Many Americans cope with anxiety--pilots included. The FAA has strict guidelines as to which antidepressant medications pilots can take and the procedures they must follow to establish their medical clearance to fly.
Fifteen years ago, the FAA began to consider special issuance of medical certificates to pilots with mild-to-moderate depression who had been treated on one of four antidepressant medications: fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro).
The news of that change made instant nation-wide headlines in 2010. This comment posted on CBSnews.com was typical of the public reaction: “Passengers should be informed several days before a flight if either the pilot or co-pilot are taking any medication that has even the remotest possibility of presenting a danger to passengers so they can make an informed decision whether to take that flight or change to a flight conducted by healthy non-medicated pilots.”
Times change. The U.S. Court of Appeals for the District of Columbia Circuit (“Court”) took the FAA to task on June 27, 2025, because the FAA had not allowed a pilot to get a special issuance medical because he was using mirtazapine (Remeron) rather than an FAA-approved antidepressant medication.
A pilot who is taking medication or undergoing treatment inconsistent with an unrestricted FAA medical certificate may, at the discretion of the Federal Air Surgeon, obtain (or regain) a Special Issuance certificate.
When Michael Solondz, an experienced airline pilot, was diagnosed with anxiety, he chose to take medical leave and receive professional treatment. Various prescription antidepressant medications are effective to treat anxiety. After Solondz experienced unwanted side effects on escitalopram (Lexapro), his healthcare provider prescribed mirtazapine (Remeron), which worked much better, and he sought medical clearance to resume flying. The difficulty is that the FAA conditionally approved Lexapro,but it has categorically disallowed pilots to fly while treated with Remeron.
The FAA makes case-by-case medical decisions about anyone taking a conditionally approved medication’s fitness to fly, but it refused to consider whether Solondz or other pilots taking Remeron and free of side effects can fly safely. Solondz appealed the FAA’s denial of his request for medical clearance.
FAA policy requires any airman taking a conditionally approved antidepressant medication to undergo a six-month waiting period to enable medical observation and certification that the airman “has been clinically stable as well as on a stable dose of medication without any aeromedically significant side effects and/or an increase in symptoms.”
The FAA has conditionally approved several antidepressants, but the court noted that the FAA has released no information describing its criteria or process for conditionally approving antidepressant medications.
By August 2021, Solondz felt ready to return to work as a pilot. He notified the FAA that he was taking Remeron and requested Special Issuance of a first-class medical certificate. In September 2021, the agency denied that request, stating that his history of anxiety and sleep disturbance, as treated with Remeron, disqualified him from medical certification.
Solondz then submitted two more requests for Special Issuance, one in January 2022 and another, accompanied by new medical reports, in February 2023. By letters dated July 2022 and April 2023, respectively, the FAA denied each of those follow-up requests. Solondz continued to request reconsideration, and the FAA continued to deny his requests, culminating in not one but two petitions for review filed with the court.
The various FAA denials added reasons that were unrelated to Solondz’s use of Remeron, but the court parsed through each of these rationales and concluded that the use of Remeron was the FAA’s “operative justification” for denying the request for a special issuance medical.
Why did the FAA refuse to approve Remeron? It asserted that Food and Drug Administration prescribing information and available medical studies establish a high incidence of somnolence (drowsiness) among people who take Remeron.
But the court found that the FAA failed to articulate a clear connection between the evidence in the record—that treatment with Remeron generally poses a risk of excessive drowsiness—and the rule it has applied here, refusing to consider whether, contrary to the evidence of drowsiness in the general run of cases, an individual pilot’s Remeron treatment causes him or her no unusual drowsiness.
The court pointed out that the structure of the FAA’s antidepressant protocol underscores the disconnect between the cited evidence and the rule. An airman must take an approved antidepressant for six months in advance of medical assessment for a Special Issuance. That treatment period allows the pilot and medical professionals to discern whether medication as prescribed is causing any significant side effects to the applicant. An aviation medical examiner then conducts an individualized medical assessment, which includes a detailed, face-to-face, in-office evaluation as well as review of records from the applicant’s treating physician, psychiatrist and neuropsychologist, among other documentation.
The court concluded that the final denial letter was arbitrary and capricious because the FAA has not adequately articulated a rationale for its policy categorically barring pilots under treatment with Remeron from Special Issuance medical certification.
However, the court did not order the FAA to give Solondz a medical certificate. Instead, the court has required the FAA to give further explanation as to why the FAA categorically disallows Special Issuance medical certification to all pilots who take Remeron instead of proceeding case-by-case to determine whether an individual pilot can demonstrate that he or she suffers none of the risk-elevating side effects.
What does this mean for pilots? Although the court’s decision creates a significant legal precedent for pilots, Solondz still does not have his medical certificate after four long years. He should be commended for his patience and perseverance, and he deserves to be back on the flight deck soon.
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