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:
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.
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.
Headlines of articles noting this failure are listed below:
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:
The headlines of articles that describe commercial/professional pilots taking antidepressants, and the drugs and alcohol they had consumed, are listed below:
From the above stories, it is reasonable to conclude the following:
Further examination of the impact of pilots use of antidepressant medications does appear warranted as a public safety measure.