Can pilots take antidepressants? A common reason for an aviation psychiatric evaluation is a pilot who takes, or who has taken, an antidepressant medication.

In 2010, the FAA published a pathway to consider Special Issuance Authorization medical certificates for a pilot who takes an antidepressant.

The FAA’s Antidepressant Decision Path I is where we start, and you can click the picture to go the FAA’s website and see a bigger image.

A few key points:

• The Antidepressant pathway allows consideration for pilots who take one of four SSRIS: fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro), or sertraline (Zoloft). As of 2023, a pilot can also be approved taking sustained-release or extended-release bupropion (Wellbutrin). As of 2024, three more antidepressants were added: duloxetine (Cymbalta), venlafaxine (Effexor), and desvenlafaxine (Pristiq).
• Other antidepressants do not have a Special Issuance pathway.
• It does not matter if the antidepressant was taken for a medical problem. For example, an antidepressants can be used to treat various gastrointestinal problems, premenstrual dysphoria, chronic headaches, and chronic pain. If you take one of these four medications, for any reason at all, you are on the pathway.

The pathways have not been formally renamed yet. The SSRI pathway now should be interpreted to include eight medications, four of which are not SSRIs.

The best pilot is a healthy pilot, and the pilot’s skill and decision making is the aircraft’s most critical piece of safety equipment.

The decision tree for antidepressant cases has too many branches to explore each outcome. But some of the key decision points are:

• What is/was the diagnosis for the antidepressant?
• What kind of symptoms did the pilot have before the antidepressant?
• How effective is/was the medication?
• If the pilot has already quit the medicine, how long did the pilot take the therapy?
• If the pilot has already quit the medicine, how long ago did the prescription lapse?
• Did the antidepressant cause any aeromedically significant side effects?

In a nutshell, the decision on if a pilot takes a antidepressant, or stops an antidepressant, is all about the PROGNOSIS. A prognosis is a prediction, based on facts, epidemiology, and medical judgment. A prognosis is not a testable fact but a prediction of future medical outcomes.