In light of recent events we wanted to reach out to our patients who may have a fear of flying. 

We often are approached by patients who request a sedative or tranquiller like Diazepam to assist them in their fear of flying. The practice are unable to prescribe a sedative therefore we wish to provide the following information to our patients informing you of the reasons why this is denied.

1) The use of any sort of Central Nervous System (CNS) depressant causes longer reaction times & slowed thinking, which during a flight will put the passenger at significant risk of not being able to act in a manner which could save their life in the event of a safety critical incident.   Incapacitation from a sedative is a risk to the lives of all onboard the aircraft in the event of an emergency requiring evacuation.

2) The use of any sort of CNS depressant has potential to increase the risk of DVT (deep vein thrombosis).  These drugs can induce non-REM sleep which tends to be of a type where the person does not move in their sleep, and therefore increases the possibility of sitting without moving for more than 4 hrs (the amount of time which has been shown to increase the risk of developing DVT whether in an aeroplane or elsewhere); 

3) The sedating effects have the possibility of causing some respiratory depression, resulting in a drop in 02 sats. Normal sats for a healthy person at 8000ft are around 90%, so with the 2 effects added together, this may become significant;

4) A paradoxical increase in aggression may be reported by patients taking benzodiazepines & therefore has potential to put other occupants of the aircraft at risk; 

5) Benzodiazepine use when added to alcohol consumption causes an increase in the risk posed by many of the points above, & many (nervous) flyers will consume alcohol in the terminal before boarding & during their flight.

6) Benzodiazepines are contraindicated in phobic states (in the British National Formulary)

7) For some countries it is illegal to import these drugs, eg in the Middle East, and so the passenger will need to use a different strategy for the homeward bound journey and / or any subsequent legs of the journey; 

8) Standard GP indemnity does not cover us for treatment initiated outside the UK, so you would only be covered for doses to be taken on journeys starting in the UK

9) NICE guidelines suggest that medication should not be used for mild & self limiting mental health disorders; in more significant anxiety related states - benzodiazepines, sedating antihistamines or antipsychotics should not be prescribed; Benzodiazepines are only advised for the short term use for a crisis in generalised anxiety disorder, ie acute anxiety emergencies & if this is the case, they would not be fit to fly anyway (potential risk to being able to allow completion of the flight without diversion) & fear of flying in isolation is not generalised anxiety disorder.

10) Risk of addiction from inappropriate benzodiazepines use; 

11) Possible risk of early dementia in benzodiazepine users (though currently unclear if this risk is in regular users only, or includes occasional users);

There are plenty of good quality fear of flying courses available in the UK which are easily accessible by those who wish to conquer their fear of flying

https://fearlessflyer.easyjet.com/; 

http://www.flyingwithoutfear.com/; 

http://flyingwithconfidence.com/; 

https://www.flyingwithoutfear.co.uk/

The UK Civil Aviation Authority (CAA) provides guidance related to fear of flying, primarily from a safety and medical perspective for passengers and pilots. Here's a summary of their position and related advice:

1. For Passengers with Fear of Flying:

• General Advice: While 90% of adults may feel apprehensive, significant fear of flying (aerophobia) affects 10-25% of airline passengers. The CAA acknowledges various components that can cause this fear, including concern over heights, loss of control, claustrophobia, physiological effects, media "hype," and fear of the unknown.
• Medical Fitness to Fly: If you have a medical condition, including mental health concerns like severe anxiety, it's crucial to discuss your fitness to fly with your doctor. They may advise you to contact the airline's special assistance or medical clearance team, especially if you require help at the airport, extra medical equipment, or oxygen.
• Medication (e.g., Diazepam): The CAA, and general medical practice guidelines (like NICE), do not recommend the use of sedative drugs like diazepam (Valium) for fear of flying. Key reasons include:
  • Safety Risks: These drugs can impair your ability to concentrate, follow instructions, and react in an emergency, posing serious safety consequences for you and others.
  • DVT Risk: Sedation can reduce movement, increasing the risk of deep vein thrombosis (DVT) or blood clots, especially on longer flights.
  • Respiratory Depression: Sedative effects can affect breathing and cause low oxygen levels, which is particularly risky at altitude.
  • Paradoxical Effects: In a small number of people, these medicines can cause agitation, aggression, or confusion.
  • Legality: Diazepam and similar controlled drugs are illegal in some countries.
  • Not a Long-Term Solution: Fear of flying in isolation is generally not considered a generalized anxiety disorder, and these medications are not licensed or recommended for this specific phobia.
• Recommended Approaches: The CAA and medical professionals advocate for:
  • Self-help resources: Distraction techniques (talking, watching movies, music, reading), informing cabin crew for reassurance.
  • Cognitive Behavioural Therapy (CBT): This is widely recommended as an effective treatment.
  • Fear of Flying Courses: Many airlines (e.g., easyJet's "Fearless Flyer," British Airways' "Flying With Confidence") offer courses that combine behavioural techniques and educational input about aircraft operations, noises, and turbulence.
• Special Assistance: If you have a disability (visible or hidden, including severe anxiety), you are entitled to special assistance at airports and on board. It's crucial to request this assistance from your airline or travel agent at least 48 hours before departure. Schemes like the "Sunflower Lanyard" are recognized at many UK airports to discreetly indicate that a passenger may need additional support or understanding.

2. For Pilots (Class 1, 2, and 3 Certificate Holders):

• Mental Health Assessment: For pilots, fear of flying (aerophobia) is treated as a mental health condition that requires medical assessment.
  • Class 1 (and Class 3) Certificate Holders: Must be assessed by a CAA consultant advisor in psychiatry.
  • Class 2 and LAPL: Before returning to flying, pilots should provide their Aeromedical Examiner (AME) with a report from a consultant psychiatrist.
• Comprehensive Assessment: Initial and renewal mental health assessments for pilots include a comprehensive review of history, symptoms, stressors, coping strategies, and potential threats to flight safety.

In essence, the CAA's guidelines for fear of flying emphasize:

• Safety first: Especially concerning medication that might impair a passenger's or pilot's ability to respond in an emergency.
• Professional medical advice: Consulting your GP and airline for personalized guidance.
• Therapeutic and educational approaches: Encouraging passengers to seek effective long-term solutions like CBT or dedicated fear of flying courses rather than relying on sedative medication.
• Accessibility and support: Ensuring passengers with anxiety or other hidden disabilities can access assistance during their travel.

If you are struggling with fear of flying, your first step should be to consult your GP to discuss your individual situation and explore appropriate strategies.