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SSRI - Aspiring ATP Pilot
Hi everyone,

I am interested in obtaining my PPL and then continuing on with Multi-Engine, Instrument Rating, Commercial, and ATP. For the latter, I am aware of the requirement to obtain a class 1 medical. I currently take Fluoxetine (an SSRI and antidepressant ) not for depression but instead for OCD which I was diagnosed with in junior high. My OCD originally manifested as general anxiety and germaphobia which I no longer have any manifestations of. How would this impact my ability to obtain a class 1 medical and what extra hoops would I need to jump through?
3 Replies
Hi Bruce,

Thank you for the information. I am also curious about how the requirements or difficulty of attaining 1st class medical differs with EASA regulations as I was eventually hoping to move to Europe. Do you know have any insight?

Thanks Again
Hi, Kyle. 
The key here is to understand that the FAA divides the firmament of Psychiatry illness into the :

(1) One offs- these are generally less than five years in duration and are without break.  Any lapse of treatment, and then restart is considered "Recurrent Disease", 
(2) Recurrent Disease, which is disease that can reasonably thought or have been in fact, recurrent.

The ONLY way to certification if you have recurrent disease is on the "On SSRI pathway".  There are about 750 pilots on this path and the relevant documents are attached.

If you have what gets judged to be "one off" disease, FAA wants you well, 60 days off meds and the history has to be evaluated (and you too, in person) by one on that rarefied list of about 70 psychiatrists, the "HIMS Psychiatrist".  These are forensic psychiatrists steeped in part 67 definitions of disease (Not the DSM 5 that the community uses), or at very least a credible Forensic psychiatrist. Neither are inexpensive, all are beyond $1,500 and not paid for by insurance. $3,000 is more common.  These guys write you up like it's their last consult (and it has been for a few- imagine if you have a problem and they say you're Okay, who gets sued?)

For recurrent disease the documents for the "on SSRI pathway" are attached.

You need to see a HIMS AME (there are HIMS AMEs, HIMS psychiatrists, and HIMS Neuropsychologists (Ph.Ds)) who becomes the quarterback for all this.   I am of the school to never to do a (Flight Physical) exam until we have everything that you need because the FAA has statutory limits on the amount of time that can elapse when they seek "further information"  to support your application.  Why? because if it turns out adverse or you can't satisfy the time limits (even with the ONE 30 day extenstion they give) you get a denial.  Then you can't even do Light Sport Pilot.  In essence I am saying never engage in battle unless you are pretty certain the battle can be won.

Understand also that the only route to a HIMS psychiatrist is through a HIMS AME.  FAA does not publish the list, and disciplines HIMS AMEs who publish names.  Why? The do not want to allow "shopping" for an opinion. Your HIMS AME  has a long list of due diligence items he has to get done B4 he can refer you for evaluation.  Also be very certain that NONE of the items in "SSRI.modifications03.12.14.pdf" are part of your past- these are "exclusion from application due to severity" items.

Lastly,  know from "SSRI.pdf" that OCD is not on the list of diagnoses which were intended for this pathway.  You are asking FAA to apply a certification program that was not intended for OCD (there are about 47 accidents in the database of anxiety disorders which the pilot was apparently unable to make the proper decision in a timely manner) and FAA is very very careful about this diagnosis.  They can deny simply on the basis that would be applying with an illness (if recurrent = lifelong) for which there is NOT A SPECIFIC pathway.

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You are facing a long, expensive, uphill battle.  The FAA has many concerns about any condition which leads to taking SSRI's.  See this FAA paper on the subject, and pay particular attention to the words "ABSOLUTE MINIMUM" as you may have to do more, even a lot more, to achieve even Third Class medical certification (no less First -- the Germanwings accident scared the heck out of the FAA) either while taking an SSRI or after you're weaned off it.  The only good news (and it's only a small glimmer of hope) I have for you is that Fluoxetine is one of the four SSRI's the FAA will even consider allowing.

Introduction (
Guide for Aviation Medical Examiners (

Also, be advised your health insurance will NOT cover this process -- you'll be out of pocket for something in the $5-10K range.

Finally, stand by for Dr, Bruce Chien to check in here with additional information.  He's one of the (or maybe the) nation's leading experts on difficult medical certifications, including folks on SSRI's (he helped write the FAA's criteria on this).