Decision Considerations - Aerospace Medical Dispositions
Item 47. Psychiatric Conditions - Use of Antidepressant Medications

The FAA has determined that airmen requesting first, second, or third class medical certificates while being treated with one of four specific selective serotonin reuptake inhibitors (SSRIs) may be considered. The Authorization decision is made on a case by case basis. The Examiner may not issue.

If the applicant opts to discontinue use of the SSRI, the Examiner must notate in Block 60, Comments on History and Findings, on FAA Form 8500-8 and defer issuance. To reapply for regular issuance, the applicant must be off the SSRI for a minimum of 60 days with a favorable report from the treating physician indicating stable mood and no aeromedically significant side effects. See SSRI Decision Path I (PDF).

An applicant may be considered for an FAA Authorization of a Special Issuance (SI) of a Medical Certificate (Authorization) if:

  1. The applicant has one of the following diagnoses:
    • Major depressive disorder (mild to moderate) either single episode or recurrent episode
    • Dysthymic disorder
    • Adjustment disorder with depressed mood
    • Any non-depression related condition for which the SSRI is used

  2. For a minimum of 6 continuous months prior, the applicant has been clinically stable as well as on a stable dose of medication without any aeromedically significant side effects and/or an increase in symptoms. If the applicant has been on the medication under 6 months, the Examiner must advise that 6 months of continuous use is required before SI consideration.

  3. The SSRI used is one the following (single use only):
    • Fluoxetine (Prozac)
    • Sertraline (Zoloft)
    • Citalopram (Celexa)
    • Escialopram (Lexapro)

    If the applicant is on a SSRI that is not listed above, the Examiner must advise that the medication is not acceptable for SI consideration.

  4. The applicant DOES NOT have symptoms or history of:
    • Psychosis
    • Suicidal ideation
    • Electro convulsive therapy
    • Treatment with multiple SSRIs concurrently
    • Multi-agent drug protocol use (prior use of other psychiatric drugs in conjunction with SSRIs.)

If applicant meets the all of the above criteria and wishes to continue use of the SSRI, advise the applicant that he/she must be further evaluated by a Human Intervention Motivation Study (HIMS) AME. See SSRI Decision Path II (HIMS AME) (PDF).

The HIMS AME will also conduct the follow up evaluation after initial issuance. See SSRI Follow Up Path for the HIMS AME (PDF).

For further details, see: