Pilots and Antidepressants

Editorial Note: This post is by Julie Wood, the central figure behind SSRI Stories in its current incarnation.

SSRI Stories has collected and posted 47 stories about pilots flying and crashing while on antidepressants. The majority are airplanes but several of the crashes involve helicopters.

With the current focus on the possible contribution of psychoactive drugs to the crash of GermanWings flight A320 on Tuesday, March 24, it is useful to sift through the 47 cases to identify potential links between the effect of the antidepressants and the events. Note that the news articles and National Transportation Safety Board (NTSB) reports for all these cases, plus several additional incidents and news reports related to pilot use of antidepressants, can be seen by going to the SSRI Stories home page and clicking the category “Pilot” from the list on the right side of the page.

In all stories, the pilots were taking antidepressant medications, mostly SSRIs, often in combination with other medications and sometimes with alcohol. The National Transportation Safety Board investigates all crashes in America. In cases involving pilot fatalities, which includes all but two of the cases, toxicology tests were done on the pilots which is how it became known that they were taking the medications. All but 3 of the cases involve pilot error, misjudgement, or sabotage.

The following patterns and information were noted in the 47 stories:

1. Substance other than antidepressant blamed: In 5 cases, the pilot had taken another substance, either alcohol (which has always been prohibited for pilots) and/ or another medication. In these 5 cases the cause of the crash was blamed on the other substance. Interaction between the other substance and the SSRI was not considered as a potential contributing cause.
2. Antidepressant present but not considered a contributing cause: In 21 of the 47 cases, the antidepressant medication is not mentioned as a possible contributing cause of the crash. In several of these cases the side effects of all the drugs present are listed. In not one case, i.e. 0 out of 47, were psychiatric side effects of any drugs mentioned in any context.
3. Pilots failed to disclose their use of medications as required: In 14 cases, the narrative specifically notes that the pilots lied on their certificate applications about their use of the medications. In most of the other cases there is no indication whether or not the pilot lied.
4. Suicides involving antidepressants and aircraft: Eight of the cases were ruled suicides. These are NOT the same 8 cited by the FAA as the only known cases of suicide involving commercial pilots. In some of the FAA-cited cases, we have no idea what medications the suicide pilots were taking, if any.
5. Death Not Confirmed or Ruled Accidental that might have been suicides: Of the 47 cases, 11 might have been suicides, given that the pilots were taking antidepressants. Reasonably enough, the NTSB only rules fatalities to be suicides where the evidence of suicide is overwhelming. However, this does mean that pilot suicides are almost certainly understated.
6. Commercial Pilots affected by use of antidepressants: The FAA only acknowledges 8 cases of commercial/professional pilot suicide involving aircraft. In these 8 cases, they have not made any connection with medications. In the 47 SSRI stories cases, 12 commercial pilots involved in fatalities had been taking antidepressant medication which potentially altered their cognitive functioning and judgement. Even though the crashes did not usually involve commercial aircraft, it does show that some commercial pilots are taking these meds. The FAA appears oblivious to the fact that antidepressant medication may have psychiatric side effects. Their policies reflect a clear belief that depression can cause problems, but as long as pilots have been successfully treated (i.e. they are taking SSRI medications for 6 months or more) then the problem, which is the depression, can be considered under control. The possibility that these drugs might cause psychiatric problems, not solve them, is not officially considered.

As David Healy notes in his March 30 blog post “Winging It: Antidepressants and Plane Crashes“: “whatever the risks are linked to anxiety or depressive states, in clinical trials antidepressants double them.” He also notes: “Once treated with a drug, a pilot is never the same again.” Withdrawal can be among the worst drug side effects, but this is simply not taken account of in FAA policy. Of course, withdrawal effects can last longer than metabolites are present in blood and tissue, and thus the role of withdrawal is rarely clear in cases where it may have been a contributor to a fatal event.

A review of the 47 stories reveals these systemic issues which expose gaps in the official FAA approach. Each of the above issues is illustrated with examples, following which there is a Conclusions section, summarizing what the stories collectively demonstrate.

1. Substance other than antidepressant blamed

• On the evening of July 22, 2013, Edwin G. Hassel, 22, intentionally crashed the Cessna 172M he had rented. Although “the Federal Aviation Administration’s Bioaeronautical Sciences Research Laboratory in Oklahoma City detected an antidepressant in his system” the fact that “It also detected ethanol, which is the active agent in alcoholic beverages” seemed to be all that concerned the investigators who noted: “The investigation was unable to determine if pre-flight ethanol ingestion played a role in pilot’s decision-making”. There is no indication that the (unspecified) antidepressant was considered a factor, and no awareness that alcohol combined with certain antidepressants might magnify impairment. The thinking seems to have been that alcohol may not have been a factor because “The ethanol level detected was below Virginia’s legal limit for impairment.” View Post

• “Dense fog and the pilot’s use of nerve pain medication not approved for flight were cited as possible factors in a November plane crash near Amarillo that killed three members of a Canyon family, according to a report issued this week by the National Transportation Safety Board. Investigators determined the official cause of the crash as a loss of control brought on by pilot spatial disorientation, the report showed. In the report, the NTSB also said William Capt tested positive for duloxetine and gabapentin, also sold as Cymbalta and Neurontin.” View Post

• On Saturday, September 29, 2012 in Fredericksburg, VA, John Morton, a commercial pilot, took his 13-year-old son Kyle flying in a Cessna 150. Morton had ingested some alcohol and was also taking Celexa. “According to a witness, who was a flight instructor, … [after its initial ascent] the accident airplane made a 90-degree left bank, and began to turn left until the nose descended and the airplane disappeared behind terrain. Other witnesses, who were on the ground near the accident site, reported seeing the airplane spinning as it descended.” The National Transportation Safety Board determined the probable cause(s) of this accident to be: “The pilot’s failure to maintain airplane control during initial climb. Contributing to the accident was the pilot’s impairment due to alcohol.” The possibility that the Celexa combined with the alcohol played a role in impairing pilot judgement was not considered. View Post

• “Two pilots who died in a small-plane crash near Collinsville in September 2008 might have been impaired by prescription or over-the-counter medications, according to the National Transportation Safety Board. But the federal agency still was not able to determine who was flying the Cessna 320. Harvey Hazelwood (left) and Larry Jackson: Hazelwood, who owned the plane, was taking medications for various ailments, and Jackson was taking an over-the-counter drug for allergy relief.” “The failure to maintain adequate airspeed was ruled the probable cause of the crash, according to an NTSB report issued Wednesday. “ “It is likely that (Hazelwood) was impaired by recent ingestion of diphenhydramine [Benedryl, an antihistamine],” the report says. “It is possible that (Jackson) was impaired or distracted by his hip pain, or impaired by nortriptyline,” the report says. Jackson was also taking Prozac and Trazodone, but there is no mention of these medications as possible contributors to the problems. View Post

• On June 4, 2002, Michael Antinori was killed when his single-engine Cessna nose-dived about 20 miles north of Tampa. A Tampa police report mentioned that alcohol appeared to have been a factor in the crash. Antinori was also taking zolpidem, and 12 times the recommended dose of Celexa. (See more about this case under Deaths Ruled Accidental that might have been suicides) View Post

2. Antidepressant present but not considered a contributing cause

Note that not all of the 21 cases are summarized here. A sample of 10 provides adequate representation of the issue. Other examples can be seen in the excerpts quoted in other categories.

• A pilot whose plane went down in Maryland last month told News4’s Shomari Stone it was the grace of God that saved him… Rothenberg was piloting to get a biannual re-certification. He said he regrets decisions he made seconds before the crash that killed his friend [the flight instructor, who was taking Zoloft, was killed]… The cause of the crash was determined to be [both] pilots’ failure to ensure that the fuel selector handle was correctly positioned, which resulted in an interruption of fuel to the engine and a loss of engine power during the takeoff, which necessitated a turn away from the trees at the end of the runway and the subsequent stall. View Post

• One man died and another was injured Wednesday when the single-engine plane they were flying took a nose-dive into a runway at Albert Whitted Airport. James Allen Finnegan, 79, was piloting the 1947 Luscombe model 8A when the two-seat aircraft crashed at 1:52 p.m., shortly after taking off, authorities said. Finnegan owned the plane, but had not flown in several years and was taking a refresher training course from James Patrick Murphy, a certified flight instructor. The plane reached an altitude between 50 and 100 feet over the westbound runway before diving straight down, authorities said. Citalopram was detected in the liver and blood of the pilot/owner, who was killed. The NTSB noted that; “Contributing to the accident were the pilots’ decisions to operate the airplane above its maximum allowable gross weight and to perform an intersection takeoff.” View Post

• LARCHWOOD, IA – Employees at the Dr. Robert Akins Sinus Specialty Clinics in Sioux Falls have confirmed the company’s namesake was killed in a plane crash. The National Transportation Safety Board determines the probable cause(s) of this accident to be: The pilot’s failure to maintain directional control of the airplane after landing. Toxicology tests showed that the pilot was taking Trazodone and Prozac. View Post

• “As federal investigators concluded their fact-finding mission into what caused a single-engine plane to crash, authorities Tuesday released the names of the two men killed. Willie Ed Bolton, 63, and Forrest Horecka, 54, died of massive traumatic injuries, the Bexar County medical examiner’s office reported… Bolton, retired from the Air Force and self-employed, was a certified flight instructor and airline transport pilot — the highest FAA certification. …the plane was cleared for takeoff from Stinson at 5:07 p.m. Two minutes later, the pilots radioed the tower and said they were returning. The communication was cut short, Latson said, and the tower controller looked up to see the plane fall and black smoke rise into the air. Bundara said the fact the pilots turned the plane around shocked local fliers. “None of us can believe that Willie Bolton, being the instructor that he is, would have done that,” he said. “When you have engine trouble on take-off, you fly straight ahead and land where you can. You don’t try to turn.” … The cause of the crash remains undetermined, Latson said”…the pilot was taking Tramadol and Paxil and had recently had his Paxil dosage increased. View Post

• “On August 13, 2011, about 1200 central daylight time, a 1943 Fairchild M-62 (PT-19A) airplane, N53956, was substantially damaged when it impacted power lines and terrain along the Des Moines River near Madrid, Iowa. The pilot and passenger were fatally injured. The National Transportation Safety Board determines the probable cause(s) of this accident to be: The pilot’s improper decision to conduct low-level flight along a river, which resulted in a collision with power lines.” The pilot was taking Zoloft (sertraline). View Post

• “Pilot error is being blamed for a horrific site back on Memorial Day weekend 2011 when a Rockwell 112 single engine plane came crashing to the ground at the Z Islander Apartments on Wellborn Road in Bryan. The National Transportation Safety Board says the pilot ran out of gas during the flight from Fort Worth Spinks Airport to Galveston and he didn’t refuel the plane after two recent flights.” The pilot was taking quinine and Prozac. View Post

• “On March 30, 2011, at 1746 eastern daylight time, a Beech 58, N569JL, operated by Jet Logistics, Inc., was destroyed when it impacted trees and a residence while conducting an instrument approach to Piedmont-Triad International Airport (GSO), Greensboro, North Carolina. The certificated airline transport pilot and her passenger were fatally injured… the pilot conducted a holding procedure while enroute INT, and during the hold, elected to divert to GSO. The pilot was cleared for the instrument landing system approach to runway 5L, and subsequently declared a missed approach before radar contact was lost.” The NTSB report discusses whether lack of sleep could have contributed to the pilot’s performance but concludes that: “the available evidence does not support a conclusion that the pilot’s performance was degraded by fatigue.” The pilot had taken Zoloft, butalbital, and promethazine. View Post

• “HOLLY SPRINGS, N.C. – Approximately 30 minutes before a twin-engine plane crashed near the Mount Airy/Surry County more than two years ago, the pilot yelled out an ominous warning to the five passengers aboard. “If anybody back there believes in the good Lord, I believe now would be a good time to hit your knees,” Ronald Rakestraw said. Rakestraw’s comments were recovered from the cockpit recorder. They are also included in the Federal Aviation’s Administration’s probable cause findings in which the NTSB said that the Feb. 1, 2008 accident, which killed all six aboard, could have been avoided. Rakestraw, the NTSB says in its report, displayed some “non-professional” behavior shortly before the impact. That behavior, the NTSB said, consisted of… singing to passengers “Save my life I’m going down for the last time”. “The National Transportation Safety Board determines the probable cause(s) of this accident to be: The pilot’s failure to maintain control of the airplane in instrument meteorological conditions. Contributing to the accident were the pilot’s improper decision to descend below the minimum descent altitude, and failure to follow the published missed approach procedure.” The pilot was taking Zoloft. View Post

• The NTSB’s final report on the fatal 2009 accident that killed a New Mexico State Police (NMSP) helicopter pilot and the hiker he had just rescued is sharply critical of the department’s flight policies and the pilot’s decision-making. The Board criticized the pilot for flying in IMC without a helicopter instrument rating. It also noted that he prepared inadequately for the mission by failing to mitigate risks by bringing readily available equipment such as cold-weather survival gear and night-vision goggles. Tingwall, the pilot, had been prescribed Prozac and the drug was found in his blood. View Post

• NEW SHOREHAM – A pilot’s poor decision to take off in bad weather likely led to the plane crash that killed three in July 2006 on Block Island, investigators have concluded. White Plains, N.Y., surgeon William P. Homan, his wife, Valerie, and mother, Betty, died July 5, 2006, when Homan’s Piper Cherokee Arrow crashed through trees about a half-mile from Block Island State Airport shortly after takeoff. The plane was bound ­in stormy weather shortly after noon with Dr. Homan at the controls ­for Westchester County, N.Y., Airport. National Transportation Safety Board investigators concluded in a March 31 report that Homan’s “inadequate pre-flight decision making” and failure to clear trees near the airport probably caused the crash… The report shows that an autopsy determined Homan, 58, had recently taken bupropion and fluoxetine prescription antidepressants and oxcarbazepine, a mildly impairing antiseizure medication. View Post

• “Ketchikan, Alaska – The National Transportation Safety Board released its probable cause findings for the plane crash near Ketchikan that killed five people on July 24, 2007. The Taquan Dehavilland Beaver crashed in Misty Fjords about 40 miles northeast of Ketchikan during a flight-seeing tour. Killed were the pilot, Joseph Campbell, 56, and two married couples who were passengers on the Sun Princess: William F. Eddy and Jeanne J. Eddy, both 59, of Jacksonville, Fla., and Paul J. McManus, 60, and his wife, Marianne M. McManus, 56, of Massachusetts. Mrs. McManus and Mrs. Eddy were sisters. In the report released August 13, 2008, the National Transportation Safety board determined the probable cause of this accident as pilot Joseph Campbell’s decision to continue under visual flight rules into an area of instrument metrological conditions. Contributing to the accident was the pilot’s inadequate weather evaluation, and the Federal Aviation’s inadequate surveillance of the commercial air tour operator.” The article in Alaska Report notes: “If you read the entire [NTSB] accident report you will find that the pilot (Joseph H. Campbell) was previously suicidal and also taking anti-depressant medication at the time of the accident which would NOT allow him to be legal to fly any aircraft”. View Post

3. Pilots fail to disclose their use of medications as required

Headlines of articles noting this failure are listed below:

• A320 Crash: The Co-Pilot Wanted the World To Know His Name  View Post
• Fog, pain medication cited as possible factors in fatal plane crash near Amarillo  View Post
• Pilot’s Last Words before Fatal Crash Help Investigation  View Post
• Plane Crash Victim Was Sioux Falls Doctor View Post
• Plane crash victims are ID’d  View Post
• Wire Strikes Cited In Three Fatalities In Two Weeks  View Post
• Pilots in crash may have been impaired  View Post
• Contraindications: Dr. Doyle John Borchers View Post
• Aircraft Incident/Accident Report Grantsburg, Wisconsin 54840  View Post
• Floatplane crashes near Ketchikan, Alaska killing five  View Post
• Pilot Took Amphetamines before Fatal Helicopter Crash, Report Says  View Post
• Suicide by airplane – Charles Kenneth Richards  View Post
• Widow Sues Richmor Aviation over Crash  View Post
• Two Die as Plane Crashes into House  View Post

4. Suicides involving antidepressants and aircraft

The Evidence has to be overwhelming to result in a ruling of suicide as the cause of a crash. The following situations were ruled to be suicides:

• Early press reports of the March 24, 2015 Germanwings crash are tending to the theory that the actions of the 27-year-old co-pilot, Andreas Lubitz, can only be interpreted as suicide. Of course, unlike most cases where there are no passengers or only a few, 150 people died as the result of his actions. It has been reported that antidepressant medication was found in Mr. Lubitz’s apartment, but the medication has not been specifically identified. View Post

• The case of Edwin Hassel (See Substance other than antidepressant blamed) was counted as suicide. View Post

• In August, 2007, Aero News reported that “The pilot involved in a weekend Cessna 206 accident is under suspicion of having used his employer’s aircraft to commit suicide. Daren Ramphal, 25, perished when the aircraft (type shown above) he was flying went down in a field east of Interstate 75 in Sumter County, FL.” He had told his Mum that he “would fly East until he could not fly anymore”, and his girlfriend, with whom he had recently split, that he was planning to use a small airplane to attempt suicide. Daren had been drinking and taking Celexa. View Post

• On July 18, 2003, Douglas Lee Scholl of Jackson, Minnesota, a 45-year-old private pilot with a history of depression, attempted suicide with sleeping pills. The day after he was released from hospital, July 21st, he “went to Jackson Municipal Airport, and crashed his Piper Cherokee… into the ground near the airport. Witnesses reported the plane flying normally and then all of the sudden turning “to the left and straight down to the ground.” “Douglas had been drinking and was taking Celexa, Prozac, and Benadryl. View Post

• On Saturday, January 5, 2002, Charles Kenneth Richards, a 54-year-old commercial pilot from Lyons, Colorado, “departed Vance Brand Airport in his Cessna 172K… He flew over his house (where his wife heard his airplane overhead), and continued to fly around for about half an hour. Then he began squawking 7700 (a transponder code indicating an onboard emergency), and several witnesses reported seeing the plane flying straight and level, very low, right into the side of Dakota Ridge. Anti-depression medication [Effexor] was found in his bloodstream during an autopsy, and his wife and his psychotherapist reported that he was being treated for severe depression.” View Post

• On Monday, July 03, 2000 in Whittier, Alaska, according to Anchorage Daily News: “Keith E. Kirsch, a 40-year-old private pilot, rented a Cessna 172S (N862SP) from Take Flight Alaska on the evening of July 3rd. He took off from Merrill Field Airport in Anchorage, and spent the next two hours buzzing boats before making a distress call and crashing into the ocean near Point Pigot. The Coast Guard recovered his floating body, and the aircraft was recovered five years later by a fishing vessel. Kirsch had multiple DUIs and had committed felony arson in 1990 when he firebombed a restaurant. At the time of the crash, he was a suspect in another arson, and a warrant was out for his arrest.” Kirsch had been taking alcohol, cocaine, Temazepam, and Valium. View Post

• In September, 1998 the Daytona Beach News-Journal reported: “Aeronautical University flight instructor Michael Nawrocki crashed a stolen plane Sunday night at Daytona Beach International Airport, authorities said. When an air traffic controller told Nawrocki he was flying high on his approach, Nawrocki radioed back: “This will be my final landing.” Nawrocki’s death in the fiery crash of a twin-engine Piper Seminole at 11:22 p.m. Sunday was ruled a suicide Tuesday after an investigation by airport police… His roommate found Nawrocki’s suicide note Monday in his Daytona Beach apartment, Grim said. In the note, Nawrocki, who was taking antidepressants, wrote he was stupid and was tired of being sick and fat,” Grim said.” View Post

5. Deaths not confirmed or ruled accidental that might have been suicides

•  MISSING: “Pilot Daroish Kraidy is missing, feared dead, after disappearing on a solo flight on March 25. The similarities [to Malaysian Airlines flight 370] are chilling. The radar transponders of both planes were switched off soon after take-off, no distress messages were sent and the planes simply disappeared… Judy Kraidy… believes her husband, who had fuel for a 300km trip, kept flying straight out to sea until he crashed. She doubts the wreckage will be found. The fact Kraidy had been seen flying low suggests “he knew what he was up to. The weather was pretty good . . . there’s no way he would have got lost there, it was his playground.” Everyone agrees Kraidy was a brilliant pilot… Judy Kraidy says her husband suffered from depression most of his life, and after their separation in 2012 he deteriorated.” The story implies that Kraidy was taking an unspecified antidepressant. View Post

• See the Morton case under Substance other than SSRI blamed. This man was an experienced pilot. “Witnesses said the plane went straight up and quickly came down, crashing.… Although the accident pilot was also a certificated mechanic, no maintenance work was performed on the airplane prior to the flight or in 2012.” The NTSB report cited impairment due to alcohol, but no consideration is given the possibility that this impairment, and possible suicidal thinking, could have been triggered by the combination of drinking and taking citalopram. The point is not that there should have been a positive conclusion about this; but rather it is a concern that the potential role of the citalopram and its interaction with the alcohol was never considered. View Post

• “A state trooper killed Oct. 15, 2010, when the highway patrol helicopter he was piloting crashed in Clarkson Valley had traces of anti-anxiety and antidepressant medications in his system, but the aircraft also was dangerously low on fuel when the fatal mishap occurred. Those findings are in a National Transportation Safety Board (NTSB) investigative report issued early this month. However, the report draws no conclusions about whether the presence of the drugs had any effect on the pilot and his reaction to what likely happened when the helicopter ran low or out of fuel. Killed in the crash was Sgt. Joseph G. Schuengel, 47, a pilot for Troop C at Weldon Spring… An experienced local helicopter pilot who asked not to be identified said the helicopter Schuengel was flying usually can be landed safely when the engine quits due to a malfunction or running out of fuel.”This pilot was taking Xanax, Effexor and Naproxen. It seems odd that a professional with 2,600 of flying time would make such basic mistakes. View Post

• “ROCKINGHAM COUNTY, Va — Brian Forrest Hall reached out for help right before he crashed his plane on Sunday morning. “He contacted air traffic control and the pilot stated that he had lost his engine,” said Brian Rayner with the National Transportation Safety Board (NTSB).“I lost my engine,” were Hall’s last words on the air. Rayner said they are trying to figure out what those words meant… At 0831 the morning of the accident, the pilot phoned the Raleigh Automated Flight Service Station (AFSS) and obtained a pre-flight weather briefing. During the briefing, he was advised multiple times that visual flight rules (VFR) flight was not recommended due to existing and forecast IMC along his intended route of flight. The pilot departed at 0903 without filing a flight plan.” This pilot was taking Prozac. View Post

• “When Stanford University neurosurgeon and amateur pilot Doyle John Borchers III (California License No. 64879) crashed his plane near Lake Tahoe last August, investigators wondered what the hell he was doing flying a plane at night in a mountainous area in the first place. Borchers, who died in the crash, had been flying sporadically for less than a year and had only flown at night once before – the night before the crash. Now, a National Transportation Safety Board review of the crash provides more details. The NTSB found that Borchers had “a dizzying cocktail of drugs in his system, including cocaine and Prozac”… The Federal Aviation Administration says that the amount of drugs found in Borchers blood, liver and urine should have prevented him from flying. The FAA found opiates, mood stabilizers and anti-psychotic drugs on top of the Prozac and cocaine.” The actions of this pilot were extreme and reckless, and it is conceivable that he acted deliberately in becoming severely impaired and flying at night. View Post

• … “A witness reported that the pilot was taxiing up and down the runway while revving the engine. The witness stated that the engine was missing on at least one cylinder during takeoff. He stated that the airplane climbed and made a left turn directly over his house, clearing it by about 80 feet. While in the turn, the wings dipped to the right, and then the wings dipped to the left “real hard.” The airplane rolled inverted and went down nose first… The pilot had a history of depression, anxiety, and sleep apnea, and had been prescribed multiple medications for the conditions. The level of a prescription antidepressant [Celexa – see NTSB report below] found on post-accident toxicology was more than 10 times higher than expected given the pilot’s prescription for the medication.” The fact that this pilot had a history of depression and had taken an overdose of Celexa, considering this actions in taking off, and causing the crash, might be an indication of self-destructive intent. View Post

• “On July 20, 2005, about 0740 central daylight time, a Cessna 172P, N65875, operated by Gran Aire as a rental airplane and piloted by a student pilot, was destroyed on impact with trees and terrain while maneuvering near Jackson, Wisconsin… No flight plan was on file… The NTSB’s Medical Officer, from the medical records maintained on the pilot by his psychiatrist, extracted the following information: 3/27/98 – “Psychiatric Intake Assessment” notes “… onset depression 1993. …severe depression, being overwhelmed by stress, and suicidal ideation. … It appears that patient has had problems prior to that with mild depression. He has been on Paxil [paroxetine] for at least the last two and a half years with significant, dramatic improvements in overall symptomatology. … notes that he has gone without his medications several times for brief periods, such as 36 to 48 hours, with resulting severe withdrawal symptomatology, including onset of mild suicidal ideation. … Provisional Diagnosis: … Major Depression, single episode, in remission …” 4/23/01 – “Psychiatric Follow-up” notes that the pilot reports “Slight increase in symptoms of depression for last 4 weeks since decreasing Paxil … suicidal intention, … anhedonia … safe for outpatient treatment for now … increase Paxil … refer to psychotherapist …”1/28/03 – “Psychiatric Follow-up” notes that the pilot “… continues to report chronic depression – but slightly better on Celexa [citalopram] … no suicidal ideations … will try Lexapro [escitalopram] …” Because this pilot had a history of problems with suicidal ideation on SSRIs, and depression, and withdrawal, it is reasonable to wonder whether the Lexapro was a factor. View Post

• A pilot who walked away from a helicopter crash and later [the same day] slammed his plane into a cyprus swamp was intoxicated at the time of his death, officials said Monday. The Hillsborough County coroner’s office said Michael Antinori’s blood alcohol level was .14, more than three times the limit considered safe for flying. The Federal Aviation Administration bans pilots from flying if they have a blood alcohol level of .04 percent. Antinori, 30, was killed June 4 when his single-engine Cessna nose-dived about 20 miles north of Tampa. Hours earlier, he was released from a hospital after he crashed his helicopter into a house. No one else was injured in either accident.  … the pilot did not perform an engine run-up before takeoff but he “gunned the throttle two times and took off at 0710 am.”…on the day of the accident sometime after 0730 hours, Tampa Approach Control contacted the FBO and asked for someone there to attempt to contact the pilot on the airport’s common traffic advisory frequency (CTAF). She reported making repeated broadcasts on the CTAF for the accident pilot, but he did not respond… A review of FAA records indicated the pilot did not have any previous accident or incidents, or previous enforcement actions… The levels of citalopram and zolpidem detected in the postmortem blood specimen are more than 12 times and more than 3 times, respectively, greater than the levels of each detected in a hospital blood specimen taken 1 hour 40 minutes following the first accident.” In this case it is hard not to conclude that this pilot was on a deliberate mission to self-destruct, yet it was counted as a fatal accident. View Post

• “James Kenneth Waddill, a 64-year-old retired diesel engine mechanic, crashed his Cessna 172L into the garage of a residence in Tucson, destroying the garage and airplane in a post-impact fire… Tucson air traffic controllers detected the plane on radar, tried unsuccessfully to make radio contact, and an Air National Guard helicopter was scrambled to check on the plane… Waddill’s wife… said that the airplane had not been flown in five years, and that Waddill had never flown it. During the crash investigation, it was revealed that the pilot was having some personal problems and had threatened suicide in the past. The Pima County Sheriff’s department couldn’t conclude, however, that Waddill intended suicide, and listed the cause of death as accidental.” View Post

• “The pilot departed with charts which did not depict accurately the area the airplane overflew. He continued VFR flight into IMC conditions. The airplane was not equipped nor certified for flight in instrument conditions. While in cruise flight, the airplane impacted a 971′ tower 30′ below the top. A witness at the accident site indicated that visibility was restricted to 100 yards in fog. Toxicological tests on blood from the pilot revealed high levels of fluoxetine (Prozac) and norfluoxetine (metabolite of fluoxetine). Probable Cause: The pilot’s VFR flight into instrument meteorological conditions in an airplane not equipped for flight into IMC. Factors were the pilot’s inadequate pre-flight preparation and his inadequate evaluation of the weather and fog.” The combination of the high levels of Prozac and irrational pilot behaviour suggest the possibility of suicide. View Post

• On August 13, 1999, about 1744 eastern daylight time, a Piper PA-28-140, N754AR, registered to Rubin & Rubin P.A., crashed into a house shortly after takeoff from the North Perry Airport, Pembroke Pines, Florida. Visual meteorological conditions prevailed at the time… According to a pilot-rated witness standing outside hangars located east and south of the departure end of runway 09R, he saw the airplane climbing out of runway 9R. He reported, “It was unusually low considering its location. It reached about 150′ then leveled off-the nose then pitched down slightly then back up and the wings rocked a little….” The airplane appeared to “slow down” and looked “floaty”. The airplane then “started a slow left bank becoming steeper, then disappeared from view behind a hangar… The application for the 1996 medical indicated he was taking “Paxil 40mg/day”, for depression. The pilot was advised by the FAA in August 1996, that “By virtue of your history of depression and present use of disqualifying medication (Paxil), it has been determined that you are not qualified for any class of medical certificate at this time.” The pilot’s doctor wrote a letter to the FAA dated January 28, 1997, advising that the pilot “…has been off of Paxil since October 30, 1996 and has been doing excellent.” …Venlafaxine (.071 ug/ml), and Desmethylvenlafaxine (.273 ug/ml) were detected in the blood…Additionally, Venlafaxine and Desmethylvenlafaxine were detected in the liver. Venlafaxine [Effexor] is antidepressant medication.” This was counted as a fatal accident, but the pilot’s history and strange behaviour raise a question. View Post

6. Commercial pilots affected by use of antidepressants

The headlines of articles that describe commercial/professional pilots taking antidepressants, and the drugs and alcohol they had consumed, are listed below:

• Commercial Pilot Crashes Small Aircraft (Zoloft and Allegra)  View Post
• Father, son who died in plane crash laid to rest (Alcohol, Celexa)  View Post
• NTSB issues report on Clarkson Valley helicopter crash (Xanax, Effexor, naproxen)  View Post
• Husband of Boynton Beach woman who died in Georgia helicopter crash sues manufacturer (phentermine, Benedryl, Wellbutrin)  View Post
• UPDATE: Men Killed in Fatal Plane Crash Identified (Zoloft, Carvedilol, enalapril)  View Post
• Plane crash victims are ID’d (Paxil, Tramadol)  View Post
• Preliminary Report on BEECH N569JL Accident at Greensboro (Zoloft, butalbital, promethazine)   View Post
• Pilots in crash may have been impaired (Prozac, Benedryl, Trazodone)  View Post
• NTSB Slams NM State Police Over 2009 Helo Crash  View Post
• Floatplane crashes near Ketchikan, Alaska killing five (unspecified antidepressant)  View Post
• Pilot medicated in fatal Cody crash (chlorpheniramine, Sudafed, Zoloft, Tylenol, phenylpropanolamine)  View Post
• Suicide by airplane – Charles Kenneth Richards (Effexor)  View Post

Conclusions

From the above stories, it is reasonable to conclude the following:

• Suicides involving aircraft are almost certainly under-reported;
• The potential contribution of antidepressant medications to crashes is not being properly considered in crash investigations, and the FAA/NTSB are either unaware of, or are disregarding many side effects reflected in black box warnings;
• Among the relevant side-effects that the FAA seems not to take into account are suicidal ideation and violent thoughts.
• Commercial pilots are taking more antidepressant drugs, and lying about it more often, than the FAA acknowledges.

Further examination of the impact of pilots use of antidepressant medications does appear warranted as a public safety measure.