The FAA and depression

June 17, 2013

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Warren Silberman

Warren Silberman

  • Former Manager, FAA Aerospace Medical Certification 
  • Doctor of Osteopathic Medicine 
  • Expert in Aerospace/Preventive Medicine 
  • Pilot since 1986

In this piece I thought I would bring you all up on the FAA's policy guidelines on the use of antidepressants and medical certification. As you may recall, on April 4, 2010, the federal air surgeon announced the new policy guidelines for the use of a class of medications known as SSRIs (selective serotonin reuptake inhibitors). The medical certification doctors had been observing these medications and their side-effect profiles for several years. After many discussions, literature searches, and panels at major aerospace medicine meetings, they established a policy for the use of these medications. The requirements are quite involved. The FAA’s website explains the policy guidelines in detail.

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Currently there are only four medications that are acceptable: Celexa, Lexapro, Prozac, and Zoloft. These medications were felt to be the ones with the least demonstrated side effects. Here are some guidelines for their use:

1. The airman must have been on the same dosage of the medication for 12 months without any changes;
2. The airman cannot have had any suicidal thoughts or acts as part of his or her depressive episode; and
3. The FAA will consider airmen who are being treated for conditions other than depression, such as migraine headache or irritable bowel syndrome. 

The federal air surgeon is considering lowering the 12-month time on medication requirement. However, if the medication is discontinued, the airman should wait 90 days and provide medical records that explain what symptoms he or she had when the airman was placed on the medication and a current status report that includes how he or she responded to treatment, when the medication was discontinued, and how he or she is functioning now that the person is no longer taking the medication.

At a recent medical meeting a physician from the FAA’s Office of Aerospace Medicine Policy Section in Washington reported that from April 2010 until June 2012 they had special issued 79 airmen of all medical classes and denied 19. 

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Dr. Warren Silberman is the former manager of FAA Aerospace Medical Certification and a doctor of osteopathic medicine. A pilot since 1986, he is recognized nationally as an expert in aerospace/preventative medicine, and is a regular writer forAOPA’s Pilot Protection Services program.