My Flight Surgeon
Sr. Aviation Medical Examiner
Here is the information guys.
The FAA is limiting consideration of special-issuance medical certificates to these four
medications. Increasingly accepted and prevalently used, these four antidepressants may be used
safely in appropriate cases with proper oversight and have fewer side effects than previous
generations of antidepressants. While the focus of this policy statement is on individuals being
treated for depression, the FAA realizes that these four medications may be used to treat
conditions other than depression. It should be noted, therefore, that, in all instances, the FAA
will continue to consider applicants and make determinations on a case-by-case basis under the
special-issuance process just as it always has.
In addition to treating psychiatrists, AMEs who have specialized training under a
program called the Human Intervention and Motivation Study (HIMS) also will assist the FAA
by making recommendations about certification cases to be considered under this new policy.
The HIMS program is a safety-critical aviation program established nearly 40 years ago. The
program, developed specifically for commercial pilots, was designed as an alcohol and drug
assistance program to coordinate the identification, assessment, treatment, and medical certification
of pilots in need of help. Under HIMS, pilots who successfully meet rigorous FAA protocols may
be returned to duty in accordance with 14 CFR 67.401. The FAA will apply the basic HIMS
evaluation and monitoring approach to this new policy and HIMS AMEs will participate in a
specialized training program tailored to evaluating and monitoring applicants who wish to be
considered under this new policy.
CONSIDERATION FOR SPECIAL ISSUANCE OF A MEDICAL CERTIFICATE
WITH REGARD TO DEPRESSION TREATED WITH MEDICATION
This protocol applies to considerations for special-issuance medical certification for airmen requesting first-, second-, and
third-class special-issuance medical certificates, for the exercise of privilege under 14 CFR Parts 121,135, or 91, who are
being treated with certain antidepressant medications.
Criteria to be Considered:
Diagnoses:
Mild to moderate depressive disorders, such as
1. Major Depressive Disorder (mild to moderate) either single episode or
recurrent episode
2. Dysthymic Disorder
3. Adjustment disorder with depressed mood
Pharmacologic Agents Considered:
(single-agent use only)
1. Fluoxetine (Prozac);
2. Sertraline (Zoloft);
3. Citalopram (Celexa); or
4. Escitalopram (Lexapro)
Specifically Unacceptable diagnoses and or symptoms:
1. Psychosis
2. Suicidal ideation
3. History of electro convulsive therapy (ECT)
4. Treatment with multiple antidepressant medications concurrently
5. History of multi-agent drug protocol use (prior use of other
psychiatric drugs in conjunction with antidepressant medications)
Psychiatric status:
1. All symptoms of the psychiatric condition for which treatment is
indicated must be ameliorated by the single medication and the condition
must be stable with no change in or exacerbation of symptoms for 12
months prior to certification;
2. Airman must be on a stable dosage of medication for a minimum of
12 months prior to certification; and
3. Airman must have no aeromedically significant side effects of
prescribed medication.
Required Reports and Consultations:
(initial consideration)
1. A consultation status report (and follow-up reports as required) from a treating psychiatrist
attesting to and describing the applicant’s diagnosis, length and course of treatment,
dosage of the antidepressant medication taken, and presence of any side effects from the
antidepressant the applicant takes or has taken in the past;
2. A written statement prepared by the applicant describing his or her history of
antidepressant usage and mental health status;
3. A report of the results of neurocognitive psychological tests with provision of the raw
test data: including, but not limited to:
COGSCREEN AE, Trails A/B; Stroop Test;
CCPT, PASSAT, Wisconsin Card Sorting Test;
4. An evaluation and a written report from a HIMS-trained AME who has reviewed items
1., 2., and 3. above and who makes a recommendation for a special-issuance medical
certificate; and
5. Any additional information the Federal Air Surgeon may require to make a determination.
Issued in Washington, DC, on March 26, 2010. .
The FAA is limiting consideration of special-issuance medical certificates to these four
medications. Increasingly accepted and prevalently used, these four antidepressants may be used
safely in appropriate cases with proper oversight and have fewer side effects than previous
generations of antidepressants. While the focus of this policy statement is on individuals being
treated for depression, the FAA realizes that these four medications may be used to treat
conditions other than depression. It should be noted, therefore, that, in all instances, the FAA
will continue to consider applicants and make determinations on a case-by-case basis under the
special-issuance process just as it always has.
In addition to treating psychiatrists, AMEs who have specialized training under a
program called the Human Intervention and Motivation Study (HIMS) also will assist the FAA
by making recommendations about certification cases to be considered under this new policy.
The HIMS program is a safety-critical aviation program established nearly 40 years ago. The
program, developed specifically for commercial pilots, was designed as an alcohol and drug
assistance program to coordinate the identification, assessment, treatment, and medical certification
of pilots in need of help. Under HIMS, pilots who successfully meet rigorous FAA protocols may
be returned to duty in accordance with 14 CFR 67.401. The FAA will apply the basic HIMS
evaluation and monitoring approach to this new policy and HIMS AMEs will participate in a
specialized training program tailored to evaluating and monitoring applicants who wish to be
considered under this new policy.
CONSIDERATION FOR SPECIAL ISSUANCE OF A MEDICAL CERTIFICATE
WITH REGARD TO DEPRESSION TREATED WITH MEDICATION
This protocol applies to considerations for special-issuance medical certification for airmen requesting first-, second-, and
third-class special-issuance medical certificates, for the exercise of privilege under 14 CFR Parts 121,135, or 91, who are
being treated with certain antidepressant medications.
Criteria to be Considered:
Diagnoses:
Mild to moderate depressive disorders, such as
1. Major Depressive Disorder (mild to moderate) either single episode or
recurrent episode
2. Dysthymic Disorder
3. Adjustment disorder with depressed mood
Pharmacologic Agents Considered:
(single-agent use only)
1. Fluoxetine (Prozac);
2. Sertraline (Zoloft);
3. Citalopram (Celexa); or
4. Escitalopram (Lexapro)
Specifically Unacceptable diagnoses and or symptoms:
1. Psychosis
2. Suicidal ideation
3. History of electro convulsive therapy (ECT)
4. Treatment with multiple antidepressant medications concurrently
5. History of multi-agent drug protocol use (prior use of other
psychiatric drugs in conjunction with antidepressant medications)
Psychiatric status:
1. All symptoms of the psychiatric condition for which treatment is
indicated must be ameliorated by the single medication and the condition
must be stable with no change in or exacerbation of symptoms for 12
months prior to certification;
2. Airman must be on a stable dosage of medication for a minimum of
12 months prior to certification; and
3. Airman must have no aeromedically significant side effects of
prescribed medication.
Required Reports and Consultations:
(initial consideration)
1. A consultation status report (and follow-up reports as required) from a treating psychiatrist
attesting to and describing the applicant’s diagnosis, length and course of treatment,
dosage of the antidepressant medication taken, and presence of any side effects from the
antidepressant the applicant takes or has taken in the past;
2. A written statement prepared by the applicant describing his or her history of
antidepressant usage and mental health status;
3. A report of the results of neurocognitive psychological tests with provision of the raw
test data: including, but not limited to:
COGSCREEN AE, Trails A/B; Stroop Test;
CCPT, PASSAT, Wisconsin Card Sorting Test;
4. An evaluation and a written report from a HIMS-trained AME who has reviewed items
1., 2., and 3. above and who makes a recommendation for a special-issuance medical
certificate; and
5. Any additional information the Federal Air Surgeon may require to make a determination.
Issued in Washington, DC, on March 26, 2010. .
