Pilots on antidepressants pose no safety risk

By Rachel Nowak Most air-safety authorities around the world ban pilots from flying while on antidepressant drugs citing safety reasons. Now the results of an Australian study suggests that taking the drugs does not increase the risk of accidents, while banning them could increase risks by encouraging depressed pilots not to seek treatment. A team led by aviation medicine specialist James Ross, who ran the study while a consultant at Australia’s Civil Aviation Safety Authority (CASA), scrutinised Australian pilot safety records spanning from 1993 to 2004. Unlike most air safety authorities around the world, CASA allows Australian pilots to fly while on antidepressant drugs, under tightly controlled conditions. For example, the pilot must have taken the drugs for at least a month before flying. This is to ensure that he or she is not suffering side-effects such as fatigue or nausea that could affect performance. Depressed pilots are also not allowed to fly if they have suicidal tendencies, pathological anger, or abnormal sleep patterns associated with the disorder. Over the 12-year study period, 481 pilots who were prescribed antidepressants had 11 accidents due to pilot error and 22 near misses. The researchers say this was not significantly different to the five accidents and 26 near misses of the similar number of pilots who did not take antidepressants, but who were matched by age, sex, and flying experience. The results will be presented by team member Kathy Griffiths of the Centre for Mental Health Research at the Australian National University in Canberra today at the World Psychiatric Association annual congress in Melbourne, Australia. Most aviation safety authorities, including the US Federal Aviation Authority, and the European Joint Aviation Authority, ban pilots from flying while on antidepressants because of concerns about the effect of treatment and the underlying depression on a pilot’s performance. That might not be wise, says Ross. He points out that the Australian study suggests that using antidepressants in a carefully managed, structured environment is safe, and that rules or regulations that encourage pilots not to seek treatment, or not to declare it, could backfire. “Antidepressants can be prescribed for years, so that means you are asking people to give up their livelihoods, or leave their depression untreated,” notes Griffiths. The Australian study also found that only 1% of pilots admitted to taking antidepressants, compared to 4.5% of Australians in the general population. That suggests that even under the Australian rules, which allow pilots on antidepressants to continue flying, the increased scrutiny by CASA could encourage pilots to avoid seeking medical help or to keep it secret when they do. US pilots taking medication for psychological conditions such as depression who were involved in fatal accidents had also rarely reported either the medication or their underlying condition to the FAA, according to two recent studies (see Aviation, Space and Environmental Medicine, vol 77, p 1171, and vol 78, p 1055, for the most recent). “Many aviation doctors have maintained that the side effects of antidepressants present far less risk to aviation safety than the problem of untreated or undeclared depression. It’s encouraging to see that the Australian evidence supports this,” says David Powell of the Occupational and Aviation Medicine Unit at Otago University in Wellington, New Zealand. “Depression is common and treatable, so surely the best way to manage it in aviation is to bring it out of hiding,” he says. Aviation – Learn more in our comprehensive special report. Mental Health – Discover the latest research in our continuously updated special report. More on these topics:
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