Selective Serotonin 

Reuptake Inhibitors: Medical 

History of Fatally Injured 

Aviation Accident Pilots

Ahmet Sen

Ahmet Akin

Gülhane Military Medical Academy

Department of Aerospace Medicine

Eskisehir 26020, Turkey

Dennis V. Canfield 

Arvind K. Chaturvedi

Civil Aerospace Medical Institute

Federal Aviation Administration

Oklahoma City, OK 73125

July 2007

Final Report

DOT/FAA/AM-07/19

Office of Aerospace Medicine

Washington, DC 20591
NOTICE

This document is disseminated under the sponsorship 

of the U.S. Department of Transportation in the interest 

of information exchange. The United States Government 

assumes no liability for the contents thereof.

___________

This publication and all Office of Aerospace Medicine 

technical reports are available in full-text from the Civil 

Aerospace Medical Institute’s publications Web site: 

www.faa.gov/library/reports/medical/oamtechreports/index.cfm
i

Technical Report Documentation Page 

1. Report No. 2. Government Accession No. 3. Recipient's Catalog No. 

DOT/FAA/AM-07/19 

4. Title and Subtitle 5. Report Date 

Selective Serotonin Reuptake Inhibitors: Medical History of Fatally July 2007 

Injured Aviation Accident Pilots 6. Performing Organization Code 

7. Author(s) 8. Performing Organization Report No. 

Sen A,1 Akin A,1 Canfield DV,2 Chaturvedi AK2

9. Performing Organization Name and Address 10. Work Unit No. (TRAIS) 

11. Contract or Grant No. 

1

Department of Aerospace Medicine

Gülhane Military Medical Academy 

Eskisehir 26020, Turkey 

2

FAA Civil Aerospace Medical Institute 

P.O. Box 25082 

Oklahoma City, OK 73125 

12. Sponsoring Agency name and Address 13. Type of Report and Period Covered 

Office of Aerospace Medicine 

Federal Aviation Administration 

800 Independence Ave., S.W. 

Washington, DC 20591 14. Sponsoring Agency Code 

15. Supplemental Notes 

This work was accomplished under the approved task AM-B-07-TOX-202. 

16. Abstract 

Selective serotonin reuptake inhibitors (SSRIs) are popularly prescribed for treating depression, but these 

antidepressants are not currently approved for use by U.S. civilian aviators. In a 2003 study, 4 SSRIs—citalopram, 

fluoxetine, paroxetine, and sertraline—were found in 61 pilot fatalities of civil aviation accidents that occurred 

during 1990–2001. However, it was not known whether these pilots had had disqualifying psychological 

conditions, including depression, and had properly reported the use of the antidepressants. The aeromedical 

history of the pilots was retrieved from the Federal Aviation Administration's (FAA's) Medical Certification 

Database; additional pilot medical information and the cause/factor of the accidents were obtained from the 

National Transportation Safety Board's (NTSB's) Aviation Accident Database. Fifty-nine pilots had medical 

records in the FAA's Certification Database. The database did not contain medical records of 2 pilots—1 had 

never received a medical certificate and another had a Canadian pilot and medical certificate. Although driving 

under the influence was self-reported by 22 of the 59 pilots during their past aeromedical examinations, 

disqualifying psychological conditions were self-reported in the past examinations of only 7 (12%) of the 59 pilots, 

and the use of an SSRI was reported by 3 of the 7 pilots. In later examinations, 6 of the 7 indicated that they were 

free from the conditions and not taking SSRIs; thus, they were reissued medical certificates. Such conditions 

and/or drug use were not self-reported in the aeromedical records of the 52 (88%) pilots. Nevertheless, the NTSB 

investigations revealed that 12 (20%) of the 61 pilots had a history of a psychological condition and/or an SSRI 

use, as suggested by their personal medical records. Psychological conditions and/or the use of drugs were 

determined to be the cause or a factor in 19 (31%) of the 61 accidents. These findings reconfirm that SSRIs were 

used by the aviators but were not reported in their last aeromedical examinations. 

17. Key Words 18. Distribution Statement 

Forensic Sciences, Toxicology, Pilot Fatalities, Selective 

Serotonin Reuptake Inhibitors, SSRIs, Medical History, 

Aviation Accident Investigation 

Document is available to the public through the 

Defense Technical Information Center, Ft. Belvior, 

VA 22060; and the National Technical Information 

Service, Springfield, VA 22161 

19. Security Classif. (of this report) 20. Security Classif. (of this page) 21. No. of Pages 22. Price 

Unclassified Unclassified 17 

Form DOT F 1700.7 (8-72) Reproduction of completed page authorized 

iii

ACKNOWLEDGMENTS

The Government of Turkey is acknowledged for allowing the participation of Dr. Ahmet 

Akin and Dr. Ahmet Sen in the Federal Aviation Administration (FAA) International Exchange 

Visitor Program at the FAA Civil Aerospace Medical Institute, Oklahoma City, Oklahoma.

The authors are grateful to Dr. Selim Kilic, Department of Epidemiology, Gülhane Military 

Medical Academy, Ankara, Turkey, for performing statistical analyses.

1

Selective Serotonin Reuptake Inhibitors: 

Medical History of Fatally Injured Aviation Accident Pilots

INTRODUCTION

The treatment of depression has become more 

effective after the advent of selective serotonin reuptake 

inhibitors (SSRIs). This new generation of antidepressants 

is better tolerated by patients (11,15). Therefore, 

they are popularly prescribed in comparison to older 

antidepressants (10), but SSRIs are not currently approved 

for use by U.S. civilian aviators (5,13).

The use of SSRIs by pilots and the associated flight 

safety concerns have been widely discussed (7,8,14,17). 

An Aerospace Medical Association position paper stated 

that, according to the Aviation Medicine Advisory Service 

database of pilots’ telephone inquiries, approximately 

15% of pilots who had been advised by their physicians 

to take antidepressant medications showed an intention 

to take the medications and continue flying without 

informing the Federal Aviation Administration (FAA). 

However, the number of active aviators using SSRIs 

without authorization is not known (8).

In a 2003 study by Akin and Chaturvedi (1), the 

prevalence of SSRIs in civil aviation accident pilot fatalities 

was evaluated. The study revealed that SSRIs—citalopram, 

fluoxetine, paroxetine, and sertraline—were found in 61 

of 4184 pilot fatalities of U.S. civil aviation accidents 

that occurred during 1990–2001. The use of an SSRI 

was found to be a contributing factor by the National 

Transportation Safety Board (NTSB) in 9 of the 61 

accidents, but the reports of all 61 accidents were not 

finalized at the time of the study. Although toxicological 

findings, flight categories, and pilot certificates of 

the 61 SSRI-involved pilot fatalities were discussed 

thoroughly in the study (1), it was not known whether 

these pilots had disqualifying psychological conditions, 

including depression, and had properly reported the 

use of the antidepressants in their past aviation medical 

examinations. Therefore, as a continuation of the earlier 

study, the present study was conducted to reveal the 

medical history of those 61 pilots and the cause/factors 

of all the associated 61 accidents.

METHODS

Aviation Medical Examinations

All U.S. civilian pilots are required to have periodical 

aviation medical examinations (2). Examination reports 

are submitted to FAA’s Civil Aerospace Medical Institute’s 

(CAMI’s) Aerospace Medical Certification Division 

online and/or through regular mail by Aviation Medical 

Examiners (AMEs). Additional medical information, 

such as specialist reports or laboratory test results, is also 

submitted to CAMI. All submitted information is stored 

both as hard copies and digitally in the Aerospace Medical 

Certification Division.

Database Search

Past aviation medical examination reports of each of 

the 61 SSRI-involved pilots were searched through the 

CAMI Medical Certification Database (Oklahoma City, 

OK). Available personal medical histories of the pilots 

were obtained through the accident reports from the 

NTSB Aviation Accident Database (Washington, DC). 

Information on the types of airman medical certificates 

held by these pilots was retrieved from the CAMI 

Certification Database and from the NTSB Aviation 

Accident Database. The number of fatal aviation accidents 

reported by the NTSB for the 1990–2001 period was 

obtained from the FAA’s National Aviation Safety Data 

Analysis Center (NASDAC) Database (Washington, 

DC). The information for the 61 SSRI-related accidents, 

including the probable cause and contributing factors of 

those accidents, as determined and reported by the NTSB, 

was retrieved from the NTSB Aviation Accident Database. 

Since the NASDAC Database includes information 

primarily associated with the registered aircraft accidents, 

information on the unregistered aircraft accidents may 

not necessarily be included in this database. It should be 

noted that not all of the pilots involved in the accidents 

had appropriate airman flying and/or medical certificates 

to fly an aircraft.

Statistics

The proportion (percentage) of the SSRI-involved 

fatal accidents/pilot fatalities in the total pilot fatalityinvolved accidents/pilot fatalities per year, as retrieved 

from the CAMI Toxicology Database (Oklahoma City, 

OK), was calculated for each year from 1990 to 2001. 

The difference of percentages in years was analyzed by 

Chi-square test using SPSS® for Windows® 10.0 (SPSS 

Inc., Chicago, IL). A trend was obtained by plotting the 

proportional values against the corresponding years by 

using Microsoft® Office Excel 2003 (Redmond, WA).
2

RESULTS

Pilot Demographics and Accident Characteristics

The age, flight time (hours), time between the 

accident and the last aviation medical examination, 

and time between the first and the last aviation medical 

examination (estimated total years of flight) of the SSRIinvolved pilots are presented in Table I. The age of the 

pilots ranged from 27 to 71 years. The flying experience 

of pilots, expressed as total flight hours and estimated 

total flight years, was distributed on a wide range of 

5 to 25,678 hours and 0 to 36 years, respectively. The 

median points were correspondingly 900 flight hours 

and 17 years. This group of pilots consisted of 1 female 

and 60 males. Professions of the 61 pilots were listed as: 

businessmen, 21; medical professionals, 13; professional 

pilots, 6; and others, 10 (ranchers, lawyers, engineers, 

aircraft mechanics, and retired individuals). Of the 13 

medical professionals, 2 were psychiatrists and 1 was a 

psychologist. The professions of 11 were not known.

Of the 61 accidents, 56 happened in general aviation, 

2 air taxi and commuter, and 3 agricultural flights. Of the 

56 general aviation accidents, 35 pilots held private (1 of 

them had a Canadian flying certificate), 10 commercial, 

4 airline transport, 3 student, and 1 recreational airman 

flying certificates. Three pilots were non-certificated. All 5 

pilots of the air taxi and commuter and agricultural flights 

held commercial airman flying certificates (Fig. 1).

Out of the 61 pilots, 3 held First-Class, 12 SecondClass, and 34 Third-Class medical certificates (1 of them 

had a Canadian medical certificate). Medical certificates 

of 5 pilots had been deferred or denied; certificates of 

6 pilots were expired at the time of the accident. One 

pilot did not have a certificate. Two of the Second-Class 

medical certificate holders were involved in air taxi 

and commuter flights and 3 in agricultural flights. The 

remaining 56 pilots were involved in general aviation 

accidents (Fig. 2).

The percentages of the SSRI-involved pilot fatalities, 

with respect to the total number of pilot fatalities (cases) 

during the 12-year period from which postmortem 

samples were received at CAMI, clearly suggest a drastic 

increase in the number of fatalities with these medications 

by 2001 (Fig. 3). For example, the SSRI-associated 

fatalities/aviation accidents increased from 0.26% in 1991 

to 5.88% in 2001. The difference in the proportions of 

the SSRI-involved fatal accidents/pilot fatalities in the 

total fatal accidents/pilot fatalities per year was statistically 

significant (Chi-square = 61.303; df = 11; p < 0.001).

Aeromedical History of the SSRI-Associated Pilots

Medical records of 59 pilots were found in the CAMI 

Certification Database. The database did not contain 

information about 1 pilot who had never received a 

medical examination. Another pilot had a Canadian 

medical certificate.

Twenty-two of the 59 pilots had self-reported a history 

of convictions involving driving under the influence 

(DUI). Additionally, 1 pilot had reported a history of 

alcohol abuse.

Eight pilots were found in the Certification Database 

with diagnosis related or attributable to psychiatric 

disorders or psychological conditions. One of these pilots 

had failed to report a diagnosis of a disorder/condition, 

and it was not discovered by the AME during medical 

examination. However, the Regional Flight Surgeon’s 

office did discover information from a court decision 

and subsequently from the treating physician’s report 

that the pilot had a history of “attempted suicide.” Seven 

of the 8 pilots had self-reported a history of psychiatric 

or psychological conditions. Three of these 7 pilots had 

reported the use of an SSRI as well.

Of the 7 pilots, 1 had reported a history of 

“unconsciousness,” 1 “mental disorder,” 1 “alcohol abuse,” 

1 “unspecified neurotic disorder” (prescribed fluoxetine), 

2 “depression” (1 of them was taking paroxetine), and 1 

Table I. Aeromedical Characteristics of the 61 SSRI-Involved Pilots 

 Statistical 

Parameters

Age

(n = 61) 

Flight Hours 

(n = 61) 

Time Between the Accident 

and the Last Aviation Medical 

Examination 

(Months; n = 59) 

Time Between the First and 

the Last Aviation Medical 

Examination* 

(Years; n = 59) 

Min 27 5 2 0

Max 71 25678 118 36

Mean 52.0 2811.6 16.7 16.7

SD 11.3 5440.1 18.3 12.4

Median 53 900 12 17

*

Estimated total flight years. 
3

Figure 1. SSRI-associated pilot fatalities with respect to airman flying certificates and flight 

categories of the aircraft involved in the fatal accidents, 1990–2001 (3). Part 91, general aviation; 

Part 135, air taxi and commuter; Part 137, agricultural. 

35

10

4 3 1 3

2

3

0

5

10

15

20

25

30

35

SSRI-Involved Pilots

Private

Commercial

Airline Transport

Student

Recreational

Without Certificate

Part 91

Part 135

Part 137

Airman Flying Certificates

Figure 2. SSRI-involved pilot fatalities with respect to airman medical certificates and flight 

categories of the aircraft associated with the fatal accidents, 1990–2001 (3). Part 91, general 

aviation; Part 135, air taxi and commuter; Part 137, agricultural. 

3

7

34

12

2

3

0

5

10

15

20

25

30

35

SSRI-Involved Pilots

First-Class

Second-Class

Third-Class

Without Certificate

Part 91

Part 135

Part 137

Airman Medical Certificates
4

“anxiety” (taking sertraline). Also, 6 of the 7 pilots had 

reported and/or submitted specialist reports denying 

that they had the disqualifying conditions or were being 

treated with the disqualifying medications. Therefore, they 

were reissued medical certificates. However, 1 pilot with 

a diagnosis of depression was deferred by the AME and 

was not issued a medical certificate. The pilot’s deferred 

medical examination was conducted 32 months before 

being involved in a fatal accident.

Personal Medical History 

The personal medical records retrieved from the 

NTSB accident reports suggested that 12 of the 61 pilots 

had a history of SSRI use and/or a diagnosis related to 

psychiatric disorders or psychological conditions. Such 

disorders/conditions were also reported in the CAMI 

aeromedical certification records of 2 of the 12 pilots, 

but no related record was found for the remaining 

10. The personal medical records of 3 of the 12 pilots 

indicated that they had used an antidepressant without 

any indication of psychiatric diagnosis—2 of them were 

taking sertraline and 1 an unspecified antidepressant. 

Five pilots had the diagnosis of “depression” (2 were 

prescribed fluoxetine, 1 citalopram, and 1 paroxetine), 

1 “panic disorder” and was prescribed fluoxetine, 1 

“bipolar disorder” and was prescribed fluoxetine, 1 “adult 

attention deficit disorder” (AADD) and was prescribed 

an unspecified AADD medication, and 1 “anxiety” and 

was prescribed paroxetine.

Psychological Conditions and/or SSRI Use as Aviation 

Accident Cause/Factor

Based on the information available in the NTSB 

Database, accident reports of all 61 accidents have been 

finalized. Accordingly, the NTSB reports indicated that 

in 19 of the 61 accidents psychological conditions and/

or the use of drugs by pilots were the probable cause or 

contributing factors (Table II). The probable cause of 1 

accident was undetermined. The cause/factor(s) of the 

remaining 41 accidents were not associated with drug 

use or medical conditions.

In 1 accident, the probable cause was determined to be 

“suicide.” “Pilot’s other psychological condition” was also 

a factor in this accident. “Pilot’s impairment (alcohol) and 

his psychological condition” was reported as contributing 

factors in 1 accident. In another accident, “pilot’s alcoholic 

and drug impairment” was the probable cause, and “pilot’s 

impairment due to alcohol” was reported as causal in 1 

accident, wherein “his psychological condition” was also a 

contributing factor. In 1 accident, the findings were “the 

Figure 3. The percentage of the SSRI-involved fatal accidents/pilot fatalities in the total pilot 

fatality-involved accidents/pilot fatalities per year from which samples were received at CAMI for 

toxicological evaluation during 1990–2001. There is a statistically significant difference in 

percentages with respect to years (Chi-square = 61.303; df = 11; p <0.001). 

0

1

2

3

4

5

6

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Years

SSRI-Involved Fatal Accidents/Pilot Fatalities (%)
5

Table II. The SSRI-Involved Accidents Wherein the Psychological Conditions and/or the Use of SSRIs 

and/or Other Drugs Were Determined by the NTSB to be the Cause/Factor(s) 

 Accident Probable Cause Contributing Factor(s) 

1 Suicide Other psychological condition 

2 – Use of a prescription drug 

3 Alcoholic and drug impairment of efficiency 

and judgment 

–

4 – Impairment due to use of drugs that were not 

approved for use while flying 

5 Impairment of judgment and performance due 

to drugs 

–

6 Loss of control due to spatial disorientation Impairment due to medication 

7 – Use of contraindicated drugs 

8 – Use of unapproved medication 

9 Physiological impairment due to alcohol Psychological condition 

10 – Impairment of the pilot's judgment by the 

use of a contraindicated drug, and his 

overconfidence in his abilities 

11 – Use of prescription drugs not approved for 

use by the FAA 

12 Alcohol impaired decision making – 

13 The pilot's incapacitation Inappropriate use of medication, and 

depression*

14 – Impairment due to drugs/medication 

15 – Pilot's impairment (alcohol), and his 

psychological condition 

16 – Drug impairment of the pilot as a result of 

higher than normal levels of Benadryl 

17 – Use of FAA prohibited drugs 

18 – Impairment (drugs) of the private pilot 

19 – Use of inappropriate medications 

*

Findings. 
6

pilot’s depression” and “inappropriate use of medication.” 

The “use of drugs” (an SSRI with or without other drugs) 

was found to be the probable cause in 1 accident and a 

contributing factor in 11. The cause of 1 accident was 

“pilot’s alcohol impaired decision making;” a contributing 

factor in another was “impairment of the pilot as a result 

of higher than normal levels of Benadryl,” wherein an 

SSRI was also present.

DISCUSSION

The use of SSRIs by aviators has attracted a great 

deal of discussion (7,8,14,17), and some authors and 

professional associations recommended a policy for 

developing criteria to allow the use of the antidepressants 

by selected pilots (8). Currently, U.S. regulations do not 

permit the use of antidepressants by civilian aviators 

(2,5). Nevertheless, some countries have different policies 

about SSRI use by aviators. For example, Canadian 

aviation authorities have an aeromedically supervised 

treatment protocol that allows a few pilots to fly “with or 

as copilots” during maintenance antidepressant therapy 

(8,9), and the Australian Civil Aviation Safety Authority 

has allowed during January 1993–June 2004 nearly 500 

pilots and air traffic controllers to return to duty while 

their depression was under control with SSRIs (4,12). 

However, safety concerns have been raised about the 

details of these procedures (6). 

Aviation safety concerns have also been raised for the 

risk potential of depressed and untreated pilots and for the 

pilots receiving SSRIs without informing the AME or the 

FAA (7,8). Furthermore, based on the pilots’ telephone 

inquiries database of Aviation Medicine Advisory Service, 

it has been reported that, when instructed about the 

current regulations banning the use of SSRIs by airmen, 

59% of the pilots preferred to refuse the medication 

and continue to fly. However, about 15% said that they 

would prefer to take the medications without informing 

the FAA (8). Another safety issue that has been reported 

by the FAA officials shows that the problem is not solely 

with the pilots’ incorrect decision but, in some instances, 

with AMEs’ practices as well (14,16). The U.S. Federal 

Air Surgeon addressed this problem: “Unfortunately, we 

recently became aware of more than 100 airmen that had 

been issued certificates while they were taking selective 

serotonin reuptake inhibitors, or SSRIs”(16).

Although the number of active pilots using SSRIs 

cannot be easily and clearly established, the only group of 

pilots with documented SSRI use was the one reported in 

the study of Akin and Chaturvedi (1), wherein SSRIs were 

found in 61 pilot fatalities of U.S. civil aviation accidents 

(1990–2001). That study was based on the postmortem 

toxicological data and did not contain information on the 

medical history of these airmen. In continuation of the 

postmortem study, the present study found that none of 

the 61 pilots was certificated mistakenly. Of the 7 pilots 

who initially self-reported a history of psychological 

condition, only 1 was not reissued a medical certificate 

after the pilot’s last aviation medical examination, which 

was conducted 32 months before being involved in a fatal 

accident. The other 6 pilots had declared that they had 

no longer had a disqualifying medical condition, and/or 

they had not been taking a disqualifying medication. 

Furthermore, personal medical records of 2 of these pilots 

and an additional 10 pilots showed that they had been on 

regular treatment with antidepressants. Although 88% 

(52/59) of the pilots had not reported their psychiatric 

condition and 95% (56/59) had never reported the use of 

an antidepressant, the higher percentage of reporting of 

a DUI—39% (23/59)—was an interesting observation. 

The reporting of DUIs in such relatively high numbers—

compared to the reporting of SSRI use—could have been 

because the FAA has the authority to access the records 

of pilots from the National Driver Registry. Also, some 

pilots may have assumed that they could continue to 

fly even with a history of DUI. This observation might 

support the suggestion that a policy allowing a supervised 

maintenance SSRI use could prevent airmen from using 

SSRIs without informing the FAA (7,8). However, the use 

of SSRIs may be underreported, similar to the situation 

in which only 1% of Australian pilots were identified as 

having been certificated while taking SSRIs (12). The 

1% value was considered to be much lower than that 

of the general population, suggesting that the SSRI use 

was underreported.

Although the majority of the SSRI-involved fatal 

aviation accident pilots were certificated, and they were 

primarily private pilot and Third-class medical certificate 

holders, there were a number of pilots (20%; 12/61) that 

chose to fly without valid medical certificates. In the group 

of 61, there were experienced and inexperienced aviators, 

ranging from young to old age groups. Interestingly, 21% 

of them were medical professionals—2 of them were 

psychiatrists and 1 was a psychologist.

In the earlier study by Akin and Chaturvedi (1), 

the use of an SSRI was reported as a contributory factor 

in 9 of 61 accidents. At that time, the reports of all 61 

accidents had not been finalized by the NTSB. All the 61 

reports have now been completed, and accordingly, pilot’s 

psychological condition and/or SSRI use was reported 

to be the probable cause or a contributing factor in 31% 

(19/61) of the accidents. 

Findings from the present study reconfirm that SSRIs 

were used by aviators, but the use was not reported in 
7

their last aeromedical examinations. Additionally, most of 

the the airmen had not self-reported their psychological 

conditions and medications while they were continuing 

a regular SSRI treatment. Even the pilots with medical 

backgrounds and education did not report their conditions 

or medications. Since the problem of not reporting the 

use of SSRI and/or psychiatric diagnosis continues, 

AMEs should use caution in certifying airmen with 

vague psychological signs, particularly when the use of 

this group of antidepressants is drastically increasing in 

the society.

REFERENCES

1. Akin A, Chaturvedi AK. Selective serotonin reuptake inhibitors in pilot fatalities of civil aviation 

accidents, 1990–2001. Aviat Space Environ Med

2003; 74:1169–76.

2. Code of Federal Regulations. Title 14—Aeronautics 

and space, Chapter I (1-1-06 Edition)—Federal 

Aviation Administration, Department of Transportation, Subchapter D—Airmen, Part 67—Medical 

standards and certification. Washington, DC: GPO, 

2006.

3. Code of Federal Regulations. Title 14—Aeronautics 

and space, Chapter I (1-1-06 Edition)—Federal 

Aviation Administration, Department of Transportation, Subchapter F—Air traffic and general 

operating rules and Subchapter G—Air carriers and 

operators for compensation or hire: certification 

and operations. Washington, DC: GPO, 2006.

4. Emonson D. Letter to the editor. Aviat Space Environ 

Med 2002; 73:1241.

5. Federal Aviation Administration, Office of 

Aerospace Medicine. Guide for aviation medical 

examiners, retrieved 9/25/2006, from www.faa.

gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide.

6. Ireland RR. In response to the letter by Emonson. 

Aviat Space Environ Med 2002; 73:1241.

7. Ireland RR. Pharmacologic considerations for 

serotonin reuptake inhibitor use by aviators. Aviat 

Space Environ Med 2002; 73:421–9.

8. Jones DR, Ireland RR. Aeromedical regulation of 

aviators using selective serotonin reuptake inhibitors 

for depressive disorders. Aviat Space Environ Med

2004; 75:461–70.

9. Lange M. Maintenance SRI use in professional 

pilots: the Canadian experience [abstract]. Aviat 

Space Environ Med 2002; 73:244.

10. Latner AW. The top 200 of 2000: Drugs of the new 

millennium. Pharm Times 2001; 67(4):14–29.

11. Physicians’ desk reference. 60th ed. Montvale, NJ: 

Thomson PDR, 2006.

12. Ross J, Crisp D, Lambeth L, et al. Antidepressant 

usage and civilian aviation activity in Australia 

1993–2004. Canberra, Australia: Civil Aviation 

Safety Authority; 2005 Sep.

13. Silberman WS. Medications in civil aviation: what 

is acceptable and what is not? Aviat Space Environ 

Med 2003; 74:85–6.

14. Silberman WS. SSRI policy reminder. Fed Air Surg 

Med Bull 2005; 43(2):9.

15. Sweetman SC, ed. Martindale: the complete drug 

reference. 34th ed. London: Pharmaceutical Press, 

2005. 

16. Tilton F. The Federal Air Surgeon’s Column—

Thanks. Fed Air Surg Med Bull 2006; 44(2):2. 

17. Van Syoc D. Serotonin reuptake inhibitors in 

aircrew [abstract]. Aviat Space Environ Med 2002; 

73:244.