Can Pilots Take Antidepressants?
As of May 31, 2023, the FAA has approved bupropion (Wellbutrin) in the sustained (SR) and extended release (XL) variants. Immediate release bupropion is not approved.
Note: the FAA will continue to reference SSRI Pathways even though bupropion is not in the SSRI category of medications.
The FAA is still in the process of deciding:
- Does a pilot have to wait six months when converting from a stable dose of immediate-release bupropion to a sustained-release or extended release version? Unlikely, but the FAA has not issued guidance yet.
- Does a pilot have to wait six months if converting from a stable dose of an SSRI (and the pilot does or would otherwise qualify for an SIA) to bupropion? As above, probably not but the FAA has not issued guidance yet.
We are advised that the FAA is sorting through these issues and new information will be posted here as it breaks.
Can pilots take antidepressants? A common reason for an aviation psychiatric evaluation is a pilot who takes, or who has taken, an antidepressant medication.
In 2010, the FAA published a pathway to consider Special Issuance Authorization medical certificates for a pilot who takes an antidepressant.
The FAA’s SSRI Decision Path I is where we start, and you can click the picture to go the FAA’s website and see a bigger image.
A few key points:
- The SSRI pathway only allows consideration for pilots who take one of four SSRIS: fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro), or sertraline (Zoloft). As of 2023, a pilot can also be approved taking sustained-release or extended-release bupropion (Wellbutrin).
- Other antidepressants do not have a Special Issuance pathway.
- It does not matter if the antidepressant was taken for a medical problem. For example, an antidepressants can be used to treat various gastrointestinal problems, premenstrual dysphoria, chronic headaches, and chronic pain. If you take one of these four medications, for any reason at all, you are on the pathway.
The best pilot is a healthy pilot, and the pilot’s skill and decision making is the aircraft’s most critical piece of safety equipment.
The decision tree for antidepressant cases has too many branches to explore each outcome. But some of the key decision points are:
- What is/was the diagnosis for the SSRI?
- What kind of symptoms did the pilot have before the antidepressant?
- How effective is/was the medication?
- If the pilot has already quit the medicine, how long did the pilot take the therapy?
- If the pilot has already quit the medicine, how long ago did the prescription lapse?
- Did the SSRI cause any aeromedically significant side effects?
In a nutshell, the decision on if a pilot takes a SSRI, or stops an SSRI, is all about the PROGNOSIS. A prognosis is a prediction, based on facts, epidemiology, and medical judgment. A prognosis is not a testable fact but a prediction of future medical outcomes.
So, should I stop my medicine? That will make it easier, right?
So, then I have to keep taking the medicine, no matter what?
My strategic advice
FIRST, I advise that you secure a HIMS AME. A HIMS AME is only mandatory for drug and alcohol special issuance authorizations, but HIMS AMEs get cross-trained in SSRI protocols and mental health issues common to pilots.
Do not asume that stopping an antidepressant improves your chances to get a medical certificate. With some prognoses, you probably cannot get a medical certificate unless you take an SSRI.
If you stop an antidepressant and need to restart it, the minimum waiting period is six months on a stable dose and with no or only a few mild symptoms.
HIMS AME SSRI CHECKLIST
The FAA publishes an SSRI checklist for a pilot taking an antidepressant and applying for a Special issuance Authorization medical certificate. The form is intended for your AME to submit with your packet. Even if not intended for the pilot, reviewing the SSRI checklist helps you understand what needs to go to the FAA for your packet.