Antidepressant medications and flying

I usually ask new airmen who want to see me for an FAA medical examination several questions prior to our appointment. One of them is, "Are you taking any medications, either prescription or over the counter?" In the case of one really nice student pilot I saw several weeks ago, I had forgotten to ask.  

Well, as in most cases the airman had not checked the AOPA medication database or asked any questions prior to completing the form. The young fellow was taking Zoloft (sertraline, an SSRI type of antidepressant). When I asked him how long, he said, “For three years.” He had had a situational depression that developed after his childhood friend died suddenly. His family doctor who had started him on the medication took the position of, “If it ain't broke, don't fix it,” and never took him off the medication. I was unable to issue him a medical certificate. This is a lesson for all new flight students: Check with the aviation medical examiner you plan on seeing or call AOPA in advance of performing your medical examination, especially if you have some medical condition or are taking a medication on a regular basis.

So, how does the FAA look at the treatment of depression? There are three common classes of antidepressants: the tricyclic antidepressants, which are old medications that have a great many side effects, especially heart related, and are never acceptable for the FAA; the SSRIs (selective serotonin reuptake inhibitors), a class of antidepressants that have been shown to have far fewer side effects, and the SNRIs (norepinephrine dopamine reuptake inhibitor, including Wellbutrin), that are still not acceptable to the FAA.

The SSRIs and SNRIs increase the level of a substance (serotonin in the case of SSRIs and serotonin and norepinephrine with SNRIs) that the body is lacking, and this lack is felt to promote the depressive symptoms. Four of the SSRI medications have been acceptable to the FAA since April 2010, Prozac (fluoxetine); Zoloft (sertraline); Celexa (citalopram); and Lexapro (escitalopram).

There are two pathways that airmen can take to gain medical certification when they have had a bout with depression. First of all, you need to get better! Like our AOPA Wellness Consultant Jonathan Sackier and I always preach, take care of your health (or mental health) problem before you tackle the certification issues. The FAA will not clear you, even if you are off the antidepressant, if you are still having significant symptoms. So, once you are feeling better, have a discussion with your treating physician about discontinuing medication. You will need to be off it entirely for at least 60 days, after which you will then provide the FAA with documentation about your treatment. A summary from the treating physician should state what your symptoms were at the time you were prescribed medication, the date the mediation was started and stopped, how you tolerated the medication, and how you have done in the subsequent time since the medication was stopped.

If your depression was “severe,” such as a case where you contemplated suicide and/or were hospitalized, the FAA will likely request a more involved evaluation. You will likely need a detailed report from the treating psychiatrist and copies of your mental health records, and you may even need to undergo neuropsychological testing by a clinical psychologist.  

If you have been on one of the four FAA-allowed SSRIs for at least six months and intend to remain indefinitely on the medication, you can attempt to gain a special issuance. This is a very involved process that will take several months to complete. You can find the complete protocol for the special issuance procedure online.

Topics: People

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