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SSRI

Q: 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 SSRI’s) are not compatible with flying. Why is this?

Zoloft™ is a Selective Seratonin Reuptake Inhibitor (SSRI) and is considered a mood altering medication. There are a number of SSRI’s and related medications presently on the market. These go under such trade names as Prozac, Paxil, Zoloft, Luvox, Serzone, and Effexor to name a few. Similar classes of mood alternating medications, which are equally important, are listed in the table below. In some ways these medications have revolutionized the treatment of mental health problems. The indications for use of these medications are expanding almost daily and more and more aviation personnel are candidates for or should be candidates for their use. These medications may be acceptable for aviation activities in selected circumstances.

At the present time, all new applicants, current aviators and air traffic controllers using mood-altering medications, will initially be refused certification or have their medical certification suspended until the circumstances of the case are reviewed.

Transport Canada’s medical advisors must determine if the medical situation requiring treatment represents a threat to flight safety. We are concerned with both the underlying medical condition for which the medication has been prescribed and the side effects arising from the medication. Every case is considered individually and assessed according to diagnosis, severity of symptoms pretreatment, medication dosage and type, response to treatment, side effects of medications and prognosis for recovery or need for prolonged therapy. Other factors related to fitness to fly will also be factored in to the decision-making process including: the category of license or permit desired or held –airline, commercial, private, recreational; operational duties – single pilot, multi crew, fixed wing, helicopter, etc.; flying experience – ab initio or experienced.

As far as the side effect profile is concerned, anyone taking these medications should be aware of the wide array of potential side effects. While most of the effects are of little significance, a small number of pilots may experience some serious alterations in thinking, mood, judgment and personality. Of even greater concern is that often these effects may go unrecognized by the pilot or air traffic controller.

Transport Canada Civil Aviation Medicine continues to review the literature and conduct studies to determine whether certain medical conditions and medications may be considered safe for aviation related activities. Our current approach to return to flying decisions can be viewed on our website under the Other Guidelines section of the Handbook for Civil Aviation Medical Examiners.

In the meantime, you would be best advised to discuss your particular situation with your physician. Discontinuing any medication should only be done under the supervision of your physician and only when the clinical situation has stabilized.

Serotonin uptake inhibitors
Selective serotonin reuptake inhibitors (SSRIs)
citalopram (Celexa, Cipramil, Emocal, Sepram, Seropram etc)
escitalopram (Cipralex, Lexapro, Cipralex, Esertia)
fluoxetine (Prozac,  Fontex, Seromex, Seronil, Sarafem, Fluctin etc.)
fluvoxamine (Luvox, Faverin etc.)
paroxetine (Paxil, Seroxat, Aropax, Deroxat, Rexetin, Xetanor, Paroxat etc.)
sertraline (Zoloft, Lustral, Serlain etc.)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
venlafaxine (Effexor)
desvenlafaxine (Pristiq)
sibutramine (Meridia, Reductil)
Others
aminoketones  
bupropion (Wellbutrin, Zyban, Budeprion, Buproban Elontril, Odranal, Quomen, Voxra, Zetron, Zylexx etc.)

Note: This list is merely representative. It is not intended to be complete nor an endorsement by Transport Canada Civil Aviation Medicine.

Date modified:
2010-06-24