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Depression and aviation safety fact sheet

While we all feel sad, moody or low from time to time, some people experience these feelings intensely, for long periods of time (weeks, months or even years) and sometimes without any apparent reason. Depression is more than just a low mood - it's a serious illness that has an impact on both physical and mental health.

Research suggests that continuing difficulties - long-term unemployment, living in an abusive or uncaring relationship, long-term isolation or loneliness, prolonged exposure to stress at work - are more likely to cause depression than recent life stresses. However, recent events (such as losing a job) or a combination of events can ‘trigger' depression in people who are already at risk because of past bad experiences or personal factors

Depression affects how people feel about themselves. They may lose interest in work, hobbies and doing things they normally enjoy. They may lack energy, have difficulty sleeping or sleep more than usual. Some people feel irritable and some find it hard to concentrate. Depression makes life more difficult to manage from day to day.

On average, one in six people - one in five women and one in eight men - will experience depression at some stage of their lives. There are different types of depression. Symptoms can range from minor (but still disabling) through to very severe.

The following guidance is relevant for applicants treated for a major depressive disorder, adjustment disorder with depressed mood, or dysthymia (a mild but chronic form of depression.

Effect of aviation on condition

Some conditions associated with Aviation can exacerbate the symptoms of people suffering from, or with a history of, depression and/or anxiety. These include:

• fatigue
• sleep deprivation
• time zone changes
• stressful events
• social isolation
• irregular access to medical care and surveillance
• remote locations.

Effect of condition on aviation

Depressive episodes during Aviation can lead to either overt or subtle incapacitation. They include:

• Overt incapacitation
  • suicidality
  • psychosis of major depression
  • development of other chronic diseases or conditions like anxiety and substance use.
• Subtle incapacitation
  • reduced concentration and memory
  • impaired cognition.

Effect of treatment on aviation

Some medications used to treat depression and anxiety can impair aviation by causing the following symptoms:

• impaired cognition
• sedation
• nausea
• disequilibrium (lack of balance)
• impaired sleep

Approach to medical certification

• Depression is one of the leading causes of disability worldwide
• Well-managed depression is compatible with medical certification.
• Any relapse in depressive symptoms must be reported to the DAME.

• Any change to medication (starting, stopping or changing drugs or doses) must be notified to DAME and will require grounding for two to four weeks.
• CASA may require additional information from family, treating doctors and flying colleagues.
• In cases that CASA assesses as 'low risk', treating doctor reports (GP or DAME) or psychologist reports may be accepted in lieu of a psychiatrist report.

More likely to be certified

You are more likely to be certified or recertified if:

• your doctor has confirmed a diagnosis of unipolar depression and excluded other conditions
• you are taking only one medication
• you are being treated with one of the following:
  • Fluoxetine
  • Sertraline
  • Citalopram
  • Escitalopram
  • Venlafaxine (low-dose only)
  • Desvenlafaxine.

Less likely to be certified

You are less likely to be certified or recertified if you have:

• alternative diagnoses including BPAD, schizophrenia, psychotic disorders
• are receiving therapy involving a multiple drug regime
• are taking Lithium, anti-psychotics, agomelatine, quetiapine, tricyclic antidepressants or monoamine oxidase inhibitors

You are unique

Every case of depression is different. CASA makes aeromedical decisions on a case by case basis. A particular assessment decision is based on the individual circumstances of the applicant under consideration.

Further information

For further information see:

• Beyond Blue