A few years ago I was hired by the FAA to defend the agency against a suit brought by a pilot who wanted to fly while taking a prescription antidepressant. I helped the FAA formulate its defense of the agency's ban on pilots using antidepressants and, as a result, the ban remained in effect. Pilots remained unable to fly while taking antidepressants, including the newer ones such as Prozac, Paxil, Zoloft, Celexa, Lexapro and Effexor.
How times have changed. Ignoring the scientific data on adverse drug effects that the agency and I generated and evaluated for the earlier case, the FAA is lifting its 70-year-old ban on allowing pilots to take antidepressants. Has the science changed--improving the adverse reaction profile of these drugs? To the contrary, since that time my most dire observations have been confirmed in the FDA-approved label for all antidepressants. Now there is not only a Black Box Warning for suicidality in children, youth and young adults, but also a lengthy Warnings section about a variety of extremely dangerous abnormal behavioral reactions in all ages including aggression, hostility, disinhibition, impulsivity and mania. Even when not severe, these reactions impair judgment and increase the likelihood of accidents and violence.
According to the FDA-approved guidelines, prescribers are supposed to give a special Medication Guide to patients and their families that warns about dangerous drug-induced reactions including suicide, violence and a variety of unexpected negative behaviors. Originally intended for children and youth, the Medication Guide is now expanded to cover all age groups, including adults. The Medication Guide for all ages can be found at the conclusion of each FDA-approved label for antidepressant drugs in the 2010 Physicians' Desk Reference.
Why did the FAA lift the ban on pilots using antidepressants? According to FAA statements to the media, depressed pilots sometimes kept on flying while secretly taking antidepressants. "Our concern is that they haven't necessarily been candid," FAA Administrator Randy Babbitt reportedly told the press on a conference call. They were flying below the radar of drug testing, so to speak. The new policy not only allows pilots to use antidepressants, it grants a degree of amnesty to those who have been using them illegally in the past.
The FAA feels it's safer to allow the use of antidepressants because it will make it easier for pilots to obtain needed treatment for depression. It supposedly will also make it easier to monitor their use of these dangerous drugs. If we accept this argument, why not legalize stimulants such as amphetamine as well? They would help keep the overworked pilots awake. And while the FAA is at it, why not let them use marijuana, since they may be doing it illegally on their own without anyone monitoring them.
Unfortunately, monitoring pilots on antidepressants won't work nearly as well as might be hoped. Many severe emotional and behavioral reactions occur in the first one to three days of antidepressant dosing, or shortly after dose changes, either up or down--long before the next scheduled appointment. Although close monitoring and informing the family to be on the alert can be helpful, and should be done, it won't prevent many of the drug reactions that occur abruptly and without warning. In addition, doctors too often fail to warn the patient and the family about the risks. As a medical expert, I've learned how cavalier some prescribers are in regard to warning patients about the adverse effects of any psychiatric drugs.
The FDA also argues that it would safer to let depressed pilots fly if they can take antidepressants. But who wants depressed pilots crisscrossing our nation's airways with hundreds of lives depending on their judgment. And it's unrealistic to hope that taking antidepressants will have such good results for depressed pilots. As I often remind readers, careful meta-analyses of antidepressant studies cast their beneficial effects into doubt while confirming their harmful effects.
Now consider this. Reckless driving is one of the most commonly reported adverse effects of antidepressants. After taking antidepressants, disinhibited, agitated or angry drivers find themselves exploding into road rage or using their cars as instruments of suicide. This is one of the first antidepressants reactions that clinicians like myself began noticing soon after Prozac hit the marketplace. In Medication Madness I describe how an otherwise calm and self-controlled individual took Paxil and then drove his car into a policeman in order to knock him down to get his gun to kill himself. He seriously injured the cop but failed to get his gun from him. In another case in my book, a kind and gentle man turned wildly psychotic on Zoloft and drove his car into a barrier in the hope of killing his passenger wife after he realized her body was harboring an alien beast bent on destroying him and all of humanity. Yes, just the class of drugs for pilots to take.
Doctors are supposed to urge depressed patients give away their guns especially if they're suicidal. Shouldn't they give up their airplanes, too?
The FAA says it wants to help remove the stigma surrounding mental illness and antidepressant medication by allowing pilots to take the medications. So now the FAA wants to join the campaign for the marketing of psychiatry and psychiatric drugs? Where is that written into its legislative mandate? And should we be encouraged to believe that it's safe for depressed individuals to pilot airplanes--with or without the added risk of their taking potent and highly unpredictable psychoactive substances?
There's another wrinkle that the FAA seems to have ignored. Nowadays many patients are given antidepressants in combination with potent benzodiazepine tranquilizers like Xanax, Ativan, and clonazepam. They are given these sedatives in order to counteract the over-stimulation and insomnia routinely caused by the newer antidepressants. Does this mean that the FAA will have to approve addictive benzodiazepines in combination with the antidepressants? Some of the most horrendous cases of violence and suicide I have evaluated in my forensic work have involved the combination of antidepressants and tranquilizers.
Just a few weeks ago I testified before the Veteran's Affairs Committee of the U. S. House of Representatives on the connection between the increased prescription of antidepressants to our troops and the increasing suicide rate among them (video on my website). I presented a mountain of scientific evidence against giving drugs that stimulate aggression and disinhibition to heavily armed young men under stress. But to pilots? It sounds even more dangerous. The FAA should reverse its ruling before it's too late and hundreds of lives are lost when a pilot becomes impulsive, suicidal or violent--or just loses his sharpness--under the influence of antidepressant medication.
Peter R. Breggin, M.D. is a psychiatrist in private practice in Ithaca, New York. He is the author of many scientific articles and books including Medication Madness: The Role of Psychiatric Drugs in Cases of Violence, Suicide and Crime. Learn about Dr. Breggin's new organization at www.empathictherapy.org or visit his professional website at www.breggin.com. He can be emailed at firstname.lastname@example.org or phoned at 607-272 5328.