FAA's Anxiety and Depression Fast Track: How to Avoid a Deferral

Updated September 2026. Every FAA requirement below comes from the FAA's current Guide for Aviation Medical Examiners.

If you've ever seen a counselor for anxiety, gone through a hard stretch after a loss, or been treated for depression after having a baby, you may be worried that your next FAA medical exam will end in a deferral. For years, many pilots with even mild, long-resolved mental health history ended up waiting on an FAA review. That changed in 2024.

The FAA published the Anxiety, Depression, and Related Conditions Disposition Table on May 29, 2024. It gives your Aviation Medical Examiner (AME) a clear path to issue your certificate at your exam for uncomplicated cases. The FAA also created a Fast Track Pathway for pilots who were already deferred for these conditions.

What the pathway actually is

There are three FAA documents you should know about. All three are linked from the AME Guide's Item 47 Psychiatric Conditions page.

• The Anxiety, Depression, and Related Conditions Disposition Table (updated 06/26/2024). Row A covers uncomplicated cases the AME can issue. Row B covers everything else, which the AME must defer.
• The Anxiety, Depression, and Related Conditions Decision Tool for the AME (updated 09/25/2024). It has 9 screening questions the AME must go through with you.
• The Fast Track Pathway Decision Tool for Current Deferred Cases (updated 09/25/2024). If you were deferred in the past, your AME uses this to ask the FAA to reconsider you under Row A.

Strictly speaking, the FAA uses the Fast Track Pathway name only for already-deferred cases. The in-office path is Row A of the disposition table. The criteria are nearly the same.

Who qualifies for Row A

Row A is for uncomplicated anxiety, depression, and related conditions. You can have up to two of the conditions the FAA lists. If you have three or more, you don't qualify.

Conditions the FAA lists

• Anxiety: generalized anxiety disorder, situational anxiety (adjustment disorder with anxiety), social anxiety disorder, or unspecified anxiety
• Depression: postpartum depression, situational depression (adjustment disorder with depressed mood), adjustment disorder with mixed anxiety and depressed mood, or unspecified depression
• Other: obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD)
• Life events recorded as a DSM V code or ICD-10 Z code, including but not limited to uncomplicated bereavement, relationship distress with a spouse or intimate partner, a parent-child relational problem, or a phase of life problem such as retiring, getting married, starting a new career, or becoming a parent

Treatment history that still fits

Row A lets you have been treated with psychotherapy, now or in the past. Therapy is not held against you. The FAA's own therapy and counseling FAQs (updated 05/27/2026) say pilots are encouraged to seek help early, and that therapy is compatible with an unrestricted medical certificate.

Row A also allows past medication, within limits. You can have used a single mental health medication, as long as it was last taken, prescribed, or recommended two or more years ago. If your doctor switched you from one medication to another for a better response, that still counts, provided you only ever took one at a time and your last use was at least two years ago.

When you can't use Row A

The disposition table says not to use Row A, and to go to Row B instead, if any of these apply to you.

• You were previously on a Special Issuance for SSRI use
• You've had recurrent episodes or symptoms, including multiple failed attempts to stop or stay off medication
• You've ever needed more than one mental health medication at a time, such as dual or triple therapy
• You've been diagnosed with major depressive disorder (MDD) or persistent depressive disorder (dysthymia)

Row B also covers seasonal affective disorder. The Fast Track Pathway tool for deferred cases also lists it as a stop.

The 9 questions your AME will ask

The Decision Tool for the AME has exactly 9 questions. Your AME must address each one during your exam and history review. To issue under Row A, every answer has to be no. If any single answer is yes, the AME must defer, and the report has to explain why.

• Do you have any other mental health diagnosis or symptoms, such as bipolar disorder, psychosis, a neurodevelopmental disorder, autism, a personality disorder, a somatoform disorder, an impulse control disorder, substance misuse or a substance use disorder, an eating disorder, or any diagnosis not listed as acceptable? ADHD that doesn't meet the FAA's ADHD Fast Track requirements counts as not acceptable.
• Have you ever had suicidal or homicidal ideation, a suicide attempt, or self-harm behavior at any point in your life?
• Have you ever had an involuntary mental health or substance use evaluation, including involuntary transport, or court-ordered treatment?
• Have you ever had electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), ketamine, or psychedelic therapy?
• Have you ever been hospitalized for a psychiatric or substance use reason?
• Have you had more than one episode, including recurrences spread out over many years?
• Does the condition have unresolved effects or ongoing symptoms severe enough to interfere with safety-related duties?
• Have you used multiple mental health medications at the same time, or has any medication use continued within the last two years?
• Does your mental health specialist, your treating clinician, or the AME have any concerns?

The tool adds one more rule: if the AME is unsure about any of these criteria, the AME should defer and note it in Block 60. This is why preparation matters so much. A clean history that you can't document can still end in a deferral.

If everything is clear, the AME issues your certificate and writes a note in Block 60 of the exam. The note summarizes your history and diagnosis and says the AME discussed it with you, found no positives to the screening questions, and had no concerns.

If you're already deferred: the Fast Track Pathway

If you were deferred for anxiety, depression, or a related condition before, you may now qualify under Row A. The Fast Track Pathway tool is completed by your AME of record and uploaded into the FAA's AMCS system. It can also be submitted if you've received an FAA request for information about these conditions. The FAA notes that in some cases it will still need more information.

The tool repeats the 9 questions above and adds a few checks of its own. It asks whether you've taken an antidepressant in the past two years, whether you've ever used multiple medications together (including augmentation therapy), and whether you've ever been treated with antipsychotics, benzodiazepines, mood stabilizers such as lithium or anti-epileptics, or stimulants. A yes to any of these means you don't qualify for the fast track. That last check matters if you've ever been prescribed a benzodiazepine such as alprazolam for anxiety. The tool also notes that past use of an antidepressant not on the FAA's acceptable list doesn't, by itself, exclude you.

How to prepare so your AME can issue

The Row A table doesn't list specific documents. But the Item 47 page says medical documentation must be submitted to support issuance for any condition, and the AME has to defer when unsure. Your goal is to make every answer easy to verify.

Step 1: Report everything on MedXPress

The FAA's therapy FAQs say all visits to licensed healthcare providers, including psychotherapists and counselors, must be reported on your MedXPress application. There are a few exceptions. You don't need to report educational counseling, or religious counseling unless the clergy member is also a licensed counselor. Couples counseling doesn't need to be reported unless you were referred for individual therapy. Employee assistance program (EAP) consultations can be left off unless they led to a referral for psychiatric evaluation or treatment. Our MedXPress prep tool can help you get organized.

Step 2: Get a clear record from your treating clinician

Ask your therapist or doctor for records or a summary that your AME can review. For Row B, the FAA specifies a current, detailed Clinical Progress Note from a clinic visit no more than 90 days before your AME exam. Row A has no specific form. Still, a record that covers the points below gives your AME what they need to answer the 9 questions with confidence.

• Your diagnosis, in DSM terminology
• What triggered the condition, if there was a trigger, and when symptoms started
• The treatment you received, whether therapy, medication, or both, with start and end dates
• The name of every mental health medication, the dates you took it, and confirmation that you took only one at a time
• When your symptoms resolved and how you're doing now
• Whether you've ever had suicidal thoughts, self-harm, hospitalization, or substance use concerns
• Whether the clinician has any concerns about your ability to perform safety-related duties

Many of these elements come from the FAA's Situational Depression Disposition Table, which lists what a detailed Clinical Progress Note should include. The FAA's information sheet for psychotherapists treating pilots (updated 06/24/2026) is also worth handing to your therapist. It asks clinicians to use DSM-5-TR terminology, to document severity and insight, and to avoid both upcoding and minimizing. You should never ask a provider to change or soften a diagnosis. An accurate record is what makes Row A possible.

Step 3: Count your two years correctly

The two-year clock runs from the last time a medication was taken, prescribed, or recommended, not from when you felt better. A recommendation you never filled can still count, so check your records for the actual dates.

Step 4: Bring it all to the exam and be ready to talk

The AME must address all 9 questions in person. Be ready to describe your history plainly and honestly. If you're looking for an examiner comfortable with mental health history, our AME directory and our guide to finding the right AME can help.

Situational depression and PTSD have their own tables

For situational depression, your AME can use either the anxiety and depression table or the older Situational Depression Disposition Table (07/27/2022), with its own 7-question decision tool. Under that table, a single, fully resolved episode that was 5 or more years ago can be issued based on the AME's history and notes. If the episode was less than 5 years ago, the AME must review a current, detailed Clinical Progress Note and your actual clinical records to verify the diagnosis.

PTSD also has a separate disposition table (updated 06/26/2024). Its Row A requires no SSRI or other psychiatric medication in the past 2 years and no symptoms in the past 2 years. Past or ongoing psychotherapy is permitted.

Common mistakes that lead to avoidable deferrals

• Leaving counseling visits off MedXPress. The FAA requires them to be reported. An undisclosed visit that surfaces later is a far bigger problem than a disclosed one.
• Arriving without records. If your AME can't verify your history, the decision tool tells them to defer.
• Assuming medication automatically rules you out. One medication last used two or more years ago fits Row A.
• Forgetting a second medication. Any history of more than one mental health medication at a time rules out Row A, so tell your AME about every medication you've taken.
• Not checking your recorded diagnosis. If your records say major depressive disorder, Row A doesn't apply, even if it felt situational to you. Know what your records say before your exam.
• Not asking about the Fast Track Pathway after a past deferral. Your AME of record can submit it.

How this differs from the Antidepressant Protocol

Row A is for pilots whose treatment is in the past, or who are in therapy without medication. If you're taking an antidepressant now, you need the FAA's Antidepressant Protocol instead. It's a Special Issuance pathway, and the AME can't issue your first certificate under it.

You can read the details in our Antidepressant Protocol guide, our article on the FAA's antidepressant policy, and the FAA's Use of Antidepressant Medications page. If you take sertraline or another antidepressant, start there. Keep in mind that other anxiety medications have their own status. Buspirone and hydroxyzine are not acceptable for flying, and you can look up any medication with our medication checker.

Never stop or change a medication to qualify for Row A. That decision belongs to you and your prescribing doctor, and stopping to pass an exam doesn't fit the FAA's criteria anyway.

Before you fly: self-grounding and honesty

Under 14 CFR 61.53, you may not act as pilot in command or as a required crewmember while you know or have reason to know of a medical condition that would make you unable to meet the standards for your medical certificate. The FAA's therapy FAQs give examples of when to ground yourself right away, including severe anxiety or panic attacks, major depression, and suicidal thoughts. The FAQs describe self-grounding as a professional safety decision and a sign of good insight.

The same FAQs say pilots don't need to report therapy to the FAA immediately. You report it on your next medical application. Whatever your history, disclose it fully. Falsifying your application puts your certificates at risk and carries criminal penalties. Our guide to common MedXPress mistakes covers more.

The bottom line

Getting help for anxiety or depression is compatible with flying. If your history is uncomplicated, your AME can issue at the exam, as long as you bring an accurate MedXPress, clear records, and correct dates. If you're struggling now, reach out to a licensed provider, a pilot peer support program, or your AME. Your health comes first, and there is a path back to the cockpit.