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A mental health diagnosis or treatment does not automatically end a pilot’s eligibility for an FAA medical certificate. The outcome depends on the specific condition, symptoms, treatment and records: an Aviation Medical Examiner (AME) may issue a certificate when the applicable standards are met, or defer the application for FAA review. Some circumstances have condition-specific special issuance or special consideration pathways.
How the application and AME exam work
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Complete the application in MedXPress
Submit the required medical application information through the FAA’s MedXPress system. The FAA’s applicant guidance describes a 60-day period after submission to complete the AME examination; confirm the current instructions because application procedures can change.
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Prepare for the appointment
If you have a current or past condition or take medication, review the FAA’s online AME Guide guidance for the relevant condition before your appointment. The FAA advises applicants to keep a copy of their application and bring relevant documents so the AME can submit them. The precise records depend on the diagnosis and circumstances; follow any requests for additional information. The FAA warns that an incomplete response to a records request can delay issuance or lead to denial.
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Attend the examination
The AME reviews your application, examination findings and available supporting documents against the applicable FAA standards and condition-specific guidance. The AME can issue a certificate if the requirements are met and the documentation supports issuance. If the case requires FAA action or the records are insufficient, the AME may defer the application for FAA medical staff to review.
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A deferral is not itself a denial: it sends the case for FAA review. The FAA communicates its review outcome in writing, and missing requested information can delay that decision.
How the FAA evaluates mental health history and medication
“Mental health conditions” are not one aeromedical category with one automatic outcome. The FAA’s AME Guide, Item 47 Psychiatric Conditions gives examiners condition-specific direction, and its Psychiatric Conditions Table of Medical Dispositions describes different actions for different diagnoses and circumstances. The guide states that psychotropic drugs are generally disqualifying for aeromedical certification purposes, while also providing specific protocols and exceptions. That general rule should not be read as saying every history permanently disqualifies an applicant.
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For example, the FAA disposition table says depression requiring antidepressant medication requires an FAA decision. It also describes an AME issue route for some resolved adjustment disorders, but only when specified stability, thought, recurrence and medication conditions are met. These examples are not a complete eligibility checklist; the applicable diagnosis and current FAA guidance determine the route.
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When antidepressant treatment may be considered
The FAA renamed its former SSRI protocol the Antidepressant Protocol after adding additional medications. It describes case-by-case consideration for a special issuance or special consideration authorization when the applicant meets the applicable medication, stability and history criteria. The FAA’s AME Guide, Use of Antidepressant Medications says the applicant must be clinically stable on a stable dose for at least three continuous months, and that the medication must be one of the conditionally acceptable medications and used alone. The protocol also lists disqualifying history factors, so meeting the time-on-dose condition by itself does not establish eligibility.
The protocol directs applicants to further evaluation by a HIMS AME. An AME may not grant the special issuance or special consideration authorization; the relevant FAA process and case-specific criteria apply. Medication names, required documents and other details should be checked in the live FAA protocol and linked materials for the applicant’s circumstances.
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If an applicant has discontinued an antidepressant
The FAA describes a separate certification route for an applicant who has discontinued an antidepressant: the examiner defers issuance, and an applicant seeking regular issuance must be off the medication for at least 60 days and provide a favorable treating-physician report indicating stable mood and no aeromedically significant side effects. This is a certification criterion, not medical advice. Do not start, stop or change treatment to pursue certification without discussing treatment decisions with the treating clinician.
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| Route | Who decides | What it means | What may follow |
|---|---|---|---|
| Ordinary issuance | The AME, when the applicant meets the applicable standards and the records support issuance. | The AME issues the certificate during the examination process. | Requirements and records depend on the condition-specific FAA guidance. |
| Deferral for FAA review | The FAA reviews the case after the AME defers it. | The AME does not issue at that examination because FAA action is needed or records are insufficient. Deferral is not a denial. | The FAA may request more information and sends its decision in writing. |
| Special issuance or special consideration | The FAA, under the applicable condition-specific process. | An individualized pathway may be available in certain circumstances even when ordinary standards are not met. | Criteria, documentation and any testing depend on the condition and protocol. An authorization has a specified validity period. |
| AME-assisted special issuance (AASI) | The FAA makes the initial authorization; an AME may handle later reissuance for eligible cases. | AASI is a follow-up route, not the initial FAA decision. | The applicant must meet the authorization’s specialized follow-up criteria. |
What a special issuance means over time
Under the FAA’s summary of 14 CFR § 67.401, the Federal Air Surgeon may grant an authorization with a specified validity period to an applicant who does not meet ordinary standards if the applicant demonstrates that they can perform the duties of the certificate without endangering public safety. The medical certificate expires no later than the authorization or its withdrawal. A further authorization requires the applicant to demonstrate eligibility again.
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After the FAA makes an initial authorization, AME-assisted special issuance may allow an examiner to reissue a certificate if the applicant meets the authorization’s specialized follow-up criteria. The initial FAA authorization and later AME-assisted reissuance are separate steps.
Where to check the current requirements
Use the FAA’s current applicant guidance, MedXPress instructions, AME Guide entries and the specific condition protocol that applies to the applicant. The FAA’s psychiatric guidance pages were listed as updated July 29, 2026, for Item 47 Psychiatric Conditions; May 29, 2024, for the Psychiatric Conditions Table of Medical Dispositions; and December 3, 2025, for Use of Antidepressant Medications. The FAA’s general application guidance and special issuance materials are also relevant. Guidance can change, so confirm the live FAA pages and discuss an individual case with an AME familiar with the applicable process.
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