May 7, 2024

NBAA welcomes the FAA’s recent conditional approval of three additional antidepressant medications as a reflection of the agency’s consideration of industry input in gaining a greater understanding of pilot mental health concerns.

The newly added medications are duloxetine (Cymbalta), venlafaxine (Effexor) and desvenlafaxine (Pristiq.) These are classified as serotonin and norepinephrine reuptake inhibitors, or SNRIs. As with selective serotonin reuptake inhibitors (SSRIs), SNRIs are commonly used to treat anxiety and depression.

In 2010, the agency first issued conditional approval to four SSRIs: fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro) and sertraline (Zoloft.) Last year, the FAA added sustained-release or extended-release bupropion, also known as Wellbutrin, to the list. This latest change was published in the April 2024 update to the Guide for Aviation Medical Examiners.

Mark Larsen, CAM, NBAA director of safety and flight operations, noted the new conditional approvals are in line with taskings and recommendations made earlier this year in a report issued by the FAA Mental Health & Aviation Medical Clearances Aviation Rulemaking Committee (ARC), on which Larsen served. Read more about the ARC.

“Consideration and conditional acceptance of SNRIs is a change the ARC asked for,” Larsen added. “It’s encouraging to see the FAA take this step to recognize more treatment methods that are known to be effective in addressing a number of mental health concerns.”

With the addition of SNRIs, the FAA’s previous SSRI Protocol is now known as the Antidepressant Protocol, under which pilots using one of these medications must petition the FAA for a special issuance medical certificate after demonstrating their treatment is not causing harmful side effects that could affect their aeromedical performance.

Although undergoing the conditional approval process may currently require up to one year or longer, during which time the pilot will be grounded from flying, “this is a positive step in the right direction,” Larsen added. “NBAA encourages the FAA to continue implementing the ARC’s recommendations to best address aviation mental health concerns.”