Mental health conditions are among the most common areas of concern for pilots seeking FAA certification. With the right documentation, many pilots with depression or anxiety history fly successfully.
Informational Use Only. The information on this page reflects our understanding of current FAA medical certification requirements and is provided for general educational purposes only. FAA policies, the AME Guide, and special issuance protocols are updated frequently and without notice. The FAA AME Guide and FAA Civil Aerospace Medical Institute (CAMI) are the authoritative sources in all cases. Nothing on this page constitutes legal or medical advice. Always verify current requirements directly with your Aviation Medical Examiner and the official FAA AME Guide at faa.gov/ame_guide before making any certification decisions.
Row A: AME Can Issue Directly — No FAA Deferral Required
Per the FAA Anxiety, Depression, and Related Conditions Disposition Table (updated 06/26/2024), pilots with up to two of the listed mild/resolved conditions may be issued directly by the AME — without sending the case to the FAA — only when every answer on the full FAA screening decision tool is in the clear/NO column, every Row A criterion is met, and the AME has no concerns. The following is not a substitute for that screening: no MDD or Persistent Depressive Disorder, no recurrent episodes, no history of more than one mental health medication at a time, and any single mental health medication was last taken, prescribed, or recommended two or more years ago. Previous SI/SC for SSRI use excludes Row A. Acceptable diagnoses include: generalized anxiety, situational anxiety, social anxiety, unspecified anxiety, situational depression, postpartum depression, unspecified depression, OCD, PTSD, and V/Z-code adjustment items. Cases that do not meet ALL Row A criteria require deferral (Row B).
FAA Antidepressant Protocol
The FAA expanded its former SSRI Protocol into the broader Antidepressant Protocol, allowing certain medications to be considered for special issuance under a structured evaluation process. Flying while on antidepressants without this authorization is not permitted.
Depression and anxiety cases vary enormously in complexity. Identify your scenario to understand your likely documentation path.
Past history, fully resolved, no current symptoms, no medications
Current symptoms present but not on any medication
Currently taking an antidepressant
History of severe episode: hospitalization, suicidality, psychosis, or bipolar features
Recent medication start, stop, or dose change
The FAA AME Guide states that use of a psychotropic drug — including antidepressants, anxiolytics, sedatives, mood stabilizers, and similar agents — is disqualifying, with narrow protocol-based exceptions. If you are on such a medication and flying without FAA authorization, that is a serious compliance issue regardless of how stable or well you feel.
The FAA's psychiatric evaluation is not designed to penalize people for seeking help — it's designed to assess safety. These are the key factors.
Is the diagnosis depression, anxiety, a mood disorder, or something on the bipolar spectrum? These have different implications. A well-documented, consistent diagnosis from a treating clinician matters.
Are you functioning well — at work, socially, sleep-wise? Any recent exacerbations, missed work, or impaired functioning will be part of the picture.
What you're taking, the dose, how long you've been on it, and whether there have been any side effects that could affect cognitive performance or alertness.
Prior hospitalizations, suicidal ideation, self-harm, psychotic symptoms, or features of bipolar disorder each trigger a more thorough review.
ADHD medications, sedating sleep aids, alcohol events, or substance use history all interact with a psychiatric history and will be considered together.
Starting, stopping, or changing dose of any psychiatric medication resets the stability observation period. The FAA expects a defined period of stability before certification.
Labeled 'anxiety' but taking a benzodiazepine — a disqualifying medication class
Multiple medications, one of which is a protocol drug — each triggers its own review
Recent dose change without completing the required stability window
Vague clinician letter that doesn't address aviation fitness specifically
Inconsistent diagnosis across records — triggers more scrutiny
Not disclosing prior mental health visits because 'it was just a few sessions'
What sets our practice apart for depression & anxiety certification cases.
HIMS Senior AME
FAA-designated HIMS Senior AME with deep experience in the antidepressant protocol and psychiatric special issuance cases.
Pilot, Not Just a Physician
Active corporate jet pilot (ATP, CFI, CFII, MEI) — understands the real-world impact of mental health certification decisions on a flying career.
Direct Physician Access
You work directly with the doctor. No case managers, no handoffs — one point of contact from consultation through certification.
Remote Consultations
Consultations available remotely for pilots nationwide who need guidance before committing to travel.
Modern Patient Portal
A digital patient portal for HIMS phase tracking, document management, and progress visibility.
Two Arizona Locations
Flagstaff and Lake Havasu City offices — serving pilots across the Southwest and beyond.