Depression and Anxiety in Pilots: A Qualitative Study of SSRI Usage in U.S. Aviation and Evaluation of FAA Standards and Practices Compared to ICAO States

Before 2010, the Federal Aviation Administration (FAA) did not allow airmen to exercise the privileges of pilot in command (PIC) of an aircraft or obtain a medical certificate if one had been diagnosed with anxiety, depression, and/or taking an SSRI medication. Since 2010, the FAA relaxed its views and certification standards. However, this is not an issue unique to the U.S. The International Civil Aviation Organization (ICAO) and other ICAO States began evaluating airmen suffering from anxiety, depression, and/or taking an SSRI medication in early 2000. ICAO and most ICAO States have identified the need for further research regarding mood disorders and airmen. In addition, ICAO has issued guidance regarding certification standards, though each ICAO State has the authority to set its own standards. While the FAA and the other ICAO States have accepted mood disorders in aviation as a reality, additional work is needed to unify standards within the international aviation community. ICAO States with more stringent standards, may force airmen to seek alternative treatment options and not disclose crucial medical information or seek appropriate treatment options in fear of reprisal. In 2018, a qualitative study was conducted that evaluated FAA medical certification standards for airmen suffering from mood disorders and compared them against medical certification standards of other ICAO State agencies and ICAO recommended practices. This qualitative study also evaluated U.S. pilot perceptions of the certification process, as well as views from a non-aviation medical physician using interviews and survey questionnaires. Responses were compared to current practices and evaluated. Findings from this study concluded that while FAA certification standards may be comparable to other ICAO States, general views regarding agency acceptance of mental health disorders can vary widely across State agencies.