Guide for Aviation Medical Examiners

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

Antidepressant Protocol Expansion - Effective April 24, 2024:
Additional medications have been added as allowed for special issuance consideration, representing an additional class of antidepressant medications beyond SSRIs. This change, along with the addition of Wellbutrin (a Dopamine/Norepinephrine-Reuptake Inhibitor) on 05/31/2023, has resulted in the FAA’s SSRI Protocol being renamed the Antidepressant Protocol.

PLEASE NOTE: All references to SSRIs, SSRI Protocol, or SSRI program in existing checklists, worksheets, charts, or protocol pages in the AME Guide are considered encompassed in the Antidepressant Protocol and include all conditionally approved medications (PDF).

If you are an Airman taking an SSRI - See the Airman Information - SSRI Initial Certification (PDF) sheet.

If you are an ATCS taking an SSRI - See the FAA ATCS How to Guide (PDF).

The FAA has determined that pilots or FAA Air Traffic Control Specialists (FAA ATCS) requesting medical certificates while being treated with one of several specific antidepressant medications may be considered. The Authorization decision is made on a case-by-case basis. The AME may not issue.

If the airman/FAA ATCS 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 medication 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 individual may be considered for an FAA Authorization of a Special Issuance (SI) or Special Consideration (SC) 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/SC.
  3. The medication used is one of the conditionally acceptable Antidepressant Medications (PDF) (single use only; not in combination).

    If the applicant is on a medication that is not listed in Antidepressant Medications (PDF), the Examiner must advise that the medication is not acceptable for SI/SC.
  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 medication, advise the applicant that he/she must be further evaluated by a Human Intervention Motivation Study (HIMS) AME.

Off Medication for 60 Days:

SSRI Decision Path I (PDF)

Initial Certification:

Recertification/Follow-Up Clearance:

Last updated: Wednesday, April 24, 2024