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SSRI Antidepressants and the Special Issuance Process
The FAA is limiting consideration of special-issuance medical certificates
to these four medications. Increasingly accepted and prevalently used,
these four antidepressants may be used safely in appropriate cases with
proper oversight and have fewer side effects than previous generations of
antidepressants. While the focus of this policy statement is on individuals
being treated for depression, the FAA realizes that these four medications
may be used to treat conditions other than depression. It should be noted,
therefore, that, in all instances, the FAA will continue to consider
applicants and make determinations on a case-by-case basis under the
special-issuance process just as it always has.In addition to treating
psychiatrists, AMEs who have specialized training under aprogram called
the Human Intervention and Motivation Study (HIMS) also will assist the
FAA by making recommendations about certification cases to be
considered under this new policy. The HIMS program is a safety-critical
aviation program established nearly 40 years ago. The program,
developed specifically for commercial pilots, was designed as an alcohol
and drug assistance program to coordinate the identification,
assessment, treatment, and medical certification of pilots in need of help.
Under HIMS, pilots who successfully meet rigorous FAA protocols may be
returned to duty in accordance with 14 CFR 67.401. The FAA will apply the
basic HIMS evaluation and monitoring approach to this new policy and
HIMS AMEs will participate in a specialized training program tailored to
evaluating and monitoring applicants who wish to be considered under
this new policy.
CONSIDERATION FOR SPECIAL ISSUANCE OF A MEDICAL CERTIFICATE
WITH REGARD TO DEPRESSION TREATED WITH MEDICATION
This protocol applies to considerations for special-issuance medical
certification for airmen requesting first-, second-, and third-class
special-issuance medical certificates, for the exercise of privilege under
14 CFR Parts 121,135, or 91, who are being treated with certain
antidepressant medications.
Criteria to be Considered:
Diagnoses:
Mild to moderate depressive disorders, such as
1. Major Depressive Disorder (mild to moderate) either single episode or
recurrent episode
2. Dysthymic Disorder
3. Adjustment disorder with depressed mood
Pharmacologic Agents Considered:(single-agent use only)
1. Fluoxetine (Prozac);
2. Sertraline (Zoloft);
3. Citalopram (Celexa);
4. Escitalopram (Lexapro)
Specifically Unacceptable diagnoses and or symptoms:
1. Psychosis
2. Suicidal ideation
3. History of electro convulsive therapy (ECT)
4. Treatment with multiple antidepressant medications concurrently
5. History of multi-agent drug protocol use (prior use of other psychiatric
drugs in conjunction with antidepressant medications)
Psychiatric status:
1. All symptoms of the psychiatric condition for which treatment is
indicated must be ameliorated by the single medication and the condition
must be stable with no change in or exacerbation of symptoms for 12
months prior to certification;
2. Airman must be on a stable dosage of medication for a minimum of 12
months prior to certification;
3. Airman must have no aeromedically significant side effects of
prescribed medication.
Required Reports and Consultations:(initial consideration)
1. A consultation status report (and follow-up reports as required) from a
treating psychiatrist attesting to and describing the applicant's diagnosis,
length and course of treatment, dosage of the antidepressant medication
taken, and presence of any side effects from the antidepressant the
applicant takes or has taken in the past;
2. A written statement prepared by the applicant describing his or her
history of antidepressant usage and mental health status;
3. A report of the results of neurocognitive psychological tests with
provision of the raw test data: including, but not limited to: COGSCREEN
AE, Trails A/B; Stroop Test; CCPT, PASSAT, Wisconsin Card Sorting Test;
4. An evaluation and a written report from a HIMS-trained AME who has
reviewed items1., 2., and 3. above and who makes a recommendation for
a special-issuance medical certificate;
5. Any additional information the Federal Air Surgeon may require to make
a determination.
We provide Special Issuance services for pilots who are taking the SSRI
antidepressants or require HIMS evaluation and monitoring for drug or
alcohol problems in compliance with the FAA standards.
Contact us at 602-368-5633
The FAA is limiting consideration of special-issuance medical certificates
to these four medications. Increasingly accepted and prevalently used,
these four antidepressants may be used safely in appropriate cases with
proper oversight and have fewer side effects than previous generations of
antidepressants. While the focus of this policy statement is on individuals
being treated for depression, the FAA realizes that these four medications
may be used to treat conditions other than depression. It should be noted,
therefore, that, in all instances, the FAA will continue to consider
applicants and make determinations on a case-by-case basis under the
special-issuance process just as it always has.In addition to treating
psychiatrists, AMEs who have specialized training under aprogram called
the Human Intervention and Motivation Study (HIMS) also will assist the
FAA by making recommendations about certification cases to be
considered under this new policy. The HIMS program is a safety-critical
aviation program established nearly 40 years ago. The program,
developed specifically for commercial pilots, was designed as an alcohol
and drug assistance program to coordinate the identification,
assessment, treatment, and medical certification of pilots in need of help.
Under HIMS, pilots who successfully meet rigorous FAA protocols may be
returned to duty in accordance with 14 CFR 67.401. The FAA will apply the
basic HIMS evaluation and monitoring approach to this new policy and
HIMS AMEs will participate in a specialized training program tailored to
evaluating and monitoring applicants who wish to be considered under
this new policy.
CONSIDERATION FOR SPECIAL ISSUANCE OF A MEDICAL CERTIFICATE
WITH REGARD TO DEPRESSION TREATED WITH MEDICATION
This protocol applies to considerations for special-issuance medical
certification for airmen requesting first-, second-, and third-class
special-issuance medical certificates, for the exercise of privilege under
14 CFR Parts 121,135, or 91, who are being treated with certain
antidepressant medications.
Criteria to be Considered:
Diagnoses:
Mild to moderate depressive disorders, such as
1. Major Depressive Disorder (mild to moderate) either single episode or
recurrent episode
2. Dysthymic Disorder
3. Adjustment disorder with depressed mood
Pharmacologic Agents Considered:(single-agent use only)
1. Fluoxetine (Prozac);
2. Sertraline (Zoloft);
3. Citalopram (Celexa);
4. Escitalopram (Lexapro)
Specifically Unacceptable diagnoses and or symptoms:
1. Psychosis
2. Suicidal ideation
3. History of electro convulsive therapy (ECT)
4. Treatment with multiple antidepressant medications concurrently
5. History of multi-agent drug protocol use (prior use of other psychiatric
drugs in conjunction with antidepressant medications)
Psychiatric status:
1. All symptoms of the psychiatric condition for which treatment is
indicated must be ameliorated by the single medication and the condition
must be stable with no change in or exacerbation of symptoms for 12
months prior to certification;
2. Airman must be on a stable dosage of medication for a minimum of 12
months prior to certification;
3. Airman must have no aeromedically significant side effects of
prescribed medication.
Required Reports and Consultations:(initial consideration)
1. A consultation status report (and follow-up reports as required) from a
treating psychiatrist attesting to and describing the applicant's diagnosis,
length and course of treatment, dosage of the antidepressant medication
taken, and presence of any side effects from the antidepressant the
applicant takes or has taken in the past;
2. A written statement prepared by the applicant describing his or her
history of antidepressant usage and mental health status;
3. A report of the results of neurocognitive psychological tests with
provision of the raw test data: including, but not limited to: COGSCREEN
AE, Trails A/B; Stroop Test; CCPT, PASSAT, Wisconsin Card Sorting Test;
4. An evaluation and a written report from a HIMS-trained AME who has
reviewed items1., 2., and 3. above and who makes a recommendation for
a special-issuance medical certificate;
5. Any additional information the Federal Air Surgeon may require to make
a determination.
We provide Special Issuance services for pilots who are taking the SSRI
antidepressants or require HIMS evaluation and monitoring for drug or
alcohol problems in compliance with the FAA standards.
Contact us at 602-368-5633
