By Cmdr. Shawnna Chee, Psy.D., ABPP, and Lt. Cmdr. Daniel CeCecchis, M.D., FAPA, Naval Aerospace Medical Institute, Pensacola, Florida
Jan. 22, 2019

Photo by Petty Officer 3rd Class Grant Grady

Can a service member who has been diagnosed with a mental health disorder and is being treated with psychotropic medication maintain their military flight status while in treatment? YES! The use of psychotropic medications was disqualifying for U. S. Naval Aviators (pilots, flight officers, air traffic controllers and aircrew members) before November 2018. After this date, the U.S. Navy Aeromedical Reference and Waiver Guide (ARWG) was updated to allow Navy and Marine Corps personnel who are on a stable dose of FDA-approved psychotropic medications to maintain their flight status during treatment.

Given that active symptoms of a mental health diagnosis means an aviator will be “grounded” from their flying duties until the symptoms are stable, a negative stigma has been strongly associated with mental health disorders in the aviation population. Since we know the prevalence of major depressive disorders and anxiety disorders in the U.S. is approximately 7 percent, with a threefold higher prevalence of depression in 18–29 year olds (the age range of most actively flying military personnel), there was concern that many aviation personnel in the Navy and Marine Corps were either going without recommended treatment, keeping any treatment they were seeking under wraps from their flight surgeons, or discontinuing therapy prematurely to regain flight status. This was a concern because untreated psychiatric symptoms are associated with a wide range of psychiatric sequelae that can negatively impact quality of life and social, emotional, and cognitive functioning.

In 2012, the Psychiatry Department at the Naval Aerospace Medical Institute began an extensive review of the experiences of the U.S. Army, U.S. Air Force, Federal Aviation Administration (FAA), Air Canada, and Civil Aviation Safety Authority in Australia to evaluate the risks and benefits of psychotropic medication usage and outcomes in military and civil aviation. It was found that each of these services had a policy in place to allow aviators to fly while taking a stable dose of medication with specified criteria and on-going monitoring requirements.

The first waiver for a class of psychotropic medication use in Army aircrews was granted in 2004 for a diagnosis of chronic pain. Currently, Army aviators on stable doses of selected medications for most mental health diagnoses are eligible to maintain flight status. Similarly, Air Force policy allows designated personnel to fly while on monotherapy with one of four approved medications for treatment of specified conditions after the prescribed waiting periods officially went into effect in 2013. The Air Force is currently conducting a 20-year study to follow airmen on antidepressants, where results from the first five years found that no antidepressant medication has been associated with any Air Force mishap since the protocol started in 2013.

The first waivers granted in the Navy began in 2017, for diagnoses of major depression and obsessive compulsive disorder. Upon review of selected individuals, the Consult Advisory Board voted to allow aviators, in specified flying billets (e.g. dual-piloted, non-tactical aircraft), to be eligible for waiver consideration with continued therapy with FDA-approved psychotropic medication(s). Consideration for a waiver may be requested after a suitable period of observation in a non-flying status has elapsed, provided that the dose of the medication(s) is stable and the clinical condition is determined to be in stable remission. The duration of this period of observation in a non-flying status is dictated by the psychiatric diagnosis and is outlined in the relevant section of the ARWG.

The overall goal of this significant change in Navy policy is to help decrease stigma associated with help seeking behavior in Navy and Marine Corps personnel. Our hope is that military personnel will feel safe to seek recommended treatment in order to have a better quality of life.

To learn more about culturally competent assessment and treatment of service members, read more Clinician's Corner blogs. To learn more about stigma and the military, visit the Real Warriors Campaign website.