Who writes this page?
I have undergone this medical examination about twenty times, and I have performed from the other side most of the tests it contains. But let's be clear from the first line: I am not a doctor. This page does not provide any diagnosis and does not judge any fitness, it demystifies a moment that causes anxiety for many pilots, and refers you to the only person who decides: your AME.
En bref
The pilot medical examination includes a mental health assessment component: at each exam, a discussion and a questionnaire with the aeromedical examiner (AME); depending on the country and the class, a dedicated psychological test may be added to the initial class 1. A history (depression, anxiety...) is not an answer in itself: the European regulation imposes an evaluation before deciding, and it explicitly organizes the return to fitness after recovery, it even provides, under strict conditions, fitness with limitation under stabilized maintenance treatment. The word "antidepressant" is nowhere to be found in it. What really puts a career in danger is not the condition, it is hiding it. And refusing to get help for fear of being grounded is the worst calculation.
What the psychological component really looks at
For a few years now, the mental health assessment has been an integral part of the medical examination. In the vast majority of cases, it is not a spectacular "test": it is a discussion and a questionnaire conducted by the AME, who is interested in your general condition, your sleep, your relationship with alcohol, any follow-up or treatment. There is nothing to revise, and above all nothing to "answer correctly": the goal is not to trap you, but to ensure that everything is fine with you, and for those who fly with you.
Depending on the country and the class, a dedicated psychological test may be added to the initial class 1 this is particularly the case in Belgium since 2019, in a specialized center. The details country by country, and the preparation case by case, are treated in depth in the comprehensive guide; here, the main thing is to understand the spirit of the system.
"€1,500 psychological test": three things not to confuse
This is the most widespread confusion on forums. Behind the words "psychological test" actually hide three different systems, which have neither the same goal nor the same decision-maker:
- 1. The mental health assessment of the medical examination. The discussion and the questionnaire with the AME, at each medical examination. In some countries, a dedicated psychological test is added to the initial class 1 (Belgium, €300 to €400 depending on the center, since July 1, 2019); in the event of a result deemed a "false positive", a re-examination (~€1,500) may be required. This is the medical component.
- 2. The psychological assessment of the airline. Since Germanwings, EASA imposes on airlines a psychological assessment of the crew before line training. It is the airline (or its ATO) that organizes it, not the AME.
- 3. Psychometric selection tests. Like DLR, COMPASS... Hiring tests (aptitudes, personality), unrelated to your medical certificate.
The famous "€1,500 test", here it is untangled. In Belgium, the psychological test for the initial class 1 has been mandatory since July 1, 2019 and is billed separately, at a price that depends on the center: €400 at CEMA, €300 at the CMA of the Military Hospital (rates noted on 07/26/2026). But when a result is deemed a "false positive": a questionnaire answered too well, which raises suspicion of a trained candidate or not entirely free in their answers: a re-examination is requested. To date, according to feedback from the field, it is only available from a single practitioner in Belgium, its report is provided in Dutch, and it would cost around €1,500. ⚠️ This last point is feedback from the field reported by a school, not a published rate: I have not found it on any official source. That is where the number comes from, and not from the airline selection tests (points 2 and 3). The details are covered in the comprehensive guide.
Why this component was strengthened
This strengthening follows, at the European level, the Germanwings accident (2015). The intention is clear: flight safety, not a witch hunt. It is a prevention framework, and understanding it changes everything, because you stop experiencing it as a tribunal.
The #1 fear: "will a history ground me?"
It is the question that comes up everywhere: past depression, anxiety, difficult period, antidepressants taken for a while... "Does this close the cockpit to me?" The honest answer is that a history is not an answer: fitness is evaluated on a case-by-case basis, by the AME and, if necessary, by the medical authority. I will never predict your fitness no honest person can do so in writing. What I can do, however, is show you what the European text actually provides. Because what pilots believe about it, and what it says, are not the same thing.
What the European text actually provides
We must start with the sticking point, because skipping it would discredit everything else: yes, the starting point is severe. Faced with an established mood disorder, the European acceptable means of compliance ask the examiner to first conclude unfitness. The same goes for a psychoactive medication deemed likely to affect flight safety. Those who find the system restrictive are not wrong.
But stopping at this first sentence means reading half the text, and this is exactly the error that circulates. The same text, in the next sentence, organizes the return. Here is what it provides, article by article.
A history triggers an evaluation, not a refusal
The rule itself (MED.B.055) targets the diagnosis or documented history of mood disorder, neurotic disorder, personality disorder, behavioral disorder or substance misuse. What it does with it is not an exclusion: it imposes a satisfactory psychiatric evaluation before fitness can be pronounced. In class 1, the file goes to the medical assessor of the authority; in class 2, it is processed in consultation with him. This is the ordinary referral mechanism, the very same one that applies to blood pressure or a vision problem.
After recovery, fitness becomes possible again
For an established mood disorder, the text states unfitness, then expressly provides that after full recovery and thorough review of the individual case, fitness may be considered depending on the characteristics and severity of the disorder. The door is closed at a given moment, not locked.
And, this is the least known point, flying while on medication is not excluded
This is the most counter-intuitive provision of the system, and it is written in black and white. A psychoactive medication likely to affect flight safety leads to unfitness, but if stability under maintenance treatment is confirmed, fitness may be considered with an OML limitation, meaning "valid only as or with qualified co-pilot". The corollary is just as important: any change in dose or molecule reopens a period of unfitness until stability is established again.
And the question the text asks to ask is not "which medication?" but: are the indication for the treatment, its side effects, its risk of dependence and the characteristics of the disorder compatible with flight safety? It is a specific question, not a blacklist.
The only truly closed door
In this article, only one unfitness is stated without an ordinary return path: schizophrenia and schizotypal or delusional disorders and even there, the text reserves the case where the medical assessor concludes that the initial diagnosis was inappropriate or inaccurate. Conversely, self-harm and attempted suicide, which also state unfitness, are followed by an explicit "however": fitness may be considered after psychiatric evaluation.
The word "antidepressant" never appears in European aeromedical regulations. Neither in Part-MED, nor in its means of compliance, nor in its guide on medications: a guide that nevertheless details nineteen families, from antibiotics to anesthetics. This silence does not mean "unconditionally authorized": the applicable category is that of psychoactive medications, and the criterion is whether they are likely to affect flight safety. But it means one important thing: there is no blanket European rule on antidepressants. What exists is a case-by-case review. ⚠️ The section that the guide does cover, and without hesitation, is that of tranquilizers and sedatives the inability to react that they cause has contributed to fatal accidents. This is probably where the confusion comes from.
The distinction that explains almost all misunderstandings: a history and an ongoing treatment do not fall under the same article. A history opens an evaluation, with the paths described above. Ongoing treatment falls under a general and immediate rule: one does not fly under a medication likely to interfere with the exercise of the license, and starting regular intake of a medication requires going through aeromedical advice before resuming. Confusing the two transforms a process into a condemnation.
A reservation that I must give you, because it is real. Everything that precedes describes what the text provides. What national authorities actually do with it in practice, how often fitness under stabilized treatment is really granted, with what delays, what documents and what follow-up, is published nowhere, and I am not making it up. A text that opens a door does not say how many people walk through it. This question has been asked to the aeromedical examiners reviewing this site; the answer will go on this page when I have it.
The pilot's perspective: honesty protects you
Having been a caregiver and then a pilot-patient, I say it plainly: do not hide anything. Not as a moral posture, but out of lucidity. A false declaration on an aeronautical medical questionnaire is fraud and the day it is discovered, it costs infinitely more than the health issue it aimed to conceal: possible withdrawal of the certificate, and a ready-made argument offered to your insurance in case of an incident. Conversely, a declared issue enters a process designed for it. Pilots fly with follow-up or conditions; no one flies serenely with a lie in their file. Honesty is not the "moral" card of this subject, it is the strategic card.
Asking for help is not a fault
There is a very real fear in the profession: that seeing a psychologist, or talking about a difficult time, "leaves a trace" and ends up grounding you. This fear pushes some to not seek help, and this is precisely the worst calculation, for them as well as for safety. Consulting is not, in itself, disqualifying: what matters is your condition and its evaluation, not the fact that you asked for help. The subject is discussed with the AME, ideally beforehand. Also know that in an airline, European regulations impose a peer support programme: a confidential listening space between pilots, designed to help, not to trap. Taking care of your mind is part of the job, just like your eyesight or your heart.
How to approach this component calmly
- Arrive rested and calm. A psychological component cannot be "revised"; showing up exhausted does not work in your favor anywhere.
- Do not try to "cheat" it. These assessments are built to spot inconsistency; "giving the right answer" is counterproductive and the opposite of the goal.
- Anticipate if a history might be involved. Talk to your AME before D-Day, and bring your reports. A prepared file helps the doctor decide quickly and well.
- Never stop a treatment on your own to "look clean". Talk to the doctor, do not improvise as a prescriber.
Questions fréquentes
Y a-t-il un test psychologique à la visite médicale de pilote ?
Peut-on être pilote avec un antécédent de dépression ou d'anxiété ?
Dois-je déclarer un antécédent psychologique ou un traitement à l'AME ?
Consulter un psychologue m'empêche-t-il de voler ?
Comment se préparer au volet psychologique ?
Pourquoi ce volet a-t-il été renforcé ?
Le « test psychologique à 1 500 € » des forums, c'est quoi ?
Peut-on voler sous traitement en Europe ?
Ce que je lis en ligne sur les antidépresseurs vaut-il en Europe ?
Pour aller plus loin
Cette page pose l'essentiel : l'esprit du dispositif et la règle d'or de la franchise. Pour le reste de la visite : le guide complet de la visite médicale (classes, validités, plafonds d'âge), préparer sa visite : la checklist, et, si un point pose problème, inaptitude et recours.
Le cœur du Labo reste en accès libre. Le traitement approfondi (préparer son dossier cas par cas (antécédent, traitement, suivi), les spécificités pays, les questions à poser à l'AME) fera partie du guide complet, plus détaillé, à sa sortie. Prévenez-moi de la sortie.
La question que personne ne pose à voix haute
Si un traitement m'est proposé, qu'est-ce qui arrive à ma licence ? Beaucoup préfèrent ne pas savoir, et c'est précisément ce silence qui fait prendre les mauvaises décisions.
Le guide y répond en sept étapes : qui décide quoi, à quel moment, et ce que vous pouvez documenter vous-même. Sans aucun pronostic, parce que la décision reste au médecin.
Voir le guide, 59 €