Independent New Hampshire Journalism · Northfield, NH

The FAA Grounds Pilots for Treating ADHD. The Fix Is Sitting in the Senate.

The agency has expanded the list of antidepressants a pilot may fly on four times since 2010. The list of approved ADHD medications is still empty.

The Federal Aviation Administration put its position in writing, in a table its own examiners use. A pilot who is currently taking ADHD medication, for any reason, including as-needed use, gets deferred. The reason given is one sentence: “Taking ADHD medication or symptoms of ADHD are incompatible with aviation safety.”

Read that again. Not untreated symptoms. The medication and the symptoms, named together, in the same breath, as the same category of hazard.

That is the rule a young person in a Laconia or Nashua flight school runs into the first time they answer a federal medical form truthfully. And it is the rule that a bill sitting on the United States Senate floor right now could finally force the agency to revisit.

What the rule requires

The FAA does not treat an ADHD diagnosis as automatically disqualifying, and its recent changes deserve credit. Since a 2023 revision, refined in October 2024, there are two evaluation paths written into the agency’s Guide for Aviation Medical Examiners.

The Fast Track is the good news. An applicant with no ADHD treatment, medication, symptoms, or functional instability in the past four years, and no other psychiatric history, can see a psychologist for a records review. If it comes back clean, the examiner can issue the certificate that day. That change spared a lot of people months of waiting and thousands of dollars in testing they did not need.

The Standard Track is where most people with a real, current diagnosis land. Symptoms, treatment, or medication use within four years sends the file to an in-person evaluation by a specially trained neuropsychologist, with cognitive testing, and a deferral to Oklahoma City while the agency decides.

And then there is the third row of the table, the one that matters most. Currently on medication, or off it for fewer than 90 days, and the answer is no. To even begin the evaluation, a pilot has to stop taking the drug that manages their condition and stay off it for three months, then demonstrate they perform well enough without it.

The requirement is not a rumor. It is the published standard, applied consistently.

The agency already built the pathway it says it cannot build

Here is what makes the ADHD position hard to defend on its own terms. The FAA has done the opposite thing, deliberately and repeatedly, for a different class of medication.

On April 5, 2010, the Federal Air Surgeon published a policy in the Federal Register allowing pilots to hold a special issuance medical certificate while taking one of four antidepressants: fluoxetine, sertraline, citalopram, and escitalopram. Before that, any antidepressant was disqualifying, full stop. The agency decided the evidence supported a supervised pathway instead of a ban.

It has widened that pathway three more times since. Extended-release bupropion was added in 2023. Three SNRIs, duloxetine, venlafaxine, and desvenlafaxine, were added in April 2024. Vilazodone followed in 2025. What began as the SSRI protocol is now called the Antidepressant Protocol, and the current list runs to nine drugs.

So the objection cannot be that a supervised medication pathway is unworkable, or that the agency lacks a model for judging psychiatric drugs one at a time. It built that model. It has simply never opened one for ADHD.

The FAA already wrote the argument against itself

Go back and read the 2010 policy statement, and something uncomfortable turns up. The agency makes the case its critics are still making.

The FAA cited a review of calls from 1,200 pilots who had been diagnosed with depression and advised to take medication. Fifty-nine percent told the consulting service they would refuse the prescription and keep flying. Another 15 percent said they would take it and not tell the FAA. One in four said they would ground themselves and get treated.

The agency also cited its own researchers, who found antidepressants in the records of dozens of pilots killed in crashes between 1990 and 2001, drugs never disclosed at their flight physicals. It wrote that it was worried about applicants “reluctant to disclose or who may be masking a struggle with depression.” It pointed to Australian data covering a decade of medicated pilots that turned up no adverse safety signal. And it said that as new evidence arrived, it might revise again.

That is a finished argument for a supervised ADHD pathway. The FAA wrote it sixteen years ago about a different drug class, acted on it, and has been expanding it ever since.

What the rule teaches pilots to do

A rule that ends a career for disclosing a treatment does not eliminate the underlying condition. It relocates it, into the space where nobody has to write it down.

The best measurement comes from a 2022 survey of 3,765 American pilots in the Journal of Occupational and Environmental Medicine, co-authored by a researcher at the FAA’s own Civil Aerospace Medical Institute. It found 56.1 percent reported healthcare avoidance driven by fear of losing their certificate. Nearly 46 percent sought informal care outside the system. And 26.8 percent admitted misrepresenting or withholding information on a written health questionnaire.

That last number is the one aviation regulators should not be able to sleep through. More than a quarter of the pilots surveyed said the paperwork the safety system runs on is unreliable, and told researchers why. The screening system manufactures the incentive to lie to it, then treats its own answers as data.

The military comparison, stated correctly

Advocates for changing the ADHD rule often reach for the military, and they usually overreach. The argument gets made this way: the armed forces hand stimulants to combat pilots, so the FAA’s fear of stimulants is absurd on its face. That version is wrong, and getting it wrong hands the other side an easy win.

What the military does is narrower. As the Congressional Research Service describes it, a flight surgeon may prescribe stimulants, informally called go pills, when a unit commander authorizes them, to counter fatigue on long missions. The Air Force uses dextroamphetamine and modafinil. Doses are limited, ground-tested first, voluntary, and collected afterward. Air Force guidance is blunt that dextroamphetamine is not approved for routine clinical use by flyers. The services also restrict chronic ADHD medication for aircrew.

So the military is not running the experiment the advocates claim. What it does establish is narrower and still useful: military aeromedical practice does not treat these compounds as inherently incompatible with operating an aircraft. It treats them as manageable under supervision, in defined circumstances, with monitoring.

That is a real dent in a pharmacological objection. It is not proof that a pilot on a daily therapeutic dose should be cleared, and anyone making this argument in good faith has to concede the difference.

The strongest case for the rule, and where it runs out

The FAA is not being irrational for sport. There is a serious argument underneath the policy and it deserves to be stated plainly.

Attention, impulse control, and working memory are the exact faculties a cockpit taxes, and the ones ADHD affects. A pilot whose baseline performance depends on a daily medication raises a question a pilot wearing glasses does not: what happens the day the prescription runs out. Stimulants carry dose timing, tolerance, and sleep effects that corrective lenses do not. The eyeglasses comparison, which the earlier version of this argument leaned on, is weaker than it sounds.

All of that argues for a designed pathway with real conditions. None of it argues for a blanket prohibition. Supply interruption is a scheduling and reserve problem, and aviation medicine handles those constantly, including for insulin-dependent pilots who now fly under a monitored protocol. Timing and side effects are what a stability period and physician oversight exist to establish.

What the Senate bill does, and what it does not

The Mental Health in Aviation Act passed the House unanimously on September 8, 2025. The Senate companion, S. 3257, was introduced that November by Senators John Hoeven of North Dakota and Tammy Duckworth of Illinois with ten bipartisan cosponsors. On April 14, 2026, the Senate Commerce, Science, and Transportation Committee advanced it unanimously. It has been waiting for floor time ever since.

The bill would direct the FAA to revise its regulations to encourage disclosure rather than punish it, implement the recommendations of the agency’s own 2024 rulemaking committee on mental health and medical clearances, expand consideration of treatment options and approved medications, attack the special issuance backlog, and set aside roughly $15 million a year to hire and train more aviation medical examiners.

Be clear about the limits. The bill does not legalize ADHD medication for pilots. It does not name a single drug. It hands the agency a mandate, a deadline, money, and a congressional expectation that the medication list gets reexamined. Whether that produces an ADHD pathway depends entirely on what the FAA does with it.

Neither of New Hampshire’s senators sits on the Commerce Committee that moved the bill. Jeanne Shaheen serves on Appropriations, Armed Services, Foreign Relations, and Small Business; Maggie Hassan on Finance, Health, Homeland Security, and Veterans’ Affairs. Neither was among the original cosponsors. Both will vote if it reaches the floor, and both are reachable this week.

Why this lands in New Hampshire

This state does not have an airline hub, and that is the point.

New Hampshire has a general aviation economy: flight schools at Laconia in the Lakes Region, at Nashua’s Boire Field, at Lebanon Municipal in the Upper Valley. Nashua Community College runs the only FAA-approved aviation maintenance program in the state. The Aviation Museum of New Hampshire helps run aircraft-building programs in high schools in Manchester, Lebanon, and Farmington. This is where pilots start.

It is also where the national shortage bites hardest. The Government Accountability Office has found hiring demand particularly difficult for regional airlines, and regional carriers are what connect small states to everywhere else. The consultancy Oliver Wyman projects a global shortfall near 24,000 pilots this year.

Now put a Granite State teenager in that pipeline. Diagnosed in middle school, medicated through high school, doing fine. The honest answer on a federal medical form starts a process that requires them to stop taking their medication for three months and prove they are fine without it. The dishonest answer risks certificate revocation and federal criminal exposure. A third group never applies, because someone at the airport told them not to bother.

None of those three outcomes is a safety win.

What should happen

The Senate should schedule the bill and pass it. It cleared committee without a dissenting vote and passed the House without one either, which in this Congress is close to a miracle and a poor reason to let it sit.

The FAA should open an ADHD medication protocol on the model it already runs for antidepressants, and it does not need to wait for Congress to start. Pick the best-studied formulations. Require a single agent at a stable dose, a documented period without aeromedically significant side effects, specialist evaluation, and ongoing reporting. Begin with third-class certificates, where the agency already accepts more personal risk, and publish the outcome data.

If the evidence then shows unacceptable risk, the agency will have a defensible basis for a restriction it currently asserts without one. That is what regulating on evidence looks like.

The current rule tells a pilot that the safest move for their career is to stop treating a real medical condition, or to keep quiet about it. More than a quarter of the pilots in the largest survey of this question admitted to a researcher that they had done exactly that. The FAA has the evidence. It wrote some of it.

— Dexter Dow, Granite State Report

Fact check

Editor’s note: This piece replaces an earlier Granite State Report version of this argument published in January 2026. That version carried no citations, overstated the survey finding on pilot disclosure, and asserted that the military “does the opposite” of the FAA on stimulants. That comparison was wrong: military go-pill programs are episodic, command-authorized fatigue countermeasures, and the services also restrict chronic ADHD medication for aircrew. Both errors are corrected here and the military section is rewritten to state the narrower claim the evidence supports. Every FAA requirement described above was read directly from the agency’s published guidance. Two items are marked ATTRIBUTED rather than VERIFIED: the military medication posture, drawn from a published service list that is periodically revised, and the pilot-shortage projections, which are private-sector estimates. Granite State Report has not obtained comment from the FAA for this piece; a request is being sent, and any response will be published. Corrections: granitestatereport@gmail.com.