Dysthymic Disorder with SSRI (SERTRALINE) usage and history of NDRI/Azapirones


I am a prior military aviator who was diagnosed and medically retired for Dysthymic Disorder in the early summer of 2017. I am working to piece together the medical requirements and get an idea of the fight I have ahead to get my medical certificate so I can return to my love of flying and pursue another career in aviation. Any tips and information that could aid in that goal would be greatly appreciated. I have already learned so much from the AOPA community.

I don't have all of my dates available currently but I will be as detailed as I can. In late 2015 I entered into therapy for self-proclaimed depression and anxiety. Starting in early 2016 I was officially diagnosed with Dysthymia and was started on a prescription program that would eventually have me taking a combination of medications that primarily included the SSRI Escitalopram (lexapro) and an azapirone buspirone (Buspar) which was later changed for the NDRI bupropion (wellbutrin). Ultimately the combinations were not fully effective and the SSRI was changed for Sertraline (Zoloft) in early 2017 which showed good promise but not quickly enough as the AF decided to refer me for an MEB for separation instead of waiting to see if I stabilized on Sertraline. Upon leaving the military I stopped taking medications and relied on the techniques I learned in therapy to ease my symptoms. Fast forward to 2022, I opted to seek treatment with the VA and I started taking Sertraline again as of 2 May. I understand that I have to be on the medication and stable for six months prior to the medical certification process. 

I have looked into the information that has been posted to the medical section on the AOPA forums as well as many of the referenced FAA pages. I have a couple of questions pertaining to potentially conflicting or ambiguous information. 

First, it is my understanding that due to the nature of Dysthymia and the fact that I have sought use of an SSRI again that the only way that a medical can be authorized is if I am on the medication and ceasing the use of an SSRI is not a viable option because my condition is considered “recurrent”. 

Second, the Guide for Aviation Medical Examiners states that a “history” of “treatment with multiple SSRIs concurrently” will result in non-issuance of a medical certificate. However, the SSRI Decision Path II guide, states that a “history of or currently on multiple psychiatric medications” is grounds for non-issuance and does not specifically state that multiple SSRIs specifically will not be allowed. My concern is since I have a history of taking multiple medications (but not simultaneous SSRIs) that my history could fall into that category.

Lastly, I am concerned about the cost in both time and money in order to pursue this passion. Any estimates on what I could expect as I reach out and start fighting the medical fight would help me plan gauge if it's a fight I can undertake.

Thank you all for your time and any information to help me along my way.



5 Replies

Hello Jacob, 

Your condition is between you, your doctor and the FAA. Ask your doctor what he thinks and the best avenue of approach….You only live once,  and if this is something that you want, keep going  the sky is the limit, the worst outcome is “no”…you can still fly, take lessons,  my father retired from construction after 50 plus years, bought his dream boat and passed away a week later, never got to enjoy his dream…don't listen to the “EXPERTS” on this site, everyone's situation is different. 



Thank you for your input. I definitely don't disagree with you. Aviation and the ability to fly and navigate is a love I've had a hard time letting go of. My desire to pursue the HIMS AME process far outways any sense or desire for “privacy”. I figured I would go where the experts are and if this can help serve others in a similar position, then all the better. 




Hi Jacob,

If you would like further assistance beyond the resources you have found online feel free to give us a call at 800-872-2672 option 3 and we would be happy to speak with you more in depth.

Thanks for flying with AOPA!

1407 Posts

The recurrence, use of more than one (more than two different, even) and recurrent use makes this a really tricky one.  You might benefit by discussing this with a HIMS AME and difficult certification expert like Bruce Chien, who handles these sorts of cases and drops in here from time to time.  He's one of the folks who helped the FAA write the SSRI protocols.  You can also reach him through his web site www.aeromedicaldoc.com.



Thank you for the tip. I am working to get physical copies of my records so I can review them as I may not fully remember all the details back when this first started. I'll give y'all a ring as soon as I knock that out.

Break Break

Ronald, that is what I am concerned about. I have never had what could be categorized as severe depression or suicidal ideations. I am hopeful the persistent low-grade nature of the underlying condition would be more important than the simultaneous (Non-SSRI) use of psychiatric medications but I understand that may not be the case. Thank you for the recommendation!