I’ve been under a lot of stress recently and my family physician has started me on "Zoloft" to help me get through this difficult time. I’m actually feeling better and I’m ready to fly but I understand that these medications (called SSRIs) are not compatible with flying. Why is this?

There are a number of Selective Serotonin Reuptake Inhibitors (SSRIs) and related medications presently on the market. These go under the trade names of Prozac, Paxil, Zoloft, Luvox, Serzone, Effexor and they are in widespread use in the general population. These medications are presently used in the treatment of depression, but they can also be useful in other disorders such as social phobias, anxiety and premenstrual mood disorders to name a few.

Transport Canada is concerned with both the side effects of, and the underlying indication for using these potent medications. Clearly if a pilot is depressed, he should not be flying. The difficulty lies in the fact that these medications are often prescribed for less serious reasons (we live in a feel-good society) and it must be determined if there is an illness that could be a threat to flight safety. For this we often request letters from the attending physician in order to understand the reason for prescribing as well as the severity of the illness. If a major depression exists, we consider the pilot unfit until a minimum of six months after discontinuing the medication with a satisfactory follow up report from the attending psychiatrist. For lesser problems, the pilot may resume flying at an earlier date based on independent considerations.

As far as the side effect profile is concerned, anyone taking these medications should be aware of the wide array of potential side effects. Granted, most of the effects are of little significance, some serious alterations in thinking, mood, judgment and personality may occur which could pose a threat to safety in a small number of pilots.

At the present time, all category applicants using these medications will be refused medical certification with extraordinary exemptions. Ongoing studies are attempting to determine if a certain population whose underlying illness is stable and who have close follow up, may be considered safe. In the meantime you would be best advised to discontinue the drug at the earliest time medically indicated and be sure your stress is controlled prior to returning to aviation.