The apparent mass murder-suicide of 150 people by a young and reportedly depressed commercial pilot crashing into the French Alps has raised several difficult questions. Since the FAA (Federal Aviation Authority of the US) and similar agencies abroad generally do not want their pilots to have any medical condition or take any medications, is the implementation of this medical standard realistic or even safe?
Considering that about 6% of people have major depression right now, and 15% of us will get major depression in our lifetime, and that there are by some estimates almost a million people holding pilots licenses (over 100,000 of them commercial pilots), what are the chances that one of them in the cockpit of your plane is depressed? We don’t know the answer because pilots have huge incentives to deny their illnesses and to avoid seeking treatment in order to prevent being temporarily or permanently grounded.
But, in my own experience as a psychiatrist treating pilots with depression, I know that most of them insist that any diagnosis and treatment of depression be done “off the record” and not reported to their employer as their condition of accepting treatment. This presents a dilemma to the psychiatrist as well as to the pilot and the FAA about conflicting loyalties, confidentiality and whether treatment “off the record” is better than forcing someone to have no treatment.
Is it time to allow depression to come out into the open, allow pilots to get treatment, and then return pilots who recover to the cockpit without stigma, shame or the end of their careers? Since depression is recurrent, can we allow pilots who recover from their depression to fly while taking antidepressants to prevent relapse? If the answers to these questions continue to be “no” then we will continue to have pilots avoid the diagnosis and treatment of depression, or conceal it.
Untreated depression can cause suicidal ideas and plans, and since suicide is the 3rd leading cause of death in the US (after cancer and heart disease) with over 38,000 cases a year, do we really want to have an aviation system that creates incentives to avoid and conceal treatment of depression?
TREATMENT and TESTING
We could institute new testing of pilots for surreptitious use of antidepressants and institute much more regular and exhaustive psychiatric screening of pilots to find undetected or unreported depression and its treatment. Or we could allow pilots to voluntarily report depression, realizing that it is a treatable illness with good chances of complete recovery, allow use of antidepressants that do not impair flying, and return pilots to the cockpit when fully recovered.
It won’t be easy to change the FAA standards for illnesses and medications, but maybe it is finally time to take a serious look.