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I don't understand the FAA's policy for psychiatric medications (specifically anti-depressants). Obviously I'm glad there is oversight into who can obtain a pilot's license for the safety of the pilot, crew, passengers, and the people on the ground. And obviously people need to be in a stable condition before they eligible to fly. But some of these rules sound ridiculous to me.

First, they won't approve you to fly while taking a psychiatric medication, but they may approve you to fly if you decide to go off of it for 60 days.

What?

So basically if you have a chronic mental health condition, and you are taking a medication for it, and it's working well without side effects, it's better to go off the medication before you try flying? Wouldn't the disease be more apt to return if you were off the medication, than on it? That sounds like a very stupid risk for the FAA to take.

Are they worried about side-effects? Most of the side effects for modern SSRIs are very limited and/or transient and/or don't apply to flying (like constipation), so I know they can't be worried about those.

Are they just concerned about withdrawals if you miss a dose? That seems pretty unlikely to happen, and probably less likely to cause trouble than to go off meds entirely.

Basically, I don't get it. It seems that if you are fully-treated for a condition without side effects that you should be eligible to fly, regardless of whatever drugs are put in your body. Honestly, I'd be more concerned if people were taking less medications for passing a test, than what they were on before.

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    $\begingroup$ Note that both the anti-depressant medications and the underlying mental illnesses they are meant to treat are disqualifying conditions. So going off medication for 60 days won't lead to an approval if the condition it was treating persists. $\endgroup$
    – BigEndian
    Commented May 27, 2016 at 4:34
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    $\begingroup$ Not familiar with the US way of doing things, but this sounds like you can get a 'special issuance' certificate on anti-depressants: "For a minimum of 6 continuous months prior, the applicant has been clinically stable as well as on a stable dose of medication without any aeromedically significant side effects and/or an increase in symptoms" $\endgroup$
    – Ben
    Commented May 27, 2016 at 10:07
  • $\begingroup$ @BigEndian My point was that even if the condition doesn't persist after 60 days (on medication or not), if it's likely to return at all, it's more likely to return while you're not on medication. Seems like you'd want to error on the side of medication. $\endgroup$
    – Jason
    Commented May 27, 2016 at 18:37
  • $\begingroup$ @Jason And your point is well taken. I agree with your logic. But the FAA does not. See my answer for my best guess as to why. $\endgroup$
    – BigEndian
    Commented May 27, 2016 at 18:55
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    $\begingroup$ I think that the medication rules were created at a time when psychotropic meds were not very common and were mostly used for people with more serious diagnoses, such as bipolar and schizophrenia. Those old meds also had a lot of side effects. The use of newer meds to treat milder conditions has only really been around since the 1990's and the FAA is moving very slow in figuring out how to integrate it safely into the rules. Now that so many people take them they have started to loosen up a bit, approving 6 ssri's for special issuance and sometimes adhd meds. $\endgroup$
    – TomMcW
    Commented May 28, 2016 at 3:32

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The FAA is concerned that individuals taking anti-depressant medication will not have the mental focus required when juggling multiple tasks in real time in the cockpit.

anti-depressant medications are psychotropic -- They are specifically intended to alter the takers' mental state. The assumption is that any artificial modification of mental state will negatively impact aeronautical decision making.

The SSRI special issuance protocol requires, among other things, the applicant to demonstrate the ability to quickly and accurately perform multiple tasks simultaneously. The idea is to make sure that you aren't being slowed down by the medications to the point where you can't make the right decisions rapidly enough to ensure safety of flight.

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