Depression FAA Flight Physical – Many people – pilots included – will struggle with depression at some point in their lives. About 8.4% of people will receive a related diagnosis in their lifetime and about 5% of people are affected by depression at any one time [1]. Symptoms of depression often come hand-in-hand with anxiety. For most purposes related to FAA medical certification, the two are treated in much the same way.
Financial difficulties, career setbacks, divorce, and other personal tragedies can affect people in many different ways. Experiencing decreased energy, sadness, changes in appetite, a decline in your general level of motivation, or other symptoms associated with depression can be a normal part of dealing with a major life stressor.
The FAA recognizes that. If you have recovered from a past period of depression, with or without anxiety, or if you have an active diagnosis of depression that is well controlled, you can still qualify for any class of medical certificate. Their approach is relatively straightforward despite widespread confusion in online forums.
Protecting public safety
While the FAA is more willing than ever to consider clearing pilots with resolved or well-controlled depression, they still take the diagnosis very seriously. About 90% of people who commit suicide suffer from a mental health diagnosis with depression being one of the most common [2]. Those diagnosed with anxiety or depression will statistically die almost eight years earlier than people without the diagnoses and have a mortality rate about 50% higher than the general population [3].
It is no accident that mental health diagnoses account for five of the 15 conditions considered disqualifying by the FAA. They can have a significant impact on aviation safety and, compared to physical ailments, it is extremely difficult to assess the scope of those impacts.
Times are changing
Qualifying for a medical certificate with a history of depression and anxiety used to be so difficult that many pilots simply suffered in silence. While that stigma still exists, the FAA has deliberately relaxed medical certification standards related to depression and anxiety.
There is growing data to support that those who seek treatment for their condition do not pose a significantly increased safety risk [3]. Since at least 2010 when they began certifying pilots who were actively treated with antidepressants, the FAA continues to soften their touch when making medical certification decisions.
Every case is different
Just because their touch is getting softer does not mean a hard line does not exist. Mental health diagnoses still receive closer scrutiny by the FAA than many other conditions. Not only that, because no lab or imaging test can objectively determine the severity of your depression or anxiety, the scrutiny they exercise generally requires careful review of well-crafted treatment notes by your treating physician or a board-certified psychiatrist.
AMEs have very few options when considering your medical certificate application. Unlike many physical diagnoses, making a risk assessment for a pilot with anxiety or depression requires time and deliberation. Still – the FAA being the FAA – has a standardized process.
When and why did it happen?
The first thing they consider is what was going on in your life when you were diagnosed. If you asked for help dealing with the emotional trauma of losing a loved one a decade ago, it will not affect your medical certification whatsoever. If you lost your ability to cope with basic responsibilities because your car door got scratched last week, it will be a different story.
How long did it last?
When it comes to pilots with depression or anxiety, the FAA gives everyone a mulligan. If you had significant symptoms only one time and they resolved within six months of the stressor that precipitated them, your AME can still issue your certificate without additional review by the FAA.
Once you recover from a single episode of adjustment disorder – or situational depression as the FAA refers to it – you can return to flying. If that episode was within the previous five years, your AME will have to review your associated treatment records, but they should not require a dedicated assessment.
For any condition that lasted more than six months or was diagnosed as something other than adjustment disorder, you will need to get a current assessment from a board-certified psychiatrist.
What about medication?
This is one of the more confusing aspects of this whole discussion. Most of that confusion comes from the fact that how the FAA considers your use of medication has much more to do with the diagnoses it was prescribed for than the medication itself.
One concept is simple. If you are still taking medication for your depression or anxiety, you must apply for your medical certificate by using a specially trained HIMS AME. Even then, only Fluoxetine (Prozac), Sertraline (Zoloft), Citalopram (Celexa), Escitalopram (Lexapro), and Bupropion (Wellbutrin) are allowed as treatment options.
If you are no longer taking medication, the FAA still considers the reason it was prescribed very carefully. If you took medication to help with a single episode of adjustment disorder after a major life stressor, your use of medication should not affect your medical. It doesn’t even matter what you took. As long as you stopped taking it more than two months ago and your symptoms have not returned, your AME can issue your certificate.
If you have taken medication on more than one occasion, you’ve dealt with depression or anxiety multiple times during your life, your symptoms lasted longer than six months, or you were diagnosed with something other than adjustment disorder, your AME is powerless. They will have to defer your medical certification to the FAA and you will need to get a current evaluation by a board-certified psychiatrist that explains your situation to the FAA.
Putting it all together
Depression and anxiety will not spare you just because you fly airplanes. As with any medical condition, the first piece of advice we offer everyone is “get treated and get better.” Once you do that, if you can honestly say you are safe to fly, the FAA will probably agree with you. The same applies if you have suffered from depression or anxiety.
Unless you had one episode of adjustment disorder that occurred more than five years ago and lasted for less than six months, you will need to provide your AME and the FAA with well-written notes from your doctor that explain your situation.
If you have been diagnosed with anything other than adjustment disorder, you will most likely need to have an evaluation by a board-certified psychiatrist.
Whether or not you take medications to manage your symptoms matters much less than most people think. If you are still taking medication, you will need to apply for your medical certificate using the HIMS process. But, simply discontinuing a medication only marginally changes the information the FAA will require. You are much better off continuing a medication that controls your symptoms.
Where to get advice
Navigating the FAA medical certification process with a history of depression or anxiety is difficult. The FAA policies contain more nuance and change more frequently than most other conditions. Not only that, the notes your doctors write to support your certification must simply be better than in other cases.
Depending on your situation, finding a good HIMS AME in your area to help with your application may be your only option. The FAA’s Guide for Aviation Medical Examiners also provides instructions on how to approach the issue, but it is written for doctors and can be confusing.
If you’d like more personalized advice unique to your situation, feel free to schedule a free consultation to find out more.
References
[1] M. E. Delphin-Rittmon, “The National Survey on Drug Use and Health: 2020”.
[2] L. Brådvik, “Suicide Risk and Mental Disorders,” Int J Environ Res Public Health, vol. 15, no. 9, p. 2028, Sep. 2018, doi: 10.3390/ijerph15092028.
[3] L. A. Pratt, B. G. Druss, R. W. Manderscheid, and E. R. Walker, “Excess mortality due to depression and anxiety in the United States: results from a nationally representative survey,” Gen Hosp Psychiatry, vol. 39, pp. 39–45, 2016, doi: 10.1016/j.genhosppsych.2015.12.003.
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