Flying and depression
FAA’s policies on mental health issues are onerous and arcane
Everyone has felt depressed at one point or another, but that does not mean they are mentally ill, nor does it mean they are not fit to fly.
There are generally two types of depression. It is a complex subject that I will try to put in very simple terms. There is endogenous depression, which means “from within,” and exogenous depression, which means “from without.” Exogenous depression, also known as situational depression, is the type of depression that occurs with a death of a relative or a friend. It is usually short lived and resolves with time and sometimes counseling. Endogenous depression is different in that it is really a medical illness with psychological symptoms. It is related to brain chemistry, usually inherited, which can cause a person to be depressed even when everything in their life is going perfectly. Endogenous depression is the type that is most amenable to drug treatment.
Many times, these types of depression are mixed. A person who is endogenously depressed may not do well in a marriage that ends in a divorce, which then causes an exogenous depression as well. Although we do not understand exactly why, a person who is exogenously depressed for a longer period may also become endogenously depressed as well. These people may benefit from medication in addition to counseling.
The FAA’s greatest fear is a disaster such as the 2015 Germanwings mass murder/suicide. In that case, the airline had multiple warnings about the pilot’s depressive episodes and, essentially, hid them. Even if the offending pilot was flying under a U.S. FAA medical, that disaster still could have happened. The FAA has responded to the German crash by being overly and unduly cautious, even though strict criteria would not have had any effect in this setting because red flags were ignored.
Unfortunately, the process that is required for a person who reports to the FAA depression or any other mental health encounter (e.g., counseling during a divorce) is onerous and arcane. If the pilot or student is on medication, the flow sheet for certification is five pages long and includes requirements for an evaluation by a board-certified psychiatrist and a CogScreen, which is a proprietary test that has no significant value in this setting. Many of the requirements also are from the last century since only one of four antidepressant medications can be used, even though there are many, and no two medications can be taken at the same time. Even more discouraging, the FAA has placed the evaluation of pilots on depressant medications under the same section as pilots with drug and/or alcohol problems (the HIMS program), which I assume is related to funding and is totally inappropriate.
Not only is this process expensive and unnecessary but has no scientific testing against pilots who are depressed and have not undergone this process (e.g., no control group). Even if the pilot passes everything with flying colors, it may take up to a year to get a final response from the FAA.
Years ago, I posted a request on the original online bulletin board AVSIG on CompuServe (yes, that long ago) asking anyone who was or had taken an antidepressant and flown to send me a postcard with nothing on it but “yes.” I got lots of postcards. Here is the modern version of the same survey. It is completely anonymous. Please take it (surveymonkey.com/r/KDCGZ5K). I will post the results in a future issue.
If you are suffering from a mental health issue, get help. Flying is one thing; your personal health is another. The suicide prevention hot line is 1-800-273-8255 and is confidential.
One other small warning, if you are going through a bit of depression like a divorce and your doctor says, “Here, try this. It might help,” consider it carefully. Anti-depressants and other mental health medications may not be the best first course of treatment for situational depression and will adversely affect your FAA medical flying status. A longer conversation with your doctor is in order to find the right treatment path for you.
Answer this question for yourself next time you get on a commercial flight: “Would it be better if your pilot is hiding depression off medications or for him to be treated on medications?”
