Treating mental health

Behavioral health is a high-profile issue for the FAA, and the number of applicants who report medical history that includes some type of mental-health-related diagnosis such as depression, anxiety disorder, PTSD, or ADHD is increasing. The Centers for Disease Control reported in September 2020 that in the three-year period between 2015 and 2018, more than 13 percent of adults used antidepressant medications. I suspect that study may under-report the true usage. We speak with many members who have questions about reporting a history of symptoms that can fall into the behavioral health category and/or the use of antidepressants, and how that history will play out when and if reported on a medical application.

Since 2010, the FAA has allowed the use of four SSRI medications, including citalopram (Celexa), sertraline (Zoloft), escitalopram (Lexapro), and fluoxetine (Prozac). The process is complicated with a lot of moving parts. It’s also an expensive process, and it takes a long time to get a decision. The FAA philosophy is to find a way to “yes” when the yes can be done safely. Not everyone who applies for a medical is going to be eligible for a special issuance, but the mechanism is in place, and there are several hundred pilots flying today with behavioral health histories.

The FAA recently published new guidance for people with situational depression, adjustment disorder with depressed mood, or minor depression. This is a huge leap and a significant advancement in the way the FAA handles the increasing numbers of pilots with these diagnoses. In many cases, with good documentation of a single episode of what we all experience from time to time—what I call “life getting in the way of living”—your AME can issue a medical certificate at the time of the FAA physical exam. There are still strings attached, but as is always the case, complete documentation that is “satisfactory to the FAA” will make your experience with the aviation medical examiner a more favorable one than in the past.

We as a pilot community need to recognize that mental health pathology is treatable and is not necessarily a disqualifying and grounding condition. Get healthy first, then become educated about what the FAA needs to see to find a way to say yes. The FAA is not in the business of disqualifying pilots—quite the opposite. Most people who apply for a medical get certificated. It just takes time, good planning, and good behavior.