Depression – should it be a career ending diagnose for pilots?

The International Civil Aviation Organization (ICAO) classifies depression as a "mental abnormality" and states that in order to receive a medical certificate, a pilot should have no medical or clinical records of suffering from such an abnormality. However, if you ban some pilots from flying while they are receiving treatment for depression, then doesn’t this mean that you discourage them from seeking professional help? In other words, is it worse to have a pilot flying whilst suffering from an untreated depression as opposed to the one whose psychological problems are being addressed professionally?

One of the most recent studies of aircraft assisted suicides in the United States has found that in a 20-year period (1993–2012) the proportion of general aviation suicides in relation to the total number of fatal aviation accidents is 0.33%. However, the study has also revealed that only 22% of all individuals committing suicide communicate such an intention during their last appointment with a health professional. The reality is that the process of reliably detecting psychological problems, particularly at the early stages, if the patient does not cooperate, is extremely difficult. On top of that, pilots, probably more than any other professionals, may find themselves under pressure to conceal the problem as the diagnosis could easily become the ending point in their careers.

The impact of SSRIs...

The treatment for depression often involves taking an antidepressant. Although the type of drugs approved by the aeromedical regulatory authorities for the use by pilots varies from country to country, the most prevalent avenue for the treatment of depression is the course of Selective Serotonin Reuptake-Inhibitors (SSRIs); however, due to adverse reactions, SSRIs have been widely criticized by many members of the aerospace medical community in terms of their effects on psychomotor performance.

In the meantime, multiple post-mortem samples from pilots involved in fatal civil aircraft accidents in the United States during 1990–2001 revealed that out of 4,184 fatal civil aviation accidents, as many as 61 plane was piloted by a professional taking SSRIs. As determined by the National Transportation Safety Board, the use of an SSRI has been a contributing factor in at least nine (0.02%) of the 4,184 accidents. However, it is noteworthy that other factors, such as the weather conditions, mechanical deficiencies, and/or piloting errors, could not be completely ruled out in the aforementioned 61 cases.

 .and other drugs used among pilots

Additionally, another notable study conducted by the FAA Civil Aerospace Medical Institute and the National Transportation Safety Board (NTSB) revealed that out of 1353 pilots involved in fatal accidents during 2004-2008, as many as 92 (or 7%) were found to have ethanol (alcohol) present in their systems. Moreover, 28 (2%) of them tested positive for marijuana and 9 (0.7%) - for cocaine.

Meanwhile, multiple studies indicate that the percentage of drug users amongst pilots has remained relatively constant over the past 20 years (around 0.02%). However, the percentage of alcohol, cocaine and marijuana users is much higher amongst pilots treated with SSRIs.

Considering the aforementioned statistics, the currently used pilot health screening system is clearly far from perfect.

The choice is ours

If the reaction to the latest catastrophe in the Alps is to immediately assume that all pilots, with or without a history of mental illness, cannot be trusted on their own, it will do a great disservice to all pilots and will certainly dissuade those who suspect having mood swings or depression from seeking help.

“As far as I know, airline pilots don't regularly have their mental health assessed. There are pilots with history of depression who have flown safely for decades. No destructive behavior can be directly linked to mental illness, as multiple studies have shown. Just as in hospital practice, pilots with alcohol problems should know they may count on receiving help, get appropriate treatment and return to their normal and happy life. Pilots dealing with stress and anxiety should know that too,” shares a psychologist familiar with aviation. “The main issue does not even lie with psychology specialists or pilots themselves. Instead, it is rather a regulatory concern, with both mental and physical well-being of pilots (and thus passengers) being the top priority for airlines and the entire industry.”

Instead of a lengthy conclusion, let’s consider several noteworthy examples. The Canadian aviation authorities have an aeromedically supervised treatment protocol that allows a small number of pilots to fly “with or as co-pilots” whilst undergoing antidepressant treatment and therapy. In the meantime, from January 1993 to June 2004 the Australian Civil Aviation Safety Authority (ACASA) allowed nearly 500 pilots and air traffic controllers to return to duty while their depression was under control with SSRIs. Guess what? All of them (apart from those in retirement) are still flying planes today… and landing them safely.

What does that mean? Mainly, that a combination of awareness, support and advocacy can help save lives. The airline industry needs to create an open environment where pilots always feel comfortable in admitting whatever issue they may have.