April 2, 2010 -- Pilots taking medication for mild or moderate depression will soon be allowed in the cockpit under new Federal Aviation Administration guidelines that reverse a nearly 70-year ban. Clinically depressed pilots, including those undergoing therapy or prescription treatment, are currently prohibited from flying.
The policy change, which takes effect Monday, was sparked by reduced risk of antidepressant side effects, such as drowsiness, and a need to "change the culture and remove the stigma" associated with the illness, said FAA Administrator Randy Babbitt.
It's also an attempt to get active pilots who need treatment or are already using antidepressants in violation of FAA rules to come clean, making the skies safer in the process.
"In the interest of safety we would much rather have them in a program that's monitored and we know what they're doing," Babbitt said, comparing the initiative to one that targeted alcohol abuse among pilots several years ago.
But allowing pilots who take antidepressants to legally fly an airplane comes with strings attached.
Under the new rules, pilots will be restricted to one of four FAA-approved antidepressants -- Prozac, Zoloft, Celexa and Lexapro -- and required to see a psychiatrist every six months.
Pilots currently taking psychiatric medication will have a six month grace period to admit use and may be grounded temporarily while doctors assess their condition. Those who want to start antidepressant use, however, will be grounded for a full year, until stabilization on the drugs is confirmed.
Antidepressants can sometimes cause fatigue, insomnia, blurred vision, dizziness, and agitation, according to the Mayo Clinic.
"A year seemed the right thing, and I'm trusting that all the medical advice that we've gotten tells us that's the right thing to do," Babbitt said of the decision to keep medicated pilots under observation for 12 months. Pilots who suffer a heart attack or undergo cardiac surgery must wait 6 months before returning to work.
Some experts say the 12 month hiatus is excessive, costing pilots in terms of wages and valuable experience -- and creating a potentially compelling reason for depressed pilots to stay under the radar.
"Pilots are going to take a huge personal sacrifice to acknowledge being depressed and getting treatment," said Dr. Charles Raison, a psychiatry professor at Emory University School of Medicine.
"So I think what's going to happen as a result... is pilots who become depressed are going to be anxious about coming forward," he said. "They're going to fly when they're depressed -- and that is something that does worry me."
Symptoms of major depression, which can be highly debilitating, include increased irritability, insomnia, slowed thinking, decreased concentration, fatigue, trouble making decisions, and suicidal thoughts.
Dr. Gary Miller, an FAA-certified aviation medical examiner, suggested Raison's concern is not entirely unfounded. "My sense is that most people are honest about [disclosing their medical conditions], but you might get a slightly different opinion for a pilot with an air carrier who's invested 20 years in a career there," he said.
FAA Insists Public Safe on Planes With Depressed, Medicated Pilots
Babbitt told ABC News he expects pilots will embrace the program, and at least initially pilots groups have been supportive of the change.
"The Air Line Pilots Association supports a change in FAA policy on antidepressant medications," the group said in a statement. But "we are currently reviewing the FAA's new policy proposal and will comment accordingly."
"Our recommendation was six months [grounded observation]," said Aircraft Owners and Pilots Association spokesman Chris Dancy, "but we're comfortable with the 12 months because it does lay out a path that can get [pilots] back into flying."
Babbitt believes the new policy will also reassure the general public regarding safety.
"People that are in this program are going to be carefully monitored as they go forward," he said. "This is not just a one-stop -- you get this and go on and nobody pays attention."
Medical experts for the most part agree. Second-generation antidepressants, including the four drugs approved by the FAA, are widely believed not to pose risks of sedation or impair cognitive ability.
"I have not seen studies showing that the newer generation of antidepressants affect reaction time to the point where it would affect [a pilot's] flying abilities," said Dr. Murali Doraiswamy, chief of biological psychiatry at Duke University Medical Center.
"Most people that [have depression] are very debilitated by their condition… they describe it as a 'black fog,' an 'anchor' weighing them down," said Doraiswamy. And for many people, "from college professors to airplane pilots to machinery operators and CIA officers," antidepressants can improve quality of life and job performance.
There were more than 600,000 licensed pilots in the U.S. in 2008, according to the FAA. 124,000 fly commercial planes.
By law, pilots are annually required to answer questions about their health, including arrests and convictions for alcohol, and can face penalties for perjury, including revocation of their licenses.
Pilots are forbidden from using narcotics, medication for seizures, anxiety conditions and stimulants, according to an FAA spokeswoman. They're also barred flying after taking over-the-counter medication that might make them drowsy, such as Benadryl or NyQuil.
Under the new rules, depressed pilots consulting a therapist or psychologist instead of taking medication will remain barred from flying while in treatment.
Australian and Canadian aviation guidelines already allow some pilots to fly while taking antidepressant medication.
More than 10 percent of the U.S. population take antidepressants, according to a 2009 Columbia University study, making the drugs the most commonly prescribed class of medication in the country.