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So, if you thought that you were depressed, what would happen if you told someone?  How would this affect your licence and future career? It is this uncertainty which holds most pilots back from seeking help early on - when perhaps their symptoms are less severe and more amenable to treatment.  

What if I am diagnosed with Depression?


There are three things worth knowing from the outset:

 

1) As with the general population, anxiety and depression among pilots is more common than you might realise

2) Whilst these conditions are serious, they lend themselves well to treatment and the vast majority of pilots diagnosed with depression successfully return to flying

3) Like most things, acknowledging to yourself that you have a problem and taking the first step to seek help is often the hardest part of the treatment process

Nonetheless, being labelled with a ‘mental health problem’ is a daunting prospect for anyone. For those employed in aviation this can feel especially threatening. Not only is there the stigma and discrimination (perceived and real) of being identified as having a mental health problem, there are the worries about the implications of receiving this diagnosis.

 

Some context

The Germanwings disaster of 2015 has clearly raised the profile of mental health issues in aviation and created a hypersensitivity towards depression in particular. What it has done is to raise important questions as to how the mental health of pilots is managed in a safety critical yet highly commoditised industry.  Worldwide, many airlines, their regulators and various international authorities are currently grappling with this topic in a more directed and focussed way than before. As a result, a wide range of regulations and initiatives have started to emerge, alongside a multitude of reviews and consultations. 

 

So how easy is it for a pilot who is looking for information or guidance from their regulator on mental health in general or depression in particular? 

 

A quick trawl through many regulators’ websites demonstrates this can be hard to find. However, that is starting to change.  There are some great resources becoming available (e.g. these articles from the FAA and Flight Safety Australia) and please let us know if you find other good examples elsewhere. 

 

In Europe, EASA has been proactive in assessing the impact of Germanwings and issuing guidance and forthcoming regulation to its member states.  Its main task is to set the regulatory framework, leaving it to local regulators to interpret and apply these regulations appropriate to local resources and requirements. While these regulators see it as their role to define the standards, compliance requirements, etc. many also see it as the responsibility of the AOCs and AMEs to provide information and guidance to individual pilots requiring help. As a result, the information on depression available to individual pilots is difficult to find and that which is available, varies widely. 

How is depression viewed by the regulator? 

Whilst most regulators have similar standards, each has a specific set of requirements. What varies is often around process and medication parameters. All of them emphasise that each case is treated on its own merits. 

United Kingdom

 

The CAA classifies depression as a mood disorder, and a “diagnosis of an established mood disorder” is disqualifying.  This is different to “feeling depressed” in response to a specific event (e.g. bereavement) or having a defined period of general low mood (e.g. feeling fed up but largely still able to function reasonably well). The examining doctor, usually a GP  or AME must determine whether your symptoms warrant a diagnosis of depression and if it does, this will result in you being deemed unfit for flying duties and the CAA will need to be notified. 

 

Alongside this, a treatment plan will be agreed with the aim of returning the pilot to flying in as short and safest time as possible.  As mentioned above, many pilots have subsequently returned to flying following diagnosis, treatment and recovery from depression and there is a clear protocol through which the CAA regulates this. This flow chart demonstrates the process.

 

Because of the nature of depression, no two pilots’ experiences will be the same but generally this is what will happen next in situations where current CAA guidelines apply.  

 

To resume flying you will need to receive treatment which complies with CAA regulations which will include medication and/or therapy (e.g. CBT - see our Resources for more information).  The optimum treatment for your depression will depend on how severe your depression is and to what degree it is affecting your mood, behaviour and cognitive processes.  

For licensing purposes, a key issue is whether anti depressant medication is recommended, what type and at what prescription dosage. (Over the counter herbal medication sometimes taken for depression (e.g. St John’s Wort is not permissible).   History of anti-depressant use does not necessarily disqualify you from flying. Receiving non-medication therapy (for example Cognitive Behaviour Therapy) may not by itself invalidate your licence. 

 

Once your symptoms have resolved, and therapy is completed (or in some cases may still be continuing), and if your psychiatric assessment is satisfactory you may be able to resume flying duties, usually 4 weeks after your symptoms are deemed to have resolved.  

 

For Class 1 pilots this will require a report submitted to the aeromedical section (AMS) and for Class 2 pilots, for the Aeromedical examiner, confirming full recovery without symptoms and with or without continuing acceptable treatment. If you are continuing to take anti depressant medication this will be restricted to certain SSRIs (CITALOPRAM, SERTRALINE or ESCITALOPRAM - see Treatment: Antidepressants) and at specified maintenance dosages. 

 

CAA specialist assessment may be required for some Class 1 Licence holders and for all Class 1 and 2 holders, where the pilot is still undergoing therapy and is taking an acceptable SSRI. 

 

If your medication is changed, withdrawn or your symptoms are not well controlled, you may have a further period of unfitness. It is all about monitoring the side effects of these medication changes and their impact on your mood.  

 

Resumption of flying duties are likely to require a simulator check (Class 1) or medical flight test (Class 2) and you may have restrictions on your licence which could subsequently be lifted when you are fully recovered.

 

What about other countries?

 

We would like to provide detail this process in other countries. If you can you tell us how this process works in your country we will include it when we adapt the site for your country.

 

What about loss of licence insurance, my employer, and other considerations?

 

This is undoubtably a major concern for any pilot who faces the prospect of being grounded and a concern that this will prevent them from seeking help in the first place. It is also the area in which bodies such as EASA, ICAO, IFALPA , etc. are focussed on addressing to provide additional clarity and reassurance.

 

However, depression is largely viewed as a common, treatable condition - just as many other physical conditions that may require a period of grounding and demonstration of fitness to fly following treatment. As a result, many insurance policies reflect this and anecdotal evidence is that many AOCs are more supportive of pilots undergoing treatment for depression than one might imagine. It is in everybody’s interests to return pilots to flying as soon as safely possible.  However, it is fair to say, this remains an area of high concern for many pilots - of which regulators, unions and AOCs are acutely aware. 

 

Our advice is that if you are concerned about this aspect of depression, seek advice from your pilot union or association who would be in the best position to guide you through your specific concerns.

Would I be better off keeping it myself and not seeking help?

 

In short, no! 

 

While many people have recovered from their depression on their own, this is not advisable and may make things worse as the chance of success is significantly lower. Like all conditions, the sooner it is acknowledged and help is sought the higher the likelihood for effective treatment and support and a return to flying. 

Depression is common

 

As with any kind of physical illness, tackling depression early may prevent it from becoming very severe.  Depression is often referred to as a common mental disorder (CMD).  CMD’s include depression, anxiety, and obsessional compulsive disorder.  CMD’s cause marked emotional distress and interfere with daily function, but do not usually affect insight or cognition.  Surveys suggest that almost half of adults (43.4%) think that they have had a mental disorder at some point.  Of these, over a third had not been medically diagnosed but of those who had, depression was the most common diagnosis.    The World Health Organisation estimates that globally 350 million people are affected by depression.

 

Depression is not an “all or nothing” condition - rather it is a continuum ranging from very mild to very severe depression.  The CAA classifies depression as a mood disorder, and a “diagnosis of an established mood disorder” is disqualifying.  This is different to “feeling depressed” in response to a specific event or having a defined period of low mood. The examining doctor must determine whether your symptoms warrant a diagnosis of depression and if it does, this will result in you being deemed unfit for flying duties.  Many pilots have subsequently returned to flying following diagnosis, treatment and recovery from depression and there is a clear protocol through which the CAA regulates this. 

 

Following the Germanwings Flight 9525 accident, EASA published a proposal in December 2016 to the European Commission on new operational rules to better support pilot mental fitness and this was released in a document known as an Opinion (Opinion 14/2016) The EASA Opinion will serve as the basis for a legislative proposal by the European Commission in the course of 2017 and will introduce revised standards including the requirements that all pilots have access to a support programme, and creating a mandate for all airlines to perform a psychological assessment of pilots before the start of employment. Also recommended is Drug & Alcohol (D&A) testing of flight and cabin crew both upon employment, and after a serious incident or accident, after rehabilitation and return to work.

 

Because of the nature of depression, no two pilots’ experiences will be the same but generally this is what will happen next in situations where current (2017) CAA guidelines apply.  

 

To resume flying you will need to receive treatment which complies with CAA (or relevant regulatory body) regulations.  The optimum treatment for your depression will depend on how severe your depression is and to what degree it is affecting your mood, behaviour and cognitive processes.  Symptoms of depression include low mood and a loss of interest and enjoyment in ordinary things and experiences. Symptoms impair emotional and physical wellbeing and behaviour. A combination of medication and cognitive behavioural therapy (CBT) is likely to be recommended. 

 

For licensing purposes, a key issue is whether anti depressant medication is recommended, what type and at what prescription dosage. (Over the counter herbal medication sometimes taken for depression (St John’s Wort is not permissible).   History of anti-depressant use does not necessarily disqualify you from flying. Receiving non-medication therapy (for example Cognitive Behaviour Therapy) may not by itself invalidate your licence. 

 

Once your symptoms have resolved, and therapy is completed (or in some cases may still be continuing), and if your psychiatric assessment is satisfactory you may be able to resume flying duties, usually 4 weeks after your symptoms are deemed to have resolved.  

 

For Class 1 pilots this will require a report submitted to the aeromedical section (AMS) and for Class 2 pilots, for the Aeromedical examiner, confirming full recovery without symptoms and with or without continuing acceptable treatment. If you are continuing to take anti depressant medication this will be restricted to certain SSRI’’s (CITALOPRAM, SERTRALINE or ESCITALOPRAM) and at specified maintenance dosages. 

 

CAA specialist assessment may be required for some Class 1 Licence holders and for all Class 1 and 2 holders, where the pilot is still undergoing therapy and is taking an acceptable SSRI. 

 

If your medication is changed, withdrawn or your symptoms are not well controlled, you may have a further period of unfitness. It is all about monitoring the side effects of these medication changes and their impact on your mood.  

 

Resumption of flying duties are likely to require a simulator check (Class 1) or medical flight test (Class 2) and you may have restrictions on your licence which could subsequently be lifted when you are fully recovered.

 

How your depression will be assessed by the examining doctor

 

The assessment will explore:

 

  • What are your symptoms and the circumstances surrounding their onset?  

  • What factors may have caused them and any other relevant medical history. 

  • How has your illness progressed and what are the current symptoms (in particular are you experiencing sleep disturbance, thoughts of suicide or self harm or actual self harm?)

  • Results of questionnaires (e.g. The Hamilton Depression Scale, Beck Depression Inventory)

  • What treatment have you sought and with what results? 

  • What is your medication history and any side effects from current medication? 

  • What follow up arrangements are in place, for example reviews of your progress and further investigations which are planned. 

  • What is the risk of recurrence? 

  • What concern might there be for how your symptoms might progress? 

  • How committed and compliant are you with your treatment?  What is your prognosis?