Medical Histories of 61 Aviation Accident Pilots with Postmortem SSRI Antidepressant Residues

Selective serotonin reuptake inhibitor (SSRI) antidepressants are popularly prescribed, but these drugs are not currently approved for use by U.S. civilian aviators. In a 2003 study, the presence of 4 SSRIs--citalopram, fluoxetine, paroxetine, and sertraline-was reported in 61 pilot fatalities of civil aviation accidents that occurred during 1990-2001. However, it was not known whether these pilots 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) Aerospace 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.There were 59 pilots who had medical records in the FAA's Certification Database. 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 remaining 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.These findings reconfirm that SSRIs were used by the aviators but were not reported in their last aeromedical examinations.