FAA approves SSRIs for medical certification

April 2, 2010

Pilots taking certain types of common antidepressants may soon return to the air, thanks to a change in FAA policy announced April 2.

Following a multi-year evaluation and one of the most interesting debates among civil aviation medical certification specialists, the FAA announced that it will allow special issuance medical certification for pilots who take four common medications for certain types of depressive disorders. Beginning April 5, the agency will consider for all classes of medical certification the use of Fluoxetine (Prozac), Sertraline (Zoloft), Citalopram (Celexa), or Escitalopram (Lexapro). For several years, AOPA has advocated for allowing pilots with conditions well-controlled by this type of medication to fly.

The FAA will announce in a separate Federal Register notice its intent to offer a one-time, six-month opportunity for airmen to disclose to the FAA previously unreported depression and use of antidepressant medications without being subjected to FAA enforcement action. 

Before deciding to allow the medications, which are all SSRIs, the FAA conducted an extensive review of literature assessing the risks and benefits of antidepressant usage. It evaluated the experiences of Transport Canada and the Civil Aviation Safety Authority in Australia, both of which have allowed antidepressant use in the cockpit for years, and recommendations from AOPA and other aviation organizations.

In 2006, AOPA and its advisory Board of Aviation Medical Advisors submitted to the FAA a draft protocol in support of granting special issuance authorizations to individuals whose symptoms were well controlled and who provided adequate documentation of control. The FAA cited AOPA’s recommendations, and those of other medical and aviation authorities, in its announcement.

Applicants for first, second, or third class medical certification will be considered for diagnoses of mild to moderate depressive disorders such as major depressive disorder (mild to moderate) either single episode or recurrent episode; dysthymic disorder; adjustment disorder with depressed mood.

The process for obtaining a special issuance will include annual monitoring by a board-certified psychiatrist to assure compliance with medication usage, side effects, or new symptoms. The special issuance will be determined on a case-by-case basis, considering several factors:

Psychiatric Status

All symptoms of the diagnosed condition must respond to treatment with use of only one of the allowed medications, and the condition must be stable with no change in or exacerbation of symptoms for 12 months prior to certification.

The airman must be on a stable dosage of medication for a minimum of 12 months prior to certification.

The airman must have no aeromedically significant side effects of prescribed medication.

Required Reports and Consultations

  1. A consultation status report (and follow up reports as required) from a treating psychiatrist attesting and describing the applicant’s diagnosis, length and course of treatment, dosage of the antidepressant medication taken, and presence of any side effects from the antidepressant the applicant takes or has taken in the past;
  2. A written statement prepared by the applicant describing his or her history of antidepressant usage and mental health status;
  3. A report of the results of neurocognitive psychological tests, including, but not limited to, COGSCREEN AE; Trails A/B; Stroop Test; CCPT; PASSAT; Wisconsin Card Sorting Test. All raw data from those tests must be included.
  4. An evaluation and a written report from a HIMS-trained aviation medical examiner who has reviewed items one, two, and three above and who makes a recommendation for a special-issuance medical certificate; and
  5. Any additional information the Federal Air Surgeon may require to make a determination.