The Depressed Pilot

Estimated reading time: 5 minutes, 50 seconds.

You’re a passenger on an airliner. You sit down, and look around you. Everywhere you look, you are surrounded by people responsible for your life. You want to know that you can trust them, that they are all there, present. You expect their training to be top-notch, and that they care. What happens if any of these people have a mental disorder? The flight attendant could be struggling with mental illness. Maybe it’s the guy sitting next to you. Perhaps the first officer, or even the captain.

Your concerns are valid. Safety is the pillar of the aviation industry. Many work very hard to keep it standing strong for all lives involved in the industry, whether as a customer or an employee. Your pilots especially want you to make it from point A to point B with zero discomfort or doubts that it will happen.

Ground zero is this. A significant amount of people don’t like the idea of depression, and they don’t trust people with this disorder to safely fly an aircraft. A study conducted on my stomping grounds, in the province of Alberta in Canada, conducted a survey of 3047 adults. The study found that 45% of people considered people with depression to be unpredictable. 20% considered them dangerous [1]. It’s pretty clear: the public does not view depression favorably.

We know from the research that depression is everywhere. Research has shown us unequivocally that the levels in critical professions such as in medicine and the military will reflect the numbers found in the general population. In my online studies, I have found that airline pilots are no more different in this regard. Research done by Alexander C. Wu et al. found that 13.5% of the 1430 airline pilots they surveyed met the criteria for depression. Even more saddening and shocking, 4.1% reported having recent suicidal thoughts [2]. Somewhere, we are dropping the ball miserably, and this affects most of all the public, whose safety we have to have in mind.

This brings me to what I’d like to highlight next. What happens to pilots who admit to their aviation doctors that they are struggling with depression? I can give you an accurate snapshot of the process.

First, bye-bye medical. You cannot fly in Canada if you currently have depression. Your depressive symptoms must be alleviated, the method of which you achieve that is up to you and your doctor. Then the process from here on out requires patience, savings in the bank, filling out forms, meeting up with the family doctor a few times, as well as appointments with psychologists. To deny that it is intimidating does all a great disservice.

Throughout this, you have no actual guarantee that you will be cleared to fly again. If you are given the privilege of getting your license back, now have to deal with the stigma of being pilot on medication. A person with a mental illness. It is suddenly clear why Transport Canada has found that the number of pilots being treated for depression does not at all reflect the stats on the number of pilots flying with it, untreated. There is an incredible amount of people out there scared to seek help. And they are deep in an industry that is stressful, that wrecks havoc on your circadian rhythm, and requires top performance at all times.

Is the answer to erect more barriers to people in the industry from flying if they have depression? Transport Canada has discussed this very issue, acknowledging that the barriers already put in place for depressed aviators has done very little but push those with the illness to resort to self-medication, some even purchasing their drugs online to avoid detection from regulatory bodies. So just by simply following the stats and literature on the topic, the answer does not seem to be, “lets make it harder or impossible for those with depression to fly,” but rather, “we know people are hiding it. Let’s help them, and make the skies a better place for everyone to be.”

Lucky for us all, stigma and discrimination does not equal reality.

Addressing people’s concerns about what perceived risks they are taking by getting on an airplane is important too. As we learned above, a good part of the public considers those with depression to be unpredictable and dangerous. These two traits in particular are those that you would obviously NOT want in the guy operating your next flight.

Lucky for us all, stigma and discrimination does not equal reality. No data exists to support the conclusion that people with depression are more likely than the next guy to commit a violent act involving others. In fact, only a very few specific mental disorders are associated with any kind of risk of violence, depression NOT being on that list [3]. The media’s portrayal of those with mental illness, especially depression given how relatively common it is, is far from reality and is even further from fair. These negative portrayals that we see and hear from our colleagues, friends, and from the news only serve to create a incredibly unfounded bias against those recovering from depression. And it’s one that doesn’t even need to exist!


MY FINAL THOUGHTS. Pilots with depression should not fly.

THE PILOTS WITH TREATED, IN REMISSION DEPRESSION SHOULD BE THE ONES HAPPILY FLYING.

I’m pleased that my thinking on this is in harmony with Transport Canada’s stance on aviators and depression. Unavoidable bureaucracy aside, it IS possible in Canada to fly on SSRIs. Just takes a little bit of time, patience, and the magic of honesty.

Unfortunately, to take that step feels impossible for many. I know I’ve been told (under complete confidence) by a few fellow aviators that they feel trapped, like as though they have no choice but to suffer in silence. These poor souls are refusing to take any steps that they may need to take to address their mental health, in fear of the many perceived consequences.

The change begins with changing public perception. A little bit of elbow grease and we can get there. It starts with people such as yourself, dear reader. Sharing and speaking openly about depression, de-stigmatizing it, and getting it into people’s heads that a pilot with treated depression is absolutely as safe as the next guy are awesome ways to start remodeling how we think of the condition. The world is going to be a better place for it!

Part two of how change happens begins with the pilots themselves. Friends, don’t fly with an illness. Just don’t do it to yourself. I have depression, and it was a monster. I KILLED IT THOUGH. It’s POSSIBLE. Reach out to a therapist (therapy is just as effective as medication!), or your family doctor, and tell them if you are struggling. It’s bloody terrifying to do that, to be candid and open and honest, but man did it feel right.

I’m well on my way to getting my medical all cleared up, and soon I will be joining my friends in the sky once again. You can do it too! Absolutely!


Sources and some short quotes for context (bolding mine):

[1] Data were collected in a probability sampled population-based survey of 3047 adults in Alberta, Canada… Over 45% of participants considered that people with depression were unpredictable. Over 20% reported that people with depression were dangerous. However, the percentages did not differ by levels of depression literacy and whether having a family/friend with depression.

[1] Wang, J., & Lai, D. (2008). The relationship between mental health literacy, personal contacts and personal stigma against depression. Journal of Affective Disorders, 110(1-2), 191-196. doi:10.1016/j.jad.2008.01.005

[2] …193 (13.5%) of 1430 pilots who reported working as an airline pilot in the last seven days at time of survey, met depression threshold–PHQ-9 total score ≥ 10. Seventy-five participants (4.1%) reported having suicidal thoughts within the past two weeks. We found a significant trend in proportions of depression at higher levels of use of sleep-aid medication (trend test z = 6.74, p < 0.001) and among those experiencing sexual harassment (z = 3.18, p = 0.001) or verbal harassment (z = 6.13, p < 0.001).

[2] Wu, A.C., Donnelly-McLay, D., Weisskopf, M.G. et al. Airplane pilot mental health and suicidal thoughts: a cross-sectional descriptive study via anonymous web-based survey. Environ Health 15, 121 (2016). https://doi.org/10.1186/s12940-016-0200-6

[3] Mental illness can explain only a very small fraction of general violence… Only a few specific mental disorders can be associated with violence, most commonly first-episode psychosis, and schizophrenia with positive symptoms such as hallucinations and command delusions. The most common diagnosis in the USA, depression, is not associated with violence except in the rare cases in which psychosis is presented.

[3] Ahonen L. (2019) The Association Between Mental Illness and Violence. In: Violence and Mental Illness. SpringerBriefs in Criminology. Springer, Cham. https://doi.org/10.1007/978-3-030-18750-7_4

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