SSRIs / Antidepressants for Pilots and ATC: The FAA Decision Paths
Last updated October 3, 2026
Pilots and air traffic control specialists (ATC) can work while taking certain antidepressants through an FAA Special Issuance managed by a HIMS AME. Those who elect to stop their medication can return to a regular medical certificate or clearance after 60 days off the medication and a favorable report from their treating physician.
The FAA lays this out in two flowcharts, SSRI Decision Path I and Decision Path II. Which one applies to you depends on a single choice.
Are you planning to stay on your medication?
Decision Path II: staying on your medication
First, check that your medication is one the FAA accepts. Important: this applies to single agent antidepressant treatment, not multiple psychiatric medications.
If it's conditionally acceptable, here is how the Special Issuance works:
- Contact a HIMS AME. Path II runs through a HIMS AME, not a regular AME. Find a HIMS AME.
- Reach 3 months on the medication. The FAA won't consider a Special Issuance until you've been on it for at least 3 months. If you decide to stop before then, Path I applies instead.
- Build your package. A personal statement, evaluation reports, records, tests, and letters, as listed on the FAA's specification sheet.
- HIMS AME review. The HIMS AME reviews your materials to make sure you have a complete packet and sends the packet to the FAA.
- FAA decision. The FAA issues the Special Issuance or denies it. Depending on the reason for a denial, you may be able to re-apply after completing reconsideration steps determined by the FAA.
Decision Path I: stopping your medication
- Your AME defers. The AME notes it in Block 60 of your exam and defers issuance, which means the FAA must review your case before making the decision.
- After staying off medication for at least 60 days, apply for regular issuance. With a favorable report from your treating physician that your mood is stable, you may apply for a regular medical certificate or clearance, with no Special Issuance needed.
Make this decision with your prescriber. It is important to make decisions about your medication with your doctor's guidance.
Comparing the two paths
| Stopping (Path I) | Staying on it (Path II) | |
|---|---|---|
| Who handles it | An AME, then the FAA | A HIMS AME, then the FAA |
| Time frame | At least 60 days off the medication | At least 3 months on the medication |
| Medication | Any antidepressant | Must be conditionally acceptable |
| Possible outcome | Regular issuance | Special Issuance, with ongoing monitoring |
A HIMS AME can help you weigh the two before you change anything, and your prescriber should be part of any decision to change or stop your medication. Find a HIMS AME.
The FAA antidepressant list
From the FAA's antidepressant medication list, updated August 27, 2025. The FAA revises this list from time to time, so always confirm with your HIMS AME.
Conditionally acceptable with a Special Issuance
Accepted only as a single agent (the only psychiatric medication you are taking), and only if you're otherwise qualified.
| Medication | Brand name | Type |
|---|---|---|
| citalopram | Celexa | SSRI |
| escitalopram | Lexapro | SSRI |
| fluoxetine | Prozac, Sarafem | SSRI |
| sertraline | Zoloft | SSRI |
| desvenlafaxine | Pristiq | SNRI |
| duloxetine | Cymbalta | SNRI |
| venlafaxine | Effexor | SNRI |
| bupropion, SR and ER only | Wellbutrin SR, Wellbutrin XL | NDRI |
| vilazodone | Viibryd | SSRI and 5-HT1A receptor partial agonist |
Not acceptable
Not accepted on their own or in any combination product.
| Medication | Brand name | Type |
|---|---|---|
| fluvoxamine | Luvox | SSRI |
| paroxetine | Paxil | SSRI |
| levomilnacipran | Fetzima | SNRI |
| bupropion, immediate release (IR) | Wellbutrin | NDRI |
| vortioxetine | Trintellix | SSRI and 5-HT1A receptor partial agonist |
| esketamine | Spravato | |
| All tricyclic antidepressants (TCAs) | ||
| All monoamine oxidase inhibitors (MAOIs) |
Bupropion is on both lists. The extended release forms (SR and ER) are conditionally acceptable, and the immediate release form is not. Check which one is on your prescription label.
Who does the evaluation
An Aviation Psychologist can do the initial assessment for antidepressant cases. If it shows cognitive deficits, the psychologist must refer you to an Aviation Neuropsychologist for a full neuropsychological evaluation. An Aviation Neuropsychologist can handle both steps. Your HIMS AME will tell you what your package needs.
Find an evaluator: Aviation Psychologists · Aviation Neuropsychologists · HIMS AMEs
Frequently asked questions
Can pilots and air traffic controllers take antidepressants?
Yes, if the medication is on the FAA's conditionally acceptable list and you receive a Special Issuance through a HIMS AME. You must be on it for at least 3 months before the FAA will consider one.
Is Zoloft approved by the FAA?
Sertraline (Zoloft) is conditionally acceptable with a Special Issuance, as are citalopram (Celexa), escitalopram (Lexapro), and fluoxetine (Prozac).
Is Wellbutrin approved by the FAA?
Only the extended release forms. Bupropion SR and ER are conditionally acceptable. Immediate release (IR) bupropion is not acceptable.
Is Paxil approved by the FAA?
No. Paroxetine (Paxil) is on the FAA's not acceptable list.
How long do I need to be on an SSRI before applying?
At least 3 months on the medication before the FAA will consider a Special Issuance.
How long after stopping an antidepressant can I get a regular medical?
After 60 days off the medication, with a favorable report from your treating physician that your mood is stable, you may apply for regular issuance.
Can I take an antidepressant with another psychiatric medication?
No. Acceptable antidepressants are accepted as a single agent only. If you're on more than one psychiatric medication, the HIMS AME will defer and send your case to the FAA for a decision.
Do I need a HIMS AME?
If you're staying on your medication, yes. Path II starts with a HIMS AME. If you're stopping it, Path I can run through your regular AME.
What happens if the FAA denies my Special Issuance?
Depending on the reason for the denial, you may be able to re-apply after completing reconsideration steps determined by the FAA. Your HIMS AME can explain your options.
FAA sources
- SSRI Decision Path I (updated August 27, 2025)
- SSRI Decision Path II (updated December 3, 2025)
- Antidepressant Medications (updated August 27, 2025)
- FAA Certification Aid: SSRI Initial Certification/Clearance (updated August 26, 2026)
This guide is general educational information for pilots and air traffic control specialists. It is not medical, legal, or aeromedical advice, and it is not affiliated with the FAA. Requirements change and every case is different. Always confirm your situation with your AME, a HIMS AME, and your treating physician.