FAA Announces Significantly Liberalized Pilot Mental-Health Policy Changes

By ALPA Staff

In the May 29 update to the Guide for Aviation Medical Examiners (AMEs), the FAA announced a new groundbreaking approach to addressing mental-health evaluation criteria for pilots.

As part of this latest revision, the agency identified 11 new conditions that an AME can issue medical certification for, without having to send the pilot’s records to the FAA for review and approval. Previously, diagnoses for these conditions resulted in an automatic medical certification deferral. In essence, the agency has decided to limit its role and empower AMEs, armed with additional guidance, to use their best judgment.

Among the conditions in the anxiety category, acceptable diagnoses include generalized anxiety disorder, situational anxiety, social anxiety disorder, and unspecified anxiety. For depression, acceptable diagnoses include postpartum depression, situational depression, situational anxiety and depression, and unspecified depression. The remaining conditions include obsessive compulsive disorder, posttraumatic stress disorder, and a general category addressing tension related to several kinds of relationship issues.

According to a corresponding table in the guide labeled Uncomplicated Anxiety, Depression, and Related Conditions, All Classes, a pilot can have “up to two listed conditions treated with any combination of psychotherapy (current or historical); medication: a single mental-health medication last taken, prescribed, or recommended two or more years ago. This includes when the treating physician changed medications for better treatment response, provided only one medication was taken at a time and last use was two or more years ago.”

Other conditions resulting in certificate deferral include special issuance of medical certificates for pilots and special-consideration clearance for selective serotonin reuptake inhibitors (SSRIs), recurrent episodes or symptoms, or the diagnosis of a major depressive disorder.

Dr. Quay Snyder, ALPA’s aeromedical advisor, applauds this latest announcement, noting, “The FAA has significantly liberalized pilot mental-health treatment with this change.” Among other improvements, this decision expedites the certification process and reduces the potential for backlogs in these kinds of cases.

Snyder remarks that this announcement is in partial response to the recommendations of the recent Mental Health and Aviation Medical Clearances Aviation Rulemaking Committee (ARC), which both he and Capt. Travis Ludwig (United), ALPA’s Air Safety Organization Pilot Assistance Committee Group chair, continue to be members of through Dec. 4, 2025.

The recent AME guide revision also includes a questionnaire that medical examiners can use to help determine whether pilots with the outlined mental-health conditions are fit to fly. This document contains slight variations of the questions developed for this same purpose by Snyder and other members of the ARC in their recommendations.

Snyder notes that the FAA called a meeting on May 29, with more than 150 AMEs participating via video conference with the FAA’s medical leadership and other subject-matter experts to expound on these modifications. At that time, the agency intimated that additional changes to pilot mental-health policy could be announced as early as September.

Previous Progress

On April 1, the Mental Health and Aviation Medical Clearances ARC issued 24 recommendations to the FAA in response to its mandate to identify and make proposals to address barriers that prevent pilots from reporting and seeking care for mental-health issues. While the recent improvements identifying 11 new conditions that an AME can issue medical certification for are certainly welcome, ALPA continues to push for full adoption of all 24 of its proposals, which included measures like an approach for incentivizing pilot self-disclosure of previously unreported medication use and a reduced minimum wait time for medical certification following the initiation or change to the use of an approved antidepressant.

On April 24, the agency expanded its list of potentially allowable antidepressants for pilots, adding three additional medications: duloxetine (Cymbalta), venlafaxine (Effexor), and desvenlafaxine (Pristiq)—serotonin and norepinephrine reuptake inhibitors (SNRIs) commonly prescribed for depression and anxiety. The FAA also noted that references to these kinds of drugs in its AMEs guide are now addressed as part of the agency’s antidepressant protocol.

Just last year, the agency updated its AME guide to include a norepinephrine-dopamine reuptake inhibitor (NDRI) antidepressant, Bupropion (Wellbutrin ER/SR). In addition, guidance at that time from the agency’s Office of Aerospace Medicine indicated that most pilots who were taking an antidepressant would no longer have to engage in follow-up neuropsychological evaluations, reportedly saving those affected pilots approximately $3,000 in annual medical costs.

These policy changes also represent a monumental shift for the agency because for decades the FAA treated a diagnosis of depression and any corresponding use of psychotropic drugs (i.e., those that treat chemical levels in the brain involved in mental-health disorders) as medically disqualifying.

Pilots who participate in this protocol are evaluated on a case-by-case basis and those authorized for certification are given special-issuance medical certificates. In addition, after being prescribed one of the approved drugs, the FAA mandates a six-month observation period to determine the presence of any side effects and their impact on performance before a pilot can fly again.

Prior to these recent developments, the agency issued a policy statement in 2010 titled “Special Issuance of Airman Medical Certificates to Applicants Being Treated with Certain Antidepressant Medications,” updating the FAA’s long-standing practice of not allowing pilots to use any antidepressant medication. “The FAA has determined that aviators diagnosed with depression taking one of four specific SSRIs may be considered for special issuance of an airman medical certificate,” the policy indicated.

The four medications include Fluoxetine (Prozac), Sertraline (Zoloft), Citalopram (Celexa), and Escitalopram (Lexapro). “Since developed in the 1980s, SSRIs have been used successfully to treat many psychiatric disorders and medical conditions,” the FAA noted. However, these were the last tangible changes to this therapy until last year.

The SNRIs and the NDRI, combined with previously approved SSRIs, now raise the count to eight different antidepressants pilots can take as a part of this treatment regimen and still maintain their medical certification.

Canadian Considerations

Transport Canada considers the use of antidepressant medication on a case-by-case basis. “Every case is considered individually and assessed according to diagnosis, severity of symptoms, pretreatment, medication dosage and type, response to treatment, side effects of medications, and prognosis for recovery or need for prolonged therapy,” the agency observes.

While Transport Canada contemplates a more permanent solution, it acknowledges, “There’s an increasing consensus of medical opinion that it’s possible to allow the use of these medications in aircrew, in circumstances that wouldn’t compromise flight safety or operational effectiveness, and, on the positive side, would allow the preservations of trained aircrew resources.”

The U.S. Centers for Disease Control and Prevention estimates that depression affects approximately 16 million American adults every year and that anxiety is equally prevalent.

Fortunately, the FAA continues to make progress in recognizing that mental fitness requires an open dialogue and a progressive attitude to ensure that pilots feel comfortable disclosing their mental-health conditions. Applying this new narrative, those who can demonstrate they’re fit to fly—both physically and mentally—should be given the chance.

Want Additional Info?

U.S.-based ALPA pilots with questions should contact the Aviation Medicine Advisory Service, ALPA’s Aeromedical Office, Monday–Friday 8:30 a.m. to 4:00 p.m., mountain time. Additional information is available on the AMAS website, including related materials in its medical article database. ALPA members based in Canada should call ALPA Canada’s Aeromedical consultant at 1-800-561-9576 ext. 8312 or visit pilotmd.ca for assistance.

This article was originally published in the June 2024 issue of Air Line Pilot.

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