Better To Treat Depressed Pilots

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As one AME put it, maybe the guy who flew into the building in Austin would not have if he had been treated with antidepressants.

In a long overdue decision, the FAA has approved the use of four anti-depressant medications (Prozac, Zoloft, Celexa, and Lexapro) for use by pilots with 1st, 2nd, and 3rd class medical certificates. This decision has been based on recommendations from various organizations from the Aerospace Medical Association to the AOPA to the U.S. Army as well as a progressive Federal Air Surgeon and his staff.

There are caveats. The pilot must be stable on the medication for 12 months and must have a letter from the treating psychiatrist attesting to the stability of the condition. Since most people on antidepressants are treated by primary care physicians (PCP), I am not sure whether the FAA will require pilots to see a psychiatrist as a consultant to affirm what the PCP has already stated.

In an interesting twist, the FAA is also offering amnesty to any pilot who is on antidepressants who reports the use within the next six months. However, those pilots will be grounded until they meet the requirements of the new order which I would estimate at four to 12 weeks. The pilots must have been stable on one of the approved medications for 12 months so I am not sure how many pilots will be forthcoming if they are on one of the nonapproved medications and face grounding for a year.

I think this is a good decision. Mild to moderate depression is basically a medical illness with psychological symptoms. Since the advent of selective seratonin re-uptake inhibitors (SSRIs), many with this problem have been treated so successfully that literally their lives were changed.

Pilots are no different. Of all the reasons I have had to deny a pilot medical over 25 plus years, the use of antidepressants has been the number one reason. The depression was well controlled and there were no side effects of the medications.

The use of antidepressants was not going to happen under the previous Federal Air Surgeon whose main psychiatric advisor was dead set against the use of the medications. mostly based on older medications which had lots of side effects and did not work very well. Fortunately, under FAS Dr. Fred Tilton, a much more enlightened approach to medical problems has emerged out of Washington with the support of Dr. Warren Silberman, Chief of Airmen Certification for the FAA's Aerospace Medical Certification Institute. I applaud the Dr. Tilton for his approval of this new policy. In the world of "take no risk" bureaucrats, Dr. Tilton is a star in the FAA.

Comments (9)

While the FAA can be applauded for this long, long overdue action, it remains a bureaucratically-ossified agency that can't seem to comprehend that there's a difference between medicines that "are" mind-altering and those that prevent the mind from becoming altered.

Posted by: Richard Carden | April 5, 2010 10:06 AM    Report this comment

It's about time! Now I'm hoping to see the FAA do away with the third class medical - I understand the exam for commercial operations, but for private pilots I think it's a little ridiculous.

Posted by: Josh Johnson | April 5, 2010 12:19 PM    Report this comment

I also applaud this move. I recall reading that Australia has allowed pilots on antidepressants to fly for some years, reasoning that un-depressed pilots are safer than depressed pilots.
I would have liked the FAA to address SSRIs as a class, however: We use SSRIs for more than depression. They can be used as adjuncts in treating neuritic pain, and in migraine prophylaxis, in patients who do not have a concurrent psychiatric diagnosis. If taking an SSRI for an off-label, i.e., non-psychiatric purpose, I can't see grounding someone...just requiring appropriate medical documentation.

Posted by: Stan Hall | April 5, 2010 1:34 PM    Report this comment

I have suffered from mild depression for many years and stopped taking Zoloft in order to get a pilot medical. I am pleased at this new enlightenment but struggling with the thought that to go back on them would require a twelve month grounding. I'd rather stay off them. That seems a bit of a negative consequence under the circumstances.

Posted by: Randy Walton | April 5, 2010 2:25 PM    Report this comment

The FAA being progressive? Finally. But there is much more to this story especially known by those of us medications have affected.
And the strict proceedures these pilots need to follow? Until you are one of these affected types, you have no idea.
An example. Me.
Many years ago after some rather tramatic experiences, I sought out a psychologist for support. He gave me a antidepressants for a possible means of support. After a number of years and a number of different anitdeppresants, I with approval of my doctor quit them all! Worked on other issues. Now in retrospect over two years later, I can say that antideppresants didn"t work for me and the diagnosis was just a shot in the dark. But I have paid the price as far as flying goes.
As I mentioned, I've been off any and all medications for over 2 years and happily so. But in the meantime I was denied a 3rd class medical, no flying. I finally was able to get the "special issuance" medical. But at what cost? I've been required to send my complete medical history to the FAA. Years worth, at my own expense. Am still required to see a psychiatrist every month without fail, with extensive written records followed up by a annual written report from this same doctor. All at my expense. And it is alot. For what? To insure safety?! This senario is to continue indefinately. It has been a complete waste of my time and money and my doctors just to say, yes I'm still fine. Figure that one out.

Posted by: Mickey Lessley | April 5, 2010 4:05 PM    Report this comment

If only this antidepressant decision had been made a few years earlier, perhaps Steve Fossett would still be alive today. Then again, being grounded for a year definitely isn't something that a lot of pilots can handle.

Posted by: Susan Simmons | April 7, 2010 6:30 AM    Report this comment

The one year experience required will still keep most pilots from going to the doctor and getting the antidepressants. If you have to give up flying for one year most will respond just like the did before this rule.

Plus there are fair amounts of evidence(by other than the drug companies)that show placebos have a greater positive effect than anti-depressants.

Posted by: Roy Zesch | April 7, 2010 10:03 AM    Report this comment

I am curious if anyone knows why paxil is not approved, or for that matter wellbutrin. I believe prozac xoloft paxil are all ssri's and somewhat interchangable to try to find a drug that works best. Wellbutrin is prescribed for smoking cessation in addition to depression.

I agree with Roy that pilots will avoid reporting anti depressant use, both for the reason that he states and for the stigma associated with anything involving psychiatry. Dr. Blue's description: "Mild to moderate depression is basically a medical illness with psychological symptoms." Seems to be an example of the squeamishness that aviation seems to have about this issue. (Couldn't you say that mild to moderate depression is basically a psychological state that is modified by taking a drug that changes brain chemistry?)

Susan's comment is the second time I have someone allude to Steve Fossett's accident as suicide. Why is this?

Posted by: robert miller | April 8, 2010 10:55 AM    Report this comment

Hello to Brent--thanks for your service to EAA Aeromedical Council, and thanks for a good essay. I also fully support the FAA's decision on antidepressant use, because it is fact-based, rational, and humane. It is also politically risky for the agency leadership, and therefore, is courageous. I hope the new policy will be applied in an even-handed way and that it can be sustained in the face of uninformed disparagement by the fear-mongering media. For those of you who pile on against the agency, I can understand because of the personal losses. However, since I started flying in the early 1980s, the agency has made incredible progress in rationalizing aeromedical assessments and certifications-- diabetes, heart disease, and treated alcoholism being the most dramatic. There is room for improvement, but let's recognize the Air Surgeon's office for what they have accomplished. At some point, each of us will have to face the reality of not being fit to fly; the FAA gets to be the bad guy. In my experience with agency medical staff, they get no pleasure whatsoever in delivering the bad news.
Hunter Heath III, M.D.

Posted by: Hunter Heath | April 8, 2010 6:37 PM    Report this comment

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