The slippery slope of the FAA's antidepressant policy change

 - June 7, 2010, 8:23 AM

The debate about whether to allow pilots who use antidepressant medication to continue flying is ongoing, and recently the Air Line Pilots Association asked the FAA to extend the comment period on the agency's planned policy change. The FAA wants to allow pilots who use selective serotonin reuptake inhibitors (SSRIs) to obtain medical certificates, provided they are carefully evaluated and monitored. While there are some concerns about whether pilots should be allowed to use antidepressants, Australia has permitted this since 1989, with no increase in the normal accident rate.

The fact is pilots of all stripes are using antidepressants, according to the NTSB's accident records. I searched for accidents in the NTSB database and found 137 as far back as 1991 that contained the word "antidepressant." What was disturbing about these accidents is that they involved every type of aircraft, from Pipers and Cessnas to homebuilts to King Airs. And only four of the 137 accidents had no fatalities, which means that for whatever reason, accidents where antidepressants are found in the pilot's body have been notably deadly. Further analysis of these accidents will be found in the forthcoming July issue of AIN.

The FAA's policy change is interesting, in that it would attempt to invite pilots who have been breaking the law back into a legal framework that would allow them to have their depression treated then monitored by their FAA medical examiner. In many of these accidents, the pilots had received a prescription for the antidepressant but never mentioned this to the medical examiner, which is a violation of FAA regulations. The FAA has found, in its experience with pilots who abuse alcohol, that treatment and monitoring is a far better way to ensure safety than prohibition, which tends to make pilots hide their problems.

Although it does make sense ultimately for the FAA to help depressed pilots, and certainly depression should be acknowledged and treated, I worry about one angle that no one has mentioned. Remember that line on your airman medical exam form, where it asks you to sign away your rights to privacy so that the FAA can match your name with the state drivers licensing database to make sure you're not lying about having been arrested for driving under the influence (DUI)? Yes, that's the sneaky bit where if you don't sign, you don't get a medical certificate and if you do sign, you are giving up a specific right to privacy. 

Now that medical records are increasingly moving into the electronic realm, what's to stop the FAA from eventually linking to your prescription history database? Wouldn't it be helpful for the agency to know that you've been prescribed Prozac for the past two years so you would be forced to admit this on your application for a medical certificate?

No one complained much when the FAA took away our privacy rights with regards to DUI. Will you complain if the FAA does the same when it comes to your medical history and the possibility that you might be lying about the use of certain prescribed drugs on your medical application? 

I just hope it's not too late to stop before we go down this slippery slope. Fortunately, the workload involved in obtaining detailed medical and/or prescription records each and every time someone signs an aeromedical application would be completely overwhelming for an FAA that appears to be minimally staffed.