ behavior and raise concerns when a pilot appears unfit for flying.

“It’s very hard for mental illness to hide under those circumstances,” said Dr. William Hurt Sledge, a professor of psychiatry at Yale who has served as a consultant to the F.A.A., as well as to the Air Line Pilots Association and a number of carriers.

Yet Dr. Sledge conceded that the screening tools available were inadequate to the task of detecting a pilot determined to hide any signs of distress. Mr. Lubitz was heard on the flight recorder chatting amiably with the captain before locking him out of the cockpit.

And given the stigma attached to depression, many pilots who have the illness do hide their symptoms, a fact that led the F.A.A. in 2010 to revise its policies, allowing pilots to take antidepressant drugs in some circumstances and continue flying.

“We know more today about the science of the medications being given and we know a lot more about depression itself,” said Randy Babbitt, the F.A.A. administrator at the time, in announcing the new policy. The European aviation agency followed suit a few years later.

Dr. Silberman, the former F.A.A. medical manager, said that the agency’s thinking evolved over years and that many within the agency were reluctant to change its policies, worried about the side effects of the drugs.

“This was an effort to let guys know that once you start getting better and you are treated, you can fly again,” he said. But he added that the agency was careful in its decisions about who could keep flying and that pilots taking the medications must follow a treatment plan and be closely monitored.

Dr. Ryan Shugarman, a psychiatrist in Alexandria, Va., who performs mental health evaluations of pilots and air controllers for airlines and the F.A.A., said he had seen one case in which an applicant to be a pilot had suicidal thoughts, but never one where a pilot threatened to bring down a plane.

“My experience is that there’s a lot of support among the aviation community for getting treatment,” he said, adding that he supported the F.A.A.’s change in policy because before it was made, pilots were going to outside doctors for mental health treatment and concealing it from their employers.

Whether the crash of Flight 9525 will prompt calls for the agency to revert to its earlier conservatism remains to be seen.

“I hope not,” said Dr. Vuorio, the Finnish researcher. “This is a good practice, in good hands.”

Correction: March 29, 2015

An earlier version of this article described incorrectly a patient whom Dr. Ryan Shugarman, a psychiatrist in Alexandria, Va., had evaluated. The patient was an applicant to be a pilot, not a pilot.

Nicola Clark contributed reporting from Paris.

A version of this article appears in print on March 29, 2015, on page A1 of the New York edition with the headline: Too Ill to Fly? Shifting Ideas of Pilot Fitness.

Source: New York Times