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additional period of at least two weeks. Their supervising medical practitioner may return them to duty
when they are assessed as stable and without unacceptable side effects or evidence of withdrawal
syndrome.
The use of objective assessment tools in the monitoring of these certificate holders is encouraged. The
Hamilton ratings scale1 is one such tool and formal neuropsychological testing is another option.
Simulator or other functional based testing can also be utilized to assess performance. States should
provide guidance on preferred medications with lower side effect profiles such as sertraline, citalopram,
and escitalopram.
Outcome criteria/data on the cohort returned to work should be established prospectively and captured for
review of the programme.
4. References to Appendix 2
1. International Civil Aviation Organization. International standards and recommended practices.
Personnel licensing. Chapter 6. Medical provisions for licensing. Montreal: ICAO; 2005.
2. Manual of Civil Aviation Medicine (Doc 8984-AN/895), Second Edition, 1985. ICAO
publication.
3. Federal Aviation Authority Guide for Aviation Medical Examiners. Accessed 18 December 2005
http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/
amd47psych.pdf
4. Joint Aviation Authorities’ Policy. JAR-FCL 3 Appendix 10, paragraph 2.
1 Hamilton Rating Scale for Depression (HRSD), also known as the Hamilton Depression Rating Scale (HDRS) or
HAM-D, is a 21-question multiple choice questionnaire used to rate the severity of major depression. After Max
Hamilton, German psychiatrist and medical statistician (1912–1988)
ICAO Preliminary Unedited Version — November 2009 III-9A2-5
5. Joint Aviation Authorities (Europe) Manual of Civil Aviation Medicine. Accessed 18 December
2005 http://www.jaa.nl/licensing/manual/11%20-%20Psychiatry.pdf
6. Prevalence, Severity, and Unmet Need for Treatment of Mental Disorders in the World Health
Organization World Mental Health Surveys. The WHO World Mental Health Survey
Consortium JAMA. 2004; 291:2581-2590.
7. Ronald C. Kessler; Patricia Berglund; Olga Demler; Robert Jin; Doreen Koretz; Kathleen R.
Merikangas; A. John Rush; Ellen E. Walters; Philip S. Wang The Epidemiology of Major
Depressive Disorder: Results From the National Comorbidity Survey Replication (NCS-R)
JAMA 2003 289: 3095-3105
8. Westenberg HG, Sandner C. Tolerability and safety of fluvoxamine and other antidepressants. Int
J Clin Pract. 2006 Apr;60(4):482-91.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16620364
9. Arroll B, MacGillivray S, Ogston S, et al. Efficacy and tolerability of tricyclic antidepressants
and SSRIs compared with placebo for treatment of depression in primary care: a
metaanalysis. Ann Fam Med. 2005;3(5):449– 456.
10. Cipriani A, Geddes JR, Furukawa TA, Barbui, C. Metareview on short-term effectiveness and
safety of antidepressants for depression: an evidence-based approach to inform clinical
practice. Can J Psychiatry. 2007 Sep;52(9):553-62
11. Geddes JR, Carney SM, Davies C, et al. Relapse prevention with antidepressant drug treatment in
depressive disorders: a systematic review. Lancet. 2003;361(9358):653–661.
12. Jones DR, Ireland RR. Aeromedical regulation of aviators using selective serotonin reuptake
inhibitors for depressive disorders. Aviat Space Environ Med 2004; 75:461–70.
13. Canfield DV, Salazar GJ, Lewis RJ, Whinnery JE. Pilot medical history and medications
found in post mortem specimens from aviation accidents. Aviat Space Environ Med. 2006
Nov;77(11):1171-3.
14. Ross J, Griffiths K, Dear K, Emonson D, Lambeth L. Antidepressant use and safety in civil
aviation: a case-control study of 10 years of Australian data. Aviat Space Environ Med. 2007
Aug;78(8):749-55.
15. Hudson DE Jr. SSRI use in professional aircrew. [abstract]. Aviat Space Environ Med 2002;
73:244–5.
16. Hudson DE Jr. SSRI use in professional aircrew. Panel presentation. Aerospace Medical
Association annual meeting. 9 May 2002, Montreal, Canada.
17. Civil Aviation Safety Authority (CASA) (2003). Use of antidepressant medication by depressed
pilots and air traffic controllers. Designated Aviation Medical Examiners handbook.
Australia: Civil Aviation Safety Authority.
18. Lange M. Maintenance SRI use in professional pilots: the Canadian experience [Abstract]. Aviat
Space Environ Med 2002; 73:244.
19. Ahmet Sen, Ahmet Akin Gülhane Dennis V. Canfield Arvind K. Chaturvedi. Selective Serotonin
Reuptake Inhibitors:Medical History of Fatally Injured Aviation Accident Pilots
DOT/FAA/AM-07/19 Office of Aerospace Medicine
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