Aeromedical regulation of aviators using selective serotonin reuptake inhibitors for depressive disorders

This report, prepared at the request of the Aerospace Medical Association (AsMA), reviews the present status of aeromedical regulation of depressive disorders and antidepressant medications, emphasizing the role of serotonin specific reuptake inhibitors (SSRIs). Aeromedical certifying authorities (CAs) generally prohibit pilots from flying with a diagnosed depressive disorder, and also prohibit flying while taking antidepressant medications, including SSRIs. Some CAs are reassessing these prohibitions, which are based on long aeromedical practices, in view of changing medical management of depressive disorders. Many pilots choose to fly while depressed, with or without medications, because of the long grounding periods mandated by current policies. Some SSRIs have very few aeromedically significant side effects. Modern psychiatric practice calls for long-term use of medication following clinical recovery from depressive disorders in order to prevent recurrent episodes. Given these and other factors, AsMA proposes that CAs remove the current absolute prohibitions against pilots flying while taking SSRIs, and adopt aeromedical protocols that include carefully controlled follow-up and review. AsMA urges all certificatory and regulatory authorities to consider immediately instituting a policy of using study groups to manage depressed aviators who require SSRI antidepressants. Protocols designed to aggressively manage the full spectrum of adverse possibilities related to SSRI use may enable the safe use of SSRIs in formerly depressed aviators who suffer no aeromedically significant side effects. In these closely managed cases of depressive disorders, special issuances or waivers for SSRI use are justified.