The Bouras Blog

I have been reading about the recent decision of the Federal Aviation Administration (FAA) to lift a ban on antidepressant medications use. Prior policy dictated that if a pilot admitted to having depression or to taking medications for depression could not fly.

This policy change is certainly a step forward in de-stigmatizing the psychiatric/medical illness called depression, but this change also comes with certain restrictions.

Pilots allowed to fly can be treated only with monotherapy (only 1 med) from the following list: Fluoxetine (Prozac), Sertraline (Zoloft), Citalopram (Celexa), or Escitalopram (Lexapro). Once admitted that they take antidepressants, pilots will be grounded while they will be undergoing psychiatric and psychological evaluations, which will take a few months to complete. If they have recently started on one of these medications, they will have to wait for at least 1 year before they can fly.

The FAA claims safety as the reason for the previous ban, from antidepressant side effects such as sedation and seizure, and from the difficulty concentrating that we see with depression.

I understand that safety is very important, especially when one is flying several thousand feet in the air. But according to statistics, about 10% of the population suffers from depression, which account to about 25,000 pilots who have been flying despite an undisclosed diagnosis and treatment of depression. How many airplane incidences have we had due to depression?

Having depression is such a common and treatable illness. It does not have to be something that people need to be secretive about. Recognizing the symptoms, which can include cognitive clouding, and seeking treatment is much healthier than feeling guilty of having symptoms and having to live in secrecy. Actually, being able to talk about depression openly can help attract support and understanding on someone’s feelings and behavior.

We do not have a blood test for depression, yet, something “objective” that tells people that a person is no longer depressed. But, I have seen so many patients who delay receiving treatment due to the stigma and being labeled “crazy” for seeing a psychiatrist, and how they wished they had seeked treatment much sooner that they actually did. I have heard from family and friends how patients who seek and get help for their depression now have their “wife, husband,son, daughter, mother, father, etc…back.”

We need to stop being afraid of psychiatric illness and encourage people from getting help when needed. Getting appropriate diagnosis and treatment is safer than not seeking help for fear of losing your job.