First Class Medical after prior mirtazapine use – post-discontinuation reality check

  • Thread starter Thread starter Justin0127
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Justin0127

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Hello everyone,


I’m trying to get a realistic understanding of my situation before doing anything irreversible with the FAA medical system.


Background
  • Diagnosed with anxiety about 1 year ago
  • Treated with low-dose mirtazapine (Remeron), for approximately 1 year
  • Fully discontinued the medication ~2 months ago
  • No history of suicidal ideation, attempts, psychosis, or psychiatric hospitalization
  • Currently stable, functioning normally (full-time employment, no symptoms)
  • Previously held a PPL years ago, prior to any antidepressant use

I understand that:
  • Mirtazapine is not on the FAA’s conditionally approved SSRI list
  • It is often viewed unfavorably due to sedation and cognitive concerns
  • Past antidepressant use — even after discontinuation — can still be a major factor for First Class certification

Questions

  1. From an FAA perspective, does a history of ~1 year of mirtazapine use, now discontinued for ~2 months, make First Class Medical essentially unattainable, regardless of current stability?
  2. In practice, would the FAA expect a significantly longer medication-free observation period (e.g., 6–12+ months) before First Class is even realistically discussable?
  3. Assuming continued stability and clean neurocognitive / psychiatric evaluations, is there any established pathway toward First Class in a case like this — or is this effectively a closed door?

To be clear, I am not planning to apply for a medical at this time.
I’m only gathering information so I don’t permanently damage future options by moving too early.


I appreciate any insight, especially from AMEs or those familiar with FAA mental health certification at the First Class level.


Thank you!
 
As a threshold matter, if you've been off the medication for less than two years, the AME will need to defer to the FAA. If you wait two years, the AME may be able to issue in the office, depending on details.

Details: https://www.faa.gov/ame_guide/media/Anxiety_Depression_Disposition_Table.pdf

Your best bet is to schedule a consult with the experienced Senior AME you plan to use.
 
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