Updated September 2026 to reflect the FAA's current Antidepressant Protocol.
For decades, any pilot taking an antidepressant was grounded. That changed in April 2010, when the FAA created a Special Issuance pathway for pilots treated with one of four selective serotonin reuptake inhibitors (SSRIs). The program has grown since then. The FAA added bupropion (Wellbutrin SR/ER) on May 31, 2023, and a second class of antidepressants — SNRIs — on April 24, 2024. With that expansion, the FAA renamed the SSRI Protocol the Antidepressant Protocol, although many FAA forms still use the older SSRI name.
Nine medications are now conditionally acceptable with a Special Issuance, as long as you take only one of them. The SSRIs are citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), and sertraline (Zoloft). The SNRIs are desvenlafaxine (Pristiq), duloxetine (Cymbalta), and venlafaxine (Effexor). The list also includes bupropion (Wellbutrin) in sustained-release or extended-release form only, and vilazodone (Viibryd).
Some antidepressants remain unacceptable under any circumstances: paroxetine (Paxil), fluvoxamine (Luvox), levomilnacipran (Fetzima), immediate-release bupropion, vortioxetine (Trintellix), esketamine (Spravato), all tricyclic antidepressants, and all MAO inhibitors. If you take one of these, talk with your prescribing physician and a HIMS AME before making any change — never switch or stop medication on your own to get certified.
Who qualifies? The FAA will consider pilots with mild to moderate major depressive disorder (single or recurrent episode), dysthymic disorder, adjustment disorder with depressed mood, or a non-depression condition treated with one of the acceptable medications. You must have been clinically stable on the same medication at the same dose for at least 3 continuous months, without aeromedically significant side effects or worsening symptoms. The FAA rules out anyone with a history of psychosis, suicidal ideation, electroconvulsive therapy, treatment with more than one antidepressant at a time, or prior multi-agent psychiatric drug regimens.
The first rule is simple: do not fly until you have an Authorization from the FAA. Under 14 CFR 61.53, you cannot act as a pilot while you know you have a disqualifying medical condition. An AME cannot issue your first certificate on these medications. The FAA reviews every initial case.
The process runs through a HIMS AME — an Aviation Medical Examiner with Human Intervention Motivation Study training. Choose one early. You'll give them a typed, signed statement describing your mental health history, every provider you've seen, every medication you've taken, any hospitalizations, and how you're doing now. You'll also provide all of your mental health treatment records, including records from times you had symptoms but weren't on medication, and sign releases so the FAA sends your complete medical file to your HIMS AME.
Your package needs three professional reports, each dated within 90 days. The HIMS AME conducts a face-to-face, in-office evaluation and writes a report. A board-certified psychiatrist evaluates you and specifically addresses the FAA's rule-outs; if your prescriber isn't a psychiatrist, you'll need a report from them as well. And a neuropsychologist — a licensed clinical psychologist who is board certified or board eligible in clinical neuropsychology — performs an evaluation that includes CogScreen-AE, a computerized cognitive test designed for aviation, plus any additional testing the FAA specifies.
Once you've reached 3 months of documented stability and the reports are ready, your HIMS AME completes a new FAA Form 8500-8 exam, defers it, fills out the HIMS AME Checklist, and sends the complete package to the FAA's Aerospace Medical Certification Division within 14 days. Incomplete packages are not reviewed, so missing a single report can set you back. If you have any other condition that needs a Special Issuance, include those records too.
Review times vary. While your case is pending, keep sending updated HIMS AME evaluations and psychiatrist reports every 6 months so the FAA has current information and doesn't need to request it.
After approval, follow-up continues. You'll see your HIMS AME in person and submit a psychiatrist report every 6 months. If every item on the HIMS AME recertification checklist is favorable, the HIMS AME can issue your certificate with the time limitation in your Authorization letter. There's good news on testing: after studying data from 425 pilots in the program, the FAA stopped requiring the neuropsychologist evaluation and routine CogScreen-AE for renewals on December 15, 2022, unless it's clinically indicated or written into your Authorization.
A few practical points. You must tell the FAA right away about any change in your condition or dose, or any plan to reduce or stop your medication. You also can't switch HIMS AMEs without prior FAA approval. If you decide to stop your antidepressant, your AME must defer, and you'll need to be off it for at least 60 days with a favorable report from your treating physician before the FAA will consider regular issuance. Don't stop medication to get through an exam — that decision belongs with your doctor.
Be completely honest on your MedXPress application. Disclose every medication and diagnosis. Falsifying FAA Form 8500-8 can cost you your certificates and carries criminal penalties, which is far worse than going through the Special Issuance process.
The Antidepressant Protocol is still demanding, but it's broader and less burdensome than it was even a few years ago. If you're a pilot dealing with depression, get treatment. Your health comes first, and the FAA's pathway means you don't have to choose between your health and your flying.