Depression or anxiety treated with an antidepressant
What the FAA's documents say about depression or anxiety treated with an antidepressant, in plain words, with the FAA's own words one press away.
FAA term: Anxiety, Depression, and Related ConditionsCovers: All classes
Short version
The FAA's table sorts it into two rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row AUp to two of the conditions the table lists, treated with psychotherapy past or current, or with a single mental health medication last taken, prescribed or recommended two or more years ago. | Examiner issues | Examiner can issue |
| Row BThe table heads this row All Others. It names being previously on a Special Issuance or Special Consideration for SSRI use; recurrent episodes or symptoms, including multiple failed attempts to discontinue or stay off medication over any period; any history of requiring more than one mental health medication at a time; a diagnosis of Major Depressive Disorder or Persistent Depressive Disorder; and Seasonal Affective Disorder. | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Depression or anxiety treated with an antidepressant
- Row A · Examiner can issue
Up to two of the conditions the table lists, treated with psychotherapy past or current, or with a single mental health medication last taken, prescribed or recommended two or more years ago. The page above the table has the examiner review all Row A criteria, including psychotherapy past and current and the medication history. The table names four situations where this row must not be used and the case goes to Row B instead. It says the examiner should gather information on the diagnosis, severity, treatment and symptoms and address all of the questions on the Anxiety, Depression, and Related conditions Decision Tool for the AME, and, for individuals who were deferred but now may possibly meet all Row A criteria, it has the examiner use the Fast Track Pathway Decision Tool for Currently Deferred Cases. If all items on the decision tool are in the clear, NO column, the examiner may issue, summarising the history and the diagnosis and annotating Block 60; on any yes answer or any concern of the examiner's, the table marks the row DEFER.
Review ALL Row A criteria including psychotherapy (past and current) and medication history. … A. 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 (2) or more years ago. … DO NOT USE THIS ROW IF (go to Row B): … Previously on an SI/SC for SSRI use; … Recurrent episodes or symptoms. If the individual had multiple failed attempts to discontinue or stay off medication(s) over any period; … If the individual has any history of requiring more than ONE mental health medication at a time (e.g., dual or triple therapy); and/or … Diagnosed with Major Depressive Disorder (MDD) or Persistent Depressive Disorder (dysthymia). … The AME should gather information regarding the diagnosis, severity, treatment, symptoms, and address ALL of the questions on the Anxiety, Depression, and Related conditions Decision Tool for the AME. … For individuals who were deferred, but now may possibly meet all Row A criteria, use the Fast Track Pathway Decision Tool for Currently Deferred Cases. … If all items on the decision tool are in the clear, “NO column, the AME may: … ISSUE … Summarize this history, diagnosis, and annotate Block 60: … If any “YES” answers OR Any AME concerns: DEFER
- Row B · Special Issuance
The table heads this row All Others. It names being previously on a Special Issuance or Special Consideration for SSRI use; recurrent episodes or symptoms, including multiple failed attempts to discontinue or stay off medication over any period; any history of requiring more than one mental health medication at a time; a diagnosis of Major Depressive Disorder or Persistent Depressive Disorder; and Seasonal Affective Disorder. The table asks for a current, detailed clinical progress note from a clinic visit with the treating physician or specialist no more than 90 days before the exam, marks the row DEFER, and has the examiner annotate in Block 60 the elements or findings behind it.
B. All Others … Previously on an SI/SC for SSRI use; … Recurrent episodes or symptoms. If the individual had multiple failed attempts to discontinue or stay off medication(s) over any period; … If the individual has any history of requiring more than ONE mental health medication at a time (e.g., dual or triple therapy); … Diagnosed with Major Depressive Disorder (MDD) or Persistent Depressive Disorder (dysthymia); … Seasonal Affective Disorder … Submit a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days before the AME exam. … DEFER Annotate (elements or findings) in Block 60.
- A note on the table, 1
The protocol for antidepressants says all references to SSRIs, the SSRI Protocol or the SSRI program in existing checklists, worksheets, charts or protocol pages in the Guide are considered encompassed in the Antidepressant Protocol and include all conditionally approved medications.
PLEASE NOTE: All references to SSRIs, SSRI Protocol, or SSRI program in existing checklists, worksheets, charts, or protocol pages in the AME Guide are considered encompassed in the Antidepressant Protocol and include all conditionally approved medications.
- A note on the table, 2
The table's first row allows only two of the conditions it lists, and it lists them under anxiety, depression and other, the last including obsessive compulsive disorder, post traumatic stress disorder and the code table items it names.
Row A on the following Anxiety, Depression, and Related Conditions Disposition Table allows only TWO of the following: … Anxiety … Depression … Other … Obsessive Compulsive disorder (OCD) … Post Traumatic Stress Disorder (PTSD) … V code^ (DSM)/Z code (ICD-10) table items
- A note on the table, 3
For a medication change, the table's first row allows it where the treating doctor changed medications for better treatment response, provided only one was taken at a time and the last use was 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.
- A note on the table, 4
Row A's own cell lists its acceptable diagnoses under the heading Uncomplicated: anxiety (generalized anxiety disorder, situational anxiety, social anxiety disorder, unspecified anxiety), depression (postpartum depression, situational depression, situational anxiety and depression, unspecified depression) and other (OCD, PTSD and V code/Z code table items). For situational depression the table says the examiner can use this table or the Situational Depression Disposition Table.
ACCEPTABLE DIAGNOSES: Uncomplicated: 1. Anxiety: • Generalized Anxiety Disorder • Situational anxiety (aka adjustment disorder with anxiety) • Social Anxiety Disorder • Unspecified anxiety 2. Depression: • Postpartum depression • Situational depression* (aka adjustment disorder with depressed mood) • Situational • Anxiety and Depression (adjustment disorder with mixed anxiety and depressed mood) • Unspecified depression … 3. Other: • Obsessive Compulsive disorder (OCD) • Post-Traumatic Stress Disorder (PTSD) • V code^ (DSM)/Z code (ICD-10) table items Note*: For Situational Depression - AME can use this table or the Situational Depression Disposition Table.
*For Situational Depression - AME can also use the Situational Depression Disposition Table.
The FAA pathways for depression or anxiety treated with an antidepressant
Which exam
Which one describes yours?
The FAA's table sorts it these ways. Choose yours to see its plan.
Your step-by-step plan
Step 1: Row A: the Decision Tool
What the examiner addresses for Row A.- Your AME: The examiner addresses all of the questions on the Decision Tool
Show the FAA's words: Row A: the Decision Tool
The AME should gather information regarding the diagnosis, severity, treatment, symptoms, and address ALL of the questions on the Anxiety, Depression, and Related conditions Decision Tool for the AME.
If all items on the decision tool are in the clear, “NO column, the AME may:
ISSUE
Summarize this history, diagnosis, and annotate Block 60:
If any “YES” answers OR Any AME concerns: DEFER
FAA source: Anxiety, Depression, and Related Conditions Disposition Table. FAA date 26 June 2024; checked by Crosscheck 14 October 2026.
Step 2: See your AME
The page above the table has the examiner review all Row A criteria, including psychotherapy past and current and the medication history. The table names four situations where this row must not be used and the case goes to Row B instead. It says the examiner should gather information on the diagnosis, severity, treatment and symptoms and address all of the questions on the Anxiety, Depression, and Related conditions Decision Tool for the AME, and, for individuals who were deferred but now may possibly meet all Row A criteria, it has the examiner use the Fast Track Pathway Decision Tool for Currently Deferred Cases. If all items on the decision tool are in the clear, NO column, the examiner may issue, summarising the history and the diagnosis and annotating Block 60; on any yes answer or any concern of the examiner's, the table marks the row DEFER.Exam day- The page above the table has the examiner review all Row A criteria, including psychotherapy past and current and the medication history. The table names four situations where this row must not be used and the case goes to Row B instead. It says the examiner should gather information on the diagnosis, severity, treatment and symptoms and address all of the questions on the Anxiety, Depression, and Related conditions Decision Tool for the AME, and, for individuals who were deferred but now may possibly meet all Row A criteria, it has the examiner use the Fast Track Pathway Decision Tool for Currently Deferred Cases. If all items on the decision tool are in the clear, NO column, the examiner may issue, summarising the history and the diagnosis and annotating Block 60; on any yes answer or any concern of the examiner's, the table marks the row DEFER.
Show the FAA's words: See your AME
Review ALL Row A criteria including psychotherapy (past and current) and medication history.
A. 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 (2) or more years ago.
DO NOT USE THIS ROW IF (go to Row B):
Previously on an SI/SC for SSRI use;
Recurrent episodes or symptoms. If the individual had multiple failed attempts to discontinue or stay off medication(s) over any period;
If the individual has any history of requiring more than ONE mental health medication at a time (e.g., dual or triple therapy); and/or
Diagnosed with Major Depressive Disorder (MDD) or Persistent Depressive Disorder (dysthymia).
The AME should gather information regarding the diagnosis, severity, treatment, symptoms, and address ALL of the questions on the Anxiety, Depression, and Related conditions Decision Tool for the AME.
For individuals who were deferred, but now may possibly meet all Row A criteria, use the Fast Track Pathway Decision Tool for Currently Deferred Cases.
If all items on the decision tool are in the clear, “NO column, the AME may:
ISSUE
Summarize this history, diagnosis, and annotate Block 60:
If any “YES” answers OR Any AME concerns: DEFER
FAA source: Anxiety, Depression, and Related Conditions Disposition Table. FAA date 26 June 2024; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row AExaminer issuesExaminer can issue
The page above the table has the examiner review all Row A criteria, including psychotherapy past and current and the medication history. The table names four situations where this row must not be used and the case goes to Row B instead. It says the examiner should gather information on the diagnosis, severity, treatment and symptoms and address all of the questions on the Anxiety, Depression, and Related conditions Decision Tool for the AME, and, for individuals who were deferred but now may possibly meet all Row A criteria, it has the examiner use the Fast Track Pathway Decision Tool for Currently Deferred Cases. If all items on the decision tool are in the clear, NO column, the examiner may issue, summarising the history and the diagnosis and annotating Block 60; on any yes answer or any concern of the examiner's, the table marks the row DEFER.
Row BDefers to the FAASpecial Issuance
The table asks for a current, detailed clinical progress note from a clinic visit with the treating physician or specialist no more than 90 days before the exam, marks the row DEFER, and has the examiner annotate in Block 60 the elements or findings behind it.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Examiner can issue
Up to two of the conditions the table lists, treated with psychotherapy past or current, or with a single mental health medication last taken, prescribed or recommended two or more years ago. The page above the table has the examiner review all Row A criteria, including psychotherapy past and current and the medication history. The table names four situations where this row must not be used and the case goes to Row B instead. It says the examiner should gather information on the diagnosis, severity, treatment and symptoms and address all of the questions on the Anxiety, Depression, and Related conditions Decision Tool for the AME, and, for individuals who were deferred but now may possibly meet all Row A criteria, it has the examiner use the Fast Track Pathway Decision Tool for Currently Deferred Cases. If all items on the decision tool are in the clear, NO column, the examiner may issue, summarising the history and the diagnosis and annotating Block 60; on any yes answer or any concern of the examiner's, the table marks the row DEFER.
Review ALL Row A criteria including psychotherapy (past and current) and medication history. … A. 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 (2) or more years ago. … DO NOT USE THIS ROW IF (go to Row B): … Previously on an SI/SC for SSRI use; … Recurrent episodes or symptoms. If the individual had multiple failed attempts to discontinue or stay off medication(s) over any period; … If the individual has any history of requiring more than ONE mental health medication at a time (e.g., dual or triple therapy); and/or … Diagnosed with Major Depressive Disorder (MDD) or Persistent Depressive Disorder (dysthymia). … The AME should gather information regarding the diagnosis, severity, treatment, symptoms, and address ALL of the questions on the Anxiety, Depression, and Related conditions Decision Tool for the AME. … For individuals who were deferred, but now may possibly meet all Row A criteria, use the Fast Track Pathway Decision Tool for Currently Deferred Cases. … If all items on the decision tool are in the clear, “NO column, the AME may: … ISSUE … Summarize this history, diagnosis, and annotate Block 60: … If any “YES” answers OR Any AME concerns: DEFER
- Row B · Special Issuance
The table heads this row All Others. It names being previously on a Special Issuance or Special Consideration for SSRI use; recurrent episodes or symptoms, including multiple failed attempts to discontinue or stay off medication over any period; any history of requiring more than one mental health medication at a time; a diagnosis of Major Depressive Disorder or Persistent Depressive Disorder; and Seasonal Affective Disorder. The table asks for a current, detailed clinical progress note from a clinic visit with the treating physician or specialist no more than 90 days before the exam, marks the row DEFER, and has the examiner annotate in Block 60 the elements or findings behind it.
B. All Others … Previously on an SI/SC for SSRI use; … Recurrent episodes or symptoms. If the individual had multiple failed attempts to discontinue or stay off medication(s) over any period; … If the individual has any history of requiring more than ONE mental health medication at a time (e.g., dual or triple therapy); … Diagnosed with Major Depressive Disorder (MDD) or Persistent Depressive Disorder (dysthymia); … Seasonal Affective Disorder … Submit a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days before the AME exam. … DEFER Annotate (elements or findings) in Block 60.
If the examiner defersSpecial Issuance
For an initial packet the examiner must submit the exam as deferred.
If this is a first-time application for an AASI for this condition, and the pilot has all the medical information needed for a determination, the examiner must defer and submit all the documentation to the AMCD or RFS for the initial determination.
What the FAA lists to send
- Item 1. All treatment records, no matter how many years have passed, from the time the pilot sought treatment for any condition that required an SSRI or psychiatric medication, or had symptoms but was not on an SSRI.
- Item 2. A complete package with all items on the HIMS examiner's checklist, sent to the FAA within 14 days.
- Item 3. While the exam is under review, continue submitting Air Traffic Manager (ATCS) reports every three months, and the HIMS examiner evaluations and treating psychiatrist reports every six months.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
For an initial packet the examiner must submit the exam as deferred.
The AME must submit your exam as DEFERRED.
- Reason 2
If this is a first-time application for an AASI for this condition, and the pilot has all the medical information needed for a determination, the examiner must defer and submit all the documentation to the AMCD or RFS for the initial determination.
If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all the documentation to the AMCD or RFS for the initial determination.
What the FAA lists to send
- Item 1
All treatment records, no matter how many years have passed, from the time the pilot sought treatment for any condition that required an SSRI or psychiatric medication, or had symptoms but was not on an SSRI.
Provide the HIMS AME with a copy of ALL of your treatment records (no matter how many years have passed) from the time you: … Sought treatment for any condition that required an SSRI or psychiatric medication or … Had symptoms but were NOT on an SSRI
- Item 2
A complete package with all items on the HIMS examiner's checklist, sent to the FAA within 14 days.
Coordinate with your AME to make sure that ALL ITEMS LISTED on the AME Checklist and a COMPLETE package is sent to the FAA at the address below WITHIN 14 DAYS.
- Item 3
While the exam is under review, continue submitting Air Traffic Manager (ATCS) reports every three months, and the HIMS examiner evaluations and treating psychiatrist reports every six months.
While your exam is under review, continue to submit your Air Traffic Manager (ATCS) reports EVERY 3 months AND your HIMS AME evaluations and treating psychiatrist reports EVERY 6 months.
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workAt later examsAASI
The disposition table for anxiety, depression and related conditions is headed All Classes.
Show the FAA's words: how often the FAA asks again
ANXIETY, DEPRESSION, AND RELATED CONDITIONS All Classes
Under an FAA Authorization stating the AASI path has been approved, the sheet lists what the pilot brings for the examiner to reissue. That is the Authorization, all interim detailed clinical progress notes with the most recent no more than 90 days before the exam, and the PATH Status Summary completed by the treating physician and the examiner.
Show the FAA's words: at later exams
AMEs may re-issue an airman medical certificate under the provisions of an Authorization if the applicant provides all the following: … 1. An Authorization granted by the FAA that states that AASI PATH has been approved; … 2. All interim Detailed Clinical Progress Notes (DCPN). … The most recent clinical progress note must be no more than 90 days before the AME exam; … 3. Anxiety, Depression, and Related Conditions PATH Status Summary completed by the treating physician and AME.
What AASI is
AASI stands for AME Assisted Special Issuance. The Guide describes it as a process that lets the examiner reissue a certificate under the provisions of an Authorization for Special Issuance, to an applicant who has a medical condition that is disqualifying under 14 CFR part 67.
How the FAA pathways workAn Authorization stating the AASI path is approved
For a reissue, the AASI sheet's first item is an Authorization granted by the FAA that states the AASI path has been approved.
Show the FAA's words: An Authorization stating the AASI path is approved
1. An Authorization granted by the FAA that states that AASI PATH has been approved;
The interim progress notes
The AASI sheet asks for all interim detailed clinical progress notes, at a minimum every six months or more often as clinically indicated, from a clinic visit with a treating physician or an extender, with at least one of those six-month visits coming from a physician, and the most recent note dated no more than 90 days before the exam.
Show the FAA's words: The interim progress notes
2. All interim Detailed Clinical Progress Notes (DCPN). At a MINIMUM, this must include: … EVERY 6 months (or more often as clinically indicated), progress notes from a clinic visit with a treating physician (MD/DO) or extender (PA-C/NP/midlevel); … At least one of these 6-month visits (and corresponding progress note) must come from a physician (MD/DO), such as a Primary Care Physician or Psychiatrist. … The most recent clinical progress note must be no more than 90 days before the AME exam;
What each progress note contains
The AASI sheet lists what a detailed clinical progress note includes.
Show the FAA's words: What each progress note contains
Detailed Clinical Progress Notes must include a detailed interim summary; current medications, dosages, and side effects (if any); any changes in medication dose or type since the last visit; physical exam findings; results of all testing performed; diagnosis; assessment and plan (prognosis); and follow-up; and
The PATH Status Summary
The AASI sheet asks for the Anxiety, Depression, and Related Conditions PATH Status Summary, completed by the treating physician and the examiner.
Show the FAA's words: The PATH Status Summary
3. Anxiety, Depression, and Related Conditions PATH Status Summary completed by the treating physician and AME.
When the examiner defers a reissue
The sheet has the examiner defer, and describe in Block 60 what caused it, where the psychiatrist, treating physician or examiner identifies any new yes answer on the status summary, any new or not previously reported psychiatric symptom, sign or diagnosis, any new history of substance use disorder or FAA substance dependence, or any progression of the disease (a change in symptoms that persist despite modifications to medication and/or therapy), or where the examiner, treating physician or treating provider has concerns.
Show the FAA's words: When the examiner defers a reissue
AME must defer and describe in Block 60 what item(s) caused the deferral if the psychiatrist, treating physician, or AME identifies any of the following: … Any NEW “Yes*” answers on the PATH Status Summary; … Any new (or not previously reported) psychiatric symptoms, signs, or diagnosis; … Any new history of substance use disorder or FAA substance dependence; … Any progression (change in symptoms that persist despite modifications to medication and/or therapy) of the disease; and/or … AME, treating physician, or treating provider has concerns.
Good to know
Points from the FAA's own documents that are easy to miss.
The Fast Track Pathway Decision Tool for currently deferred cases
The FAA's Fast Track Pathway Decision Tool for currently deferred cases tells the examiner that such a pilot may now be considered under Row A of the disposition table. The examiner completes the tool and uploads it.
Show the FAA's words: good to know, 1
FAST TRACK PATHWAY Decision Tool for Current Deferred Cases … AME instructions: If a pilot was previously deferred for anxiety, depression, or related conditions they MAY now qualify for consideration per Row A of the Anxiety, Depression, and Related Conditions Disposition Table (published 05/29/2024). Complete the following and upload into AMCS:
The diagnoses the decision tool names
The decision tool asks whether the individual has 3 or more of the conditions or diagnoses it lists as the reason for deferral. Its list covers several kinds of anxiety and depression, OCD, PTSD, and code-table items: uncomplicated bereavement, relationship distress with a spouse or partner, a parent-child problem, and problems adjusting to a major life change. The tool says the examiner must verify that all items fall into the NO (clear) column to use the fast track pathway; if any item falls into the YES column, the individual does not qualify for it.
Show the FAA's words: good to know, 2
A. Diagnosis: Does the individual have 3 or more of the following conditions/ diagnosis as the reason for deferral? … Unspecified anxiety … Generalized Anxiety Disorder … Situational anxiety (also called adjustment disorder with anxiety) … Social Anxiety Disorder … Unspecified depression … Postpartum depression … Situational depression* (also called adjustment disorder with depressed mood) … Situational Anxiety and Depression (adjustment disorder with mixed anxiety and depressed mood) … Obsessive Compulsive disorder (OCD) … Post Traumatic Stress Disorder (PTSD) … V code^ (DSM)/Z code (ICD-10) table items … Uncomplicated Bereavement; … Relationship distress with spouse or intimate partner; … Parent-Child relational problem; and/or … Phase of Life Problem (problems adjusting to major life transitions such as newly retired, getting married, empty-nest, new career, becoming a parent, etc.
The AME who submitted the exam must verify that ALL items fall into the “NO”/CLEAR COLUMN to use this FAST TRACK pathway. If any items fall into the “YES” column, STOP. The individual does not qualify for the FAST TRACK pathway.
Past use of an unlisted antidepressant
The decision tool's note says historic use of an antidepressant not on its list does not exclude this pathway.
Show the FAA's words: good to know, 3
Note: Historic use of an antidepressant not on the above list does not exclude this pathway.
Further questions the decision tool asks
The decision tool also asks about any treatment ever with antipsychotics, benzodiazepines, mood stabilizers or stimulants; suicidal or homicidal thoughts, attempts or self-harm, ever; an involuntary mental health or substance use evaluation or transport, or court-ordered treatment; and any other mental health diagnosis or symptoms.
Show the FAA's words: good to know, 4
D. Do Not Issue/Do Not Fly Medications: Has the individual ever been treated with: … Antipsychotics (neuroleptics) … Benzodiazepines … Mood stabilizers (lithium, anti-epileptics) … Stimulants … Does the individual have any additional mental health diagnosis or symptoms such as bipolar disorder, psychosis, neuro-developmental disorder, autism, personality disorder, somatoform disorder, impulse control disorders, substance misuse or disorder, eating disorder, or any diagnosis NOT listed as acceptable? … Any history of suicidal (or homicidal) ideation, attempt(s), or self-harm behavior (such as cutting) ever in their life? … Any history of an involuntary mental health or substance use evaluation (including involuntary transport) and/or court-ordered treatment?
Stopping the medication has its own clock
If the airman stops the medication, the examiner notes it in Block 60 and defers. To reapply for regular issuance, the applicant must be off it at least 60 days, with the treating physician's favorable report of stable mood and no aeromedically significant side effects.
Show the FAA's words: good to know, 5
If the airman/FAA ATCS opts to discontinue use of the SSRI, the Examiner must notate in Block 60, Comments on History and Findings, on FAA Form 8500-8 and defer issuance. To reapply for regular issuance, the applicant must be off the medication for a minimum of 60 days with a favorable report from the treating physician indicating stable mood and no aeromedically significant side effects.
The examiner may not issue while you are treated with one of several specific antidepressant medications
The Guide's page on antidepressant medications says pilots requesting medical certificates while being treated with one of several specific antidepressant medications may be considered; the Authorization decision is made case by case, and the examiner may not issue.
Show the FAA's words: good to know, 6
The FAA has determined that pilots or FAA Air Traffic Control Specialists (FAA ATCS) requesting medical certificates while being treated with one of several specific antidepressant medications may be considered. The Authorization decision is made on a case-by-case basis. The AME may not issue .
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 7
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
The SSRI Protocol is now the Antidepressant Protocol
An expansion effective 24 April 2024 added antidepressants beyond SSRIs for special issuance consideration; with Wellbutrin (added 31 May 2023), this led to the rename. All SSRI references in the Guide are considered part of the Antidepressant Protocol and include all conditionally approved medications.
Show the FAA's words: good to know, 8
Antidepressant Protocol Expansion - Effective April 24, 2024: Additional medications have been added as allowed for special issuance consideration, representing an additional class of antidepressant medications beyond SSRIs. This change, along with the addition of Wellbutrin (a Dopamine/Norepinephrine-Reuptake Inhibitor) on 05/31/2023, has resulted in the FAA's SSRI Protocol being renamed the Antidepressant Protocol.
PLEASE NOTE: All references to SSRIs, SSRI Protocol, or SSRI program in existing checklists, worksheets, charts, or protocol pages in the AME Guide are considered encompassed in the Antidepressant Protocol and include all conditionally approved medications.
What the three months means
The airman sheet's three months means stable, with no symptoms or side effects, on the same dose for three months, and this must be documented.
Show the FAA's words: good to know, 9
When you have been stable with no symptoms or side effects and on the same dose of medication for 3 months (this must be documented)
All treatment records, however old
The airman sheet asks for all treatment records, however many years old, from when the pilot sought treatment for any condition that required an SSRI or psychiatric medication, or had symptoms but was not on an SSRI. It notes the SSRI term is now Antidepressant.
Show the FAA's words: good to know, 10
Provide the HIMS AME with a copy of ALL of your treatment records (no matter how many years have passed) from the time you: … Sought treatment for any condition that required an SSRI or psychiatric medication or … Had symptoms but were NOT on an SSRI
Note: SSRI term updated to “Antidepressant”
Other conditions go to the HIMS examiner too
The airman sheet says to also tell the HIMS examiner about any other medical conditions at this time. The examiner should be able to help identify and collect what a CACI or Special Issuance for them will need.
Show the FAA's words: good to know, 11
At this time, make sure you also tell your HIMS AME about any other medical conditions you may have. They should be able to help you identify and collect the information that will be needed for a CACI/Special Issuance for these other conditions .
One reissue visit must be with a physician
On a reissue, at least one of the six-month visits, with its progress note, must be with a physician (MD/DO). The most recent progress note must be no more than 90 days before the exam.
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At least one of these 6-month visits (and corresponding progress note) must come from a physician (MD/DO), such as a Primary Care Physician or Psychiatrist. … The most recent clinical progress note must be no more than 90 days before the AME exam;
Recertification has its own documents
For recertification, the airman sheet points to the HIMS AME Checklist – SSRI Recertification/Follow-up Clearance. The Guide's page on antidepressant medications lists the recertification and follow-up documents. These are SSRI Recertification - Neuropsychological Report Changes and FAQs (policy change 12/15/2022), the Airman SSRI Follow-Up Path for the HIMS AME, the FAA ATCS SSRI Follow-Up Path for the HIMS AME, the HIMS AME Checklist and the FAA Certification Aid for SSRI Recertification/Follow-Up Clearance, the HIMS AME Change Request, and the Specifications for Neuropsychological Evaluations for Treatment with SSRI Medications.
Show the FAA's words: good to know, 13
For RECERTIFICATION, see the HIMS AME Checklist – SSRI Recertification/ Follow-up Clearance.
Recertification/Follow-Up Clearance: SSRI Recertification - Neuropsychological Report Changes and FAQs ( PDF ) (Policy change 12/15/2022) Airman SSRI Follow-Up Path for the HIMS AME FAA ATCS SSRI Follow-Up Path for the HIMS AME ( PDF ) HIMS AME Checklist - SSRI Recertification/Follow-Up Clearance ( PDF ) FAA Certification Aid - SSRI Recertification/Follow-Up Clearance ( PDF ) HIMS AME Change Request ( PDF ) Specifications for Neuropsychological Evaluations for Treatment with SSRI Medications ( PDF )
The examiner notifies the FAA of a significant deterioration
The AASI sheet says the examiner must notify the FAA Aeromedical Certification Division (405-954-4821) if there is a significant clinical deterioration in cognition, judgment, emotional stability, or insight; the sheet prints it as "my client's".
Show the FAA's words: good to know, 14
The AME must notify the FAA Aeromedical Certification Division (405-954-4821) if there is a significant clinical deterioration in my client's cognition, judgment, emotional stability, or insight.
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
- Airman Information – SSRI Initial CertificationOpen to print: Airman Information – SSRI Initial Certification, a PDF at the FAA, in a new tab
Special Issuance
- AASI for Anxiety, Depression, and Related ConditionsOpen to print: AASI for Anxiety, Depression, and Related Conditions, a PDF at the FAA, in a new tab
The sheet the examiner follows to reissue under an FAA Authorization.
AASI
- Anxiety, Depression, and Related Conditions Disposition TableOpen to print: Anxiety, Depression, and Related Conditions Disposition Table, a PDF at the FAA, in a new tab
Examiner can issue
- Open at the FAA: Protocol for Antidepressant Medications, a PDF at the FAA, in a new tab
- Open at the FAA: Antidepressants, a page at the FAA, in a new tab
- Open at the FAA: Antidepressant Medications (table), a PDF at the FAA, in a new tab
- Open at the FAA: Pilot Information – What a Detailed Clinical Progress Note must contain, a PDF at the FAA, in a new tab
- Open at the FAA: Exam Techniques – Item 47, Use of Antidepressant Medications, a page at the FAA, in a new tab
- Open at the FAA: Anxiety, Depression, and Related Conditions – Fast Track Pathway, a PDF at the FAA, in a new tab
Related conditions
Each has its own page, with what the FAA's documents say about it.
Medication guidance
Medications Crosscheck lists as taken for depression or anxiety treated with an antidepressant, each with its own page on what published FAA guidance says about it.
- NDRI antidepressant
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.