AircraftOwner Online

In a surprise announcement, the FAA announced April  2nd, that for the first time, it will allow pilots to fly on anti- depressant medications. There are multiple caveats and “gotchas” but it is a remarkable forward step for the normally conservative bureaucracy in understanding this disease.

I am one physician and AME that is glad to see this change. I have always said that I would rather be flying with a pilot with depression controlled on medication than a pilot who is depressed and needs medication.

Mild to moderate endogenous depression is very responsive to antidepressant medications mainly because it is a medical disease with psychological symptoms. Endogenous depression is due to an inadequate level of serotonin in the brain. When this chemical is below normal levels, a person will be depressed regardless of the life events around him. Unfortunately, serotonin does not cross the “blood-brain” barrier so it is not measurable in the blood. If it were, the diagnosis and treatment of depression would be immeasurably easier.

The FAA’s policy allows for the use of four medications for depression. They are
fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro). These are very common, non-sedating medications, which have a long history of use with minimal side effects. In order to gain approval, the pilot must be stable on one (and only one) of these medications for 12 months. That means if a pilot was on non-accepted medication, he would have to change and then be stable for 12 additional months before he could apply for the certificate.

The initial consideration of a special issuance for depression also requires a consultation with a psychiatrist that describes the patient’s condition and full details of the treatment. As I interpret the written criteria, this evaluation could not be a primary care physician (PCP) who has been treating the patient but must be a psychiatrist. Since 90% of patients with depression are treated by PCPs, this is going to be a hurtle. I can assure you that a psychiatrist is not going to be excited about doing a consult on a well control, mild to moderately depressed pilot, in order to write a letter.

In addition to the consultation, the pilot will be required to take several psychological tests including COGSCREEN AE, Trails A/B, Stroop Test, CCPT, PASSAT, and Wisconsin Card Sorting Test. A psychologist usually administers these tests so a second consult will be required and the cost is attention getting.

The pilot will also be required to write a statement describing his history of medication use and mental health status.

Once everything above is all completed, a specially trained AME (HIMS trained) must review all the material and make a recommendation for a SI certificate to Oklahoma City. HIMS trained AMEs are part of a program to get pilots who have had drug or alcohol problems back in the cockpit. Unfortunately, there are not many of these specially trained AMEs. (I guess another FAA course is in my future.)

In an unusual twist to all this, pilots who have been taking antidepressants have six months of amnesty to admit their transgressions. Of course, they will be immediately grounded but will not be prosecuted. If pilot are on one of the accepted medications for a year or more, been stable and controlled, then they can apply for an SI by following the above criteria. In that situation and all goes well, the pilot would only be grounded for one to three months. However, if on a non-approved medication, the pilot would have to be switched to an approve one and the twelve month clock would start ticking.

What is the bottom line? Although there are many pilots out there who are taking antidepressant medication, my bet is there will not be many who are forthcoming since no one wants to be grounded for a minimum of three months and possibly permanently if they do not meet all the specifications.

The people who it will help most are pilots to be who have not started the training process because there has been a heretofore locked door prior. With time and experience with pilots flying under this new directive, the FAA may relax some of these requirements especially with regards to renewal of medical certificates.

As one AME wrote to the Federal Air Surgeon six weeks prior to this ruling, maybe the guy who flew into the IRS in Austin might not have if he had been on an antidepressant!