The second most common mental health issue leading to 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 fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro), or sertraline (Zoloft).
- 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. You can find a HIMS AME by clicking this sentence.
DO NOT ASSUME 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 FEW OR NO SYMPTOMS.
If you are currently taking an SSRI but your prognosis predicts that you would do okay without it, you are able to apply for a medical certificate after sixty days without the SSRI.