Selective Serotonin Reuptake Inhibitors: Medical History of Fatally Injured Aviation Accident Pilots

Abstract

Selective serotonin reuptake inhibitors (SSRIs) are popularly prescribed for treating depression, but these antidepressants are not currently approved for use by U.S. civilian aviators. In a 2003 study, 4 SSRIs—citalopram, fluoxetine, paroxetine, and sertraline—were found in 61 pilot fatalities of civil aviation accidents that occurred during 1990–2001. However, it was not known whether these pilots had had disqualifying psychological conditions, including depression, and had properly reported the use of the antidepressants. The aeromedical history of the pilots was retrieved from the Federal Aviation Administration's (FAA's) Medical Certification Database; additional pilot medical information and the cause/factor of the accidents were obtained from the National Transportation Safety Board's (NTSB's) Aviation Accident Database. Fifty-nine pilots had medical records in the FAA's Certification Database. The database did not contain medical records of 2 pilots—1 had never received a medical certificate and another had a Canadian pilot and medical certificate. Although driving under the influence was self-reported by 22 of the 59 pilots during their past aeromedical examinations, disqualifying psychological conditions were self-reported in the past examinations of only 7 (12%) of the 59 pilots, and the use of an SSRI was reported by 3 of the 7 pilots. In later examinations, 6 of the 7 indicated that they were free from the conditions and not taking SSRIs; thus, they were reissued medical certificates. Such conditions and/or drug use were not self-reported in the aeromedical records of the 52 (88%) pilots. Nevertheless, the NTSB investigations revealed that 12 (20%) of the 61 pilots had a history of a psychological condition and/or an SSRI use, as suggested by their personal medical records. Psychological conditions and/or the use of drugs were determined to be the cause or a factor in 19 (31%) of the 61 accidents. These findings reconfirm that SSRIs were used by the aviators but were not reported in their last aeromedical examinations.