FAA Office of Aerospace Medicine
Civil Aerospace Medical Institute

Report No: DOT/FAA/AM-14/11

Title and Subtitle: Tricyclic Antidepressants Found in Pilots Fatally Injured in Civil Aviation AccidentsTricyclic Antidepressants Found in Pilots Fatally Injured in Civil Aviation Accidents

Report Date: November 2014

Authors: Dulkadir Z, Chaturvedi AK, Craft KJ, Hickerson JS, Cliburn KD

Abstract: Since the 1950s, tricyclic antidepressants (TCAs) have been used for treating depression. The prevalence of this group of antidepressants in the pilot population has not been explored. Therefore, the National Transportation Safety Board (NTSB) aviation accident and the Federal Aviation Administration's Civil Aerospace Medical Institute (CAMI) toxicology and medical certification databases were searched for the necessary information related to pilots fatally injured in aviation accidents.

During 1990-2012, CAMI received biological samples of fatally injured pilots from 7,037 aviation accidents for toxicological evaluation. Of these, 2,644 cases (pilot fatalities) were positive for drugs. TCAs were present in 31 pilot fatalities. Only TCAs were found in nine cases; in addition to TCAs, other substances were also present in the remaining 22 cases. Blood samples were available for TCA analysis in only 17 cases. TCA blood concentrations ranged from therapeutic to toxic levels.

The NTSB determined that the use of drugs and ethanol as the probable cause or contributing factor in 35% (11 of 31) of the accidents, and six pilots had taken TCAs, as documented in their personal medical records and histories obtained by the NTSB. None of the 31 pilots reported the use of TCAs during their aviation medical examination, though 45% of them did report other drugs.

The present study disclosed that the prevalence of TCAs in aviators was less than 0.5% (31 of 7,037 cases). This study suggests that aviators should fully disclose the use of medications at the time of their aviation medical examination for the improvement of aviation safety.

Key Words: Forensic Sciences, Toxicology, Pilot Fatalities, Tricyclic Antidepressants, Depression, Aviation Accident Investigation

No. of Pages: 13