The U.S. Federal Aviation Administration (FAA) on Friday cleared pilots who have depression to regain their flying privileges, with one tiny caveat — they have to be taking one of only four “approved” antidepressants. I can only express my extreme disappointment at this decision because while it has the potential to help pilots take to the air again if they were suffering from depression, it fails to recognize other effective treatments for depression.

Apparently, the FAA doesn’t recognize the effectiveness of psychotherapy in the treatment of depression. This despite something on the order of four decades’ (or more) worth of research demonstrating its effectiveness for everything from mild to severe depression. In fact, if anything, there’s more research that calls into question the effectiveness of these four antidepressants than there is showing they help.

The Los Angeles Times has the upshot:

FAA policy bans pilots from flying if they have depression because the condition can be distracting in the cockpit and pose a safety risk, according to the agency. Under the new policy, pilots with depression can seek treatment with one of the four medications and keep flying.

You know what else can be distracting in the cockpit? Laptops. Guess what the FAA doesn’t ban in the cockpit. Yes, laptops. So how can this be about “distraction” rather than simple ignorance about mental illness? Does a diagnosis of attention deficit disorder (ADD) also get you banned from the cockpit (given that one of its hallmarks is distraction)? No, it doesn’t, unless you happen to be taking a medication to treat it.

In fact, if you’re taking any psychiatric medication outside of these four antidepressants, you’re going to lose your pilot’s license unless you go off of them for at least 90 days. The FAA doesn’t care about your illness or your mental health. All they care about are possible side effects of the medications — but not the effects or symptoms of the illness itself! (The exceptions are substance/alcohol abuse, schizophrenia and bipolar disorder — all of which are grounds for a license denial.)

None of this makes any sense. Either disqualify pilots from obtaining their license with any kind of mental health issue outright, or qualify them if they are seeking and in treatment for them. Don’t hand out piecemeal, arbitrary decisions like this one about specific types of treatment you accept that are apparently based upon, not research, but something else. What that something else is (given 3 of the 4 antidepressants are generics, I don’t think it was pharmaceutical lobbying) is anyone’s guess.

From the FAA press release:

On a case-by-case basis beginning April 5, pilots who take one of four antidepressant medications – Fluoxetine (Prozac), Sertraline (Zoloft), Citalopram (Celexa), or Escitalopram (Lexapro) – will be allowed to fly if they have been satisfactorily treated on the medication for at least 12 months. The FAA will not take civil enforcement action against pilots who take advantage of a six-month opportunity to share any previously non-disclosed diagnosis of depression or the use of these antidepressants.

I don’t feel any less safe flying knowing that pilots who are seeking and getting treatment for their depression and in the cockpit. I’d feel far less safe flying knowing the FAA was pretending that mental health conditions don’t exist or don’t affect their pilots, or that pilots weren’t taking action to help themselves. The FAA still lives in a state of denial about the prevalence of these disorders, and is hiding its head in the sand by approving just these four drugs.

Read the full article: Depressed pilots may fly with medication, FAA says

FAA Disease Protocols (note the lack of any mental illness protocols outside of substance abuse)