While activist groups have been trying to raise attention to the issue for years, a number of high-profile incidents have brought pilot mental health to the forefront of both industry and general conversation. The most well-known incident occurred when, in December 2023, an off-duty Alaska Airlines (ALK) pilot with a history of mental illness had taken psychedelic mushrooms and attempted to shut off the engines in the middle of a Horizon Air flight.
At the start of April, the Federal Aviation Administration (FAA) published a 169-page report on the issue of pilot mental health. Recommendations to improve it include everything from creating better avenues for reporting problems without having it affect one's career to expanding the list of approved medication for mental health conditions.
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The FAA took the latter suggestion and ended up adding three antidepressants to the list of those approved for use by pilots and and air traffic controllers. These include general classes of selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) and nonrepinephrine and dopamine reuptake inhibitors (DNRIs) used for treating disorders like depression and anxiety.
FAA approves more antidepressants but says clearance given on 'case by case basis'
In each case, the drugs are approved for conditional use after being prescribed by a doctor and cleared during the independent health evaluation pilots need to go through. Wellbutrin, a DNRI commonly prescribed to treat major depression and seasonal affective disorder, had been approved a year earlier in May 2023.
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"The FAA has determined that pilots or FAA Air Traffic Control Specialists requesting medical certificates while being treated with one of several specific antidepressant medications may be considered," the FAA explains in a press release on the decision. "The Authorization decision is made on a case-by-case basis.”
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'Why would pilots report that if it impacts their livelihood?'
In its instruction manual for pilots who have been prescribed one of these medications, the FAA requires air crew to provide the medical committee "a copy of ALL of your treatment records (no matter how many years have passed) from the time you: sought treatment for any condition" or "had symptoms but were NOT on an SSRI" as well as a "copy of your complete FAA file sent to the [aviation medical examiner] and to a board certified psychiatrist if your treating physician is not a board certified psychiatrist."
Such strict requirements still contribute to the stigma and career setbacks that many pilots say they faced after coming forward with any mental health struggles. Pilots have, in the past, described being fined for not reporting diagnoses earlier or being declared unfit to fly and placed on long periods of evaluation in which they were not bringing in income — a system that discourages coming forward and, in doing so, endangers pilots and passengers alike as it lets more unreported problems fester until they reach a tipping point.
"The paradox is [that] we have this system that we need to self-report if we are struggling with depression or anxiety," Reyné O’Shaughnessy, a captain who founded the Piloting 2 Wellbeing advocacy group, recently told Salon Magazine. "But the paradox is, why would pilots report that if it impacts their livelihood?"
