Antidepressants & Flying (SSRI Protocol)
Last updated: 2026-09-12
Quick Facts
- 9 antidepressants are conditionally acceptable: 4 SSRIs, 3 SNRIs, bupropion SR/ER, and vilazodone
- Single agent only — no second antidepressant or psychiatric medication
- At least 3 continuous months stable on the same dose before your HIMS AME submits
- The AME cannot issue your first certificate — the FAA decides every initial case
- Initial package: HIMS AME, board-certified psychiatrist, and neuropsychologist (CogScreen-AE) reports, all within 90 days
- Follow-up: HIMS AME evaluation and psychiatrist report every 6 months
- CogScreen is no longer routinely required for renewal (policy change December 15, 2022)
- Stopping medication requires at least 60 days off with a favorable physician report
- BasicMed is an option if you previously held a medical certificate
Overview
The FAA allows pilots to hold a medical certificate while taking certain antidepressants through a Special Issuance. What began in April 2010 as a program limited to four SSRIs is now called the Antidepressant Protocol. The FAA added bupropion (Wellbutrin SR/ER) on May 31, 2023, and SNRIs on April 24, 2024. Nine medications are now conditionally acceptable: citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), sertraline (Zoloft), desvenlafaxine (Pristiq), duloxetine (Cymbalta), venlafaxine (Effexor), bupropion (Wellbutrin, SR/ER formulations only), and vilazodone (Viibryd). Whichever you take must be your only antidepressant, and the AME cannot issue your first certificate — the FAA decides every initial case.
To be considered, you must have a qualifying diagnosis: 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 these medications. You must have been clinically stable on the same medication and dose for at least 3 continuous months without aeromedically significant side effects. The FAA rules out anyone with psychosis, suicidal ideation, electroconvulsive therapy, treatment with multiple antidepressants at the same time, or prior multi-agent psychiatric drug regimens. Some antidepressants are unacceptable under any circumstances: paroxetine (Paxil), fluvoxamine (Luvox), levomilnacipran (Fetzima), immediate-release bupropion, vortioxetine (Trintellix), esketamine (Spravato), all tricyclic antidepressants, and all MAO inhibitors.
Do not fly until you have an FAA Authorization (14 CFR 61.53). The process runs through a HIMS AME, who performs a face-to-face evaluation and reviews your complete FAA medical file and treatment records. Your package also needs a report from a board-certified psychiatrist (plus a treating physician report if your prescriber is not a psychiatrist) and a neuropsychological evaluation that includes CogScreen-AE. All reports must be dated within 90 days. The HIMS AME defers the exam and must send the complete package to the FAA within 14 days — incomplete packages are not reviewed.
After approval, you'll see your HIMS AME in person and submit a psychiatrist report every 6 months. Since December 15, 2022, the neuropsychologist evaluation and routine CogScreen-AE are no longer required for renewal unless clinically indicated or specified in your Authorization. You must notify the FAA of any change in your condition or dose, or any plan to stop your medication. If you stop, you must be off the medication for at least 60 days with a favorable report from your treating physician before the FAA will consider regular issuance.
FAA Requirements
Document Checklist
Gather these documents before your AME appointment to avoid delays and deferrals.
- 1Typed, signed personal statement describing your mental health history, providers, medications, other treatments, hospitalizations, and current status
- 2All mental health treatment records, including periods when you had symptoms but were not on medication
- 3Signed releases so the FAA sends your complete medical file to your HIMS AME and, if needed, a board-certified psychiatrist
- 4HIMS AME face-to-face evaluation report and completed HIMS AME Checklist
- 5Board-certified psychiatrist report addressing the FAA SSRI rule-outs
- 6Treating physician report (if your prescriber is not a board-certified psychiatrist)
- 7Neuropsychologist report with CogScreen-AE printout and score summary sheet
- 8Reports for any other condition that requires Special Issuance
- 9New FAA Form 8500-8 exam, deferred by the HIMS AME
Related Medications
Use our medication checker to see the FAA status of each medication related to this condition.
Sources & References
- FAAFAA AME Guide — Item 47: Use of Antidepressant Medications
- FAAFAA Antidepressant Medications Table (Updated 08/27/2025)
- FAAFAA Airman Information — SSRI (Antidepressant) Initial Certification
- FAAFAA Certification Aid — SSRI Initial Certification/Clearance
- FAAFAA SSRI Recertification — Neuropsychological Report Changes and FAQs
- FAAFAA Pilot Medical Certification Overview
- PubMedCanfield et al. — Medical Histories of 61 Aviation Accident Pilots with Postmortem SSRI Residues (2007)
- AOPAAOPA Medical Resources — Mental Health
Last verified: 2026-09-12
Important Disclaimer
This guide provides FAA regulatory information for educational purposes only. It does not constitute medical advice, legal advice, or a guarantee of certification outcome. FAA policies are subject to change. Always consult with a qualified Aviation Medical Examiner (AME) and/or aviation attorney for guidance specific to your individual situation. ClearedMed is not affiliated with or endorsed by the FAA.