The FAA on April 2 announ-ced a new policy that will allow pilots taking medication for mild to moderate depression to obtain a special issuance medical certificate. Special issuances are needed for medical conditions that are not allowable for normal first-, second- and third-class medical certification of pilots. The new policy allows, on a case-by-case basis, pilots to fly “if they have been satisfactorily treated” on one of four selective serotonin reuptake inhibitors (SSRI) antidepressant medications for at least 12 months. The medications are Fluoxetine (Prozac), Sertraline (Zoloft), Citalopram (Celexa), or Escitalopram (Lexapro). The FAA will not take civil enforcement actions against pilots who take advantage of a six-month amnesty to share any previously non-disclosed diagnosis of depression or the use of these antidepressants.
The FAA’s action on allowing antidepressants mirrors what the agency did when it reached out to alcohol-dependent pilots. In the 1970s, the National Institute for Alcohol Abuse and Alcoholism and the Air Line Pilots Association (ALPA) used a grant to perform the Human Intervention Motivation Study (Hims). The study resulted in development of a peer identification and referral program for alcohol-dependent pilots, which has since helped rehabilitate more than 3,500 airline pilots.
Before Hims, pilots hid their alcohol problems, which caused more safety problems than allowing pilots to participate in a process that helps them deal with alcoholism.
According to the FAA, “concern regarding applicants who may be reluctant to disclose or who may be masking a struggle with depression remains a safety concern that this policy will serve to address.” The FAA also was acting on recommendations from the Aerospace Medical Association, Aircraft Owners and Pilots Association, ALPA and the International Civil Aviation Organization as well as the fact that “the Civil Aviation Authority of Australia, Transport Canada and the U.S. Army already allow some pilots to fly using antidepressant medications.”
The FAA noted in the policy proposal, “Because SSRIs have been more effective and better tolerated (fewer side effects) than previous antidepressant medications, they soon became the most frequently prescribed medications for depression. Five of the top 40 medications prescribed in the United States are SSRIs, and their usage is increasing.” The FAA said that other medications will be considered in the future as the agency gains experience and data under its new policy.
The FAA will employ psychiatrists and aviation medical examiners trained under the Hims program to monitor and evaluate pilots using SSRIs who want special issuance medicals.
“I’m encouraging pilots who are suffering from depression or using antidepressants to report their medical condition to the FAA,” said FAA Administrator Randy Babbitt. “We need to change the culture and remove the stigma associated with depression. Pilots should be able to get the medical treatment they need so they can safely perform their duties.”
Psychiatrist Peter Breggin doesn’t agree with the FAA’s new policy. Having helped the FAA defend against a lawsuit filed by a pilot who wanted to keep flying while taking an antidepressant, Breggin wrote in The Huffington Post blog, the FAA is “ignoring the scientific data on adverse drug effects that the agency and I generated and evaluated for the earlier case…” He added, “If we accept this argument, why not legalize stimulants such as amphetamine as well? They would help keep the overworked pilots awake. And while the FAA is at it, why not let them use marijuana, since they may be doing it illegally on their own without anyone monitoring them.”
In the FAA’s view, rather than force pilots into a situation where they hide a problem, it is better to address it. In a review of 127 accidents in the NTSB database since 1991 containing the word “antidepressant,” AIN found that only three of those accidents were nonfatal. In 124 of those accidents, 211 people were killed. In accident after accident, antidepressants, including those listed above, were found in the tissues of dead pilots, and the pilots had falsified their medical certificate applications to show that they had never been treated for psychiatric problems.
Paul Lowe contributed to this article.