CogScreen Around the World: How 4 Regulators Compare

TL;DR: The FAA is the only major aviation regulator that names a single, specific cognitive test (CogScreen-AE) in its guidance. EASA, CASA, and Transport Canada all require neurocognitive or neuropsychological evaluation in similar circumstances, but they leave the specific instrument to the treating psychologist and vary meaningfully on approved medications, stability periods, and how centralized the review process is. If you fly internationally, hold licenses in more than one country, or are simply trying to understand why your pilot friend in Australia has a different SSRI timeline than you do, this is the comparison nobody has put in one place.

Table of Contents

• Why This Comparison Matters
• The FAA Approach: Named Test, Centralized Review
• EASA: Decentralized, Personality-Focused, Research-Driven
• CASA (Australia): Progressive on SSRIs, Individualized on ADHD
• Transport Canada: The Broadest Approved Medication List
• Side-by-Side Comparison Table
• What This Means If You Fly Under More Than One Authority
• What to Do Next

Why This Comparison Matters

I get some version of this question every few weeks: "My friend flies for a regional airline in Australia and got cleared on his SSRI in half the time it took me." Or: "I have a UK license and a US license. Whose rules actually apply to me?"

The honest answer is that every major aviation regulator agrees on the underlying safety concern (untreated or unstable psychiatric conditions and their medications can affect the cognitive skills flying requires) but they have built genuinely different systems to manage that risk. None of them is obviously "right" or "wrong." They reflect different regulatory philosophies, different legal systems, and in some cases different amounts of research investment into the question.

This matters practically for a growing number of pilots: those pursuing licenses or type ratings across borders, dual citizens weighing where to train, and anyone who has read a US-focused forum thread and assumed the same numbers apply everywhere. They don't.

The FAA Approach: Named Test, Centralized Review

The FAA is unusual among major regulators in naming CogScreen-AE specifically in its guidance for pilots with a history of ADHD, SSRI use, TBI, or other neurocognitive triggers. That specificity is a double-edged sword: it gives applicants clarity about exactly what to prepare for, but it also means the FAA's Aerospace Medical Certification Division in Oklahoma City is a bottleneck for anything that can't be resolved at the AME's desk.

Key FAA parameters, as of mid-2026:

• SSRI stability period: 3 months on a stable dose (reduced from 6 months in a December 2025 update to the Antidepressant Protocol)
• Approved antidepressants: A defined list built around select SSRIs, with SNRIs (duloxetine, venlafaxine, desvenlafaxine), bupropion, and vilazodone added in recent updates
• ADHD pathway: Fast Track (no symptoms or medication in the prior four years, AME can often issue same-day) or Standard Track (90-day medication washout, comprehensive neuropsychological evaluation including CogScreen-AE, months-long FAA review)
• Who evaluates: A HIMS-certified neuropsychologist for the comprehensive battery; CogScreen-AE itself must be administered by an examiner holding the CogScreen-AE Pro qualification

The centralization has a cost. Backlogs at AMCD have, at times, stretched processing to nearly a year for pilots with ADHD or depression history in the file. The upside is consistency: two pilots with similar histories are (in theory) evaluated against the same published disposition tables.

EASA: Decentralized, Personality-Focused, Research-Driven

The European Union Aviation Safety Agency took a structurally different path after the 2015 Germanwings tragedy prompted a hard look at pilot mental health screening across Europe. EASA's forthcoming regulations required airlines to psychologically assess pilots before entering service, or to demonstrate that a recent assessment by a previous employer was sufficient, but the agency deliberately left the specific format to member states and airlines rather than mandating a single instrument the way the FAA names CogScreen-AE.

That decentralization was also intentional in scope. After consultation, EASA clarified that the pre-service assessment is not a clinical assessment; it's more focused on personality and fit between the pilot and the airline's operational culture, which is a meaningfully different purpose than the FAA's post-diagnosis cognitive screening.

Where EASA has invested distinctively is in research. The MESAFE project ("MEntal health for aviation SAFEty"), launched by EASA as a Horizon Europe-funded research initiative starting in May 2022, set out to overcome the challenges preventing effective implementation of aeromedical certification for pilots and air traffic controllers with regard to mental-health-related incapacitation risk, and to provide evidence-based recommendations for early diagnosis and treatment. This followed EU Commission Regulation 2018/1042, which introduced new technical requirements and administrative procedures for support programmes and psychological assessment of flight crew in the wake of Germanwings.

Peer-reviewed comparison of the two systems has noted that a persistent obstacle to referring crew for neuropsychological testing is the shortage of neuropsychological specialists, combined with variable training among aeromedical examiners in assessing mental health concerns, a challenge that shows up on both sides of the Atlantic, not just in Europe.

Key EASA characteristics:

• No single named cognitive test; specific instrument left to the evaluating psychologist and national aviation authority
• Pre-service psychological assessment is explicitly not diagnostic; it's a fit assessment
• Heavier emphasis on research-driven policy development (MESAFE) than on a fixed disposition table
• More recent academic work is exploring digital phenotyping and continuous, passive monitoring as a complement to periodic assessment, reflecting a longer-term shift in thinking about when and how often mental health status should be checked

CASA (Australia): Progressive on SSRIs, Individualized on ADHD

Australia's Civil Aviation Safety Authority has, by several accounts, been comparatively progressive on psychiatric medication. Following the Germanwings tragedy, aviation regulators globally tightened scrutiny on mental health, but CASA has allowed pilots to fly while taking SSRIs for depression or anxiety under a defined stability rule.

CASA's own published guidance is direct about the philosophy shift: you are not automatically disqualified from flying if you are living with depression, and CASA or an authorised Designated Aviation Medical Examiner (DAME) will consider individual circumstances to help pilots stay safely involved in aviation. In general, CASA may approve medical certification for mild to moderate depression, and the certificate is typically suspended while treatment begins, then reinstated once the pilot has stabilized and symptoms have resolved.

CASA also publishes a specific approved-medication list for depression: fluoxetine, sertraline, citalopram, escitalopram, and low-dose venlafaxine or desvenlafaxine, while lithium, antipsychotics, agomelatine, quetiapine, tricyclic antidepressants, and MAOIs remain unacceptable. Any change to medication requires notifying the DAME and typically triggers grounding for two to four weeks.

On ADHD, CASA's posture is individualized rather than categorical. A 2024 Administrative Appeals Tribunal decision is instructive: CASA's own clinical practice guidelines suggested that untreated ADHD would not preclude issuance of a medical certificate, particularly where both symptoms and treatment had been absent for six months, and expert evidence in that case showed no measurable difference in the applicant's cognitive performance before and after treatment. The Tribunal ultimately found CASA had not adequately justified its refusal and remitted the decision back for reconsideration, a reminder that even a conservative-sounding rule can be successfully challenged with the right documentation.

Transport Canada: The Broadest Approved Medication List

Transport Canada's Civil Aviation Medicine branch takes a case-by-case approach similar in spirit to CASA's, administered through Civil Aviation Medical Examiners (CAMEs) rather than a named cognitive instrument.

On antidepressants, Canadian guidance sourced from CAME practice notes describes a notably broad approved list: pilots have been successfully recertified while taking fluoxetine, sertraline, bupropion, citalopram, escitalopram, venlafaxine, desvenlafaxine, and vortioxetine, while mirtazapine, paroxetine, trazodone, doxepin, and fluvoxamine are considered incompatible with a medical certificate. That's a wider net than either the FAA's or CASA's published lists, particularly in accepting vortioxetine and unrestricted venlafaxine/desvenlafaxine. Stability requirements described by CAMEs run around a minimum of four months on a stable, non-sedating antidepressant dose without significant side effects before reinstatement can be considered, shorter than CASA's six-month benchmark and longer than the FAA's current three months.

On ADHD, the picture is stricter in practice than the medication list might suggest. A true ADHD diagnosis and any medication used to treat it are considered incompatible with a Canadian medical certificate, and if ADHD medication is discontinued, a neurocognitive assessment is required six months after discontinuation to determine whether the applicant still meets diagnostic criteria. Advocacy groups have pushed back on how this plays out for depression and anxiety specifically, arguing that Canadian aviation medicine policy presumes all anxiety- or depression-related conditions are disqualifying by default, placing the burden on the applicant to prove otherwise under an individualized-consideration provision, a criticism that, notably, doesn't have a direct FAA or CASA parallel, given how those two agencies have publicly framed their more recent policy language.

Side-by-Side Comparison Table

	FAA (United States)	EASA (European Union)	CASA (Australia)	Transport Canada
Named cognitive test	CogScreen-AE (specifically named)	Not specified; left to evaluating psychologist	Not specified; neuropsych report required	Not specified; neuropsych assessment required
SSRI stability period	3 months (reduced from 6, Dec. 2025)	Varies by member state	Typically 6+ months	~4 months (CAME guidance)
Approved SSRIs/SNRIs (illustrative)	Select SSRIs + duloxetine, venlafaxine, desvenlafaxine, bupropion, vilazodone	Left to national authority	Fluoxetine, sertraline, citalopram, escitalopram, low-dose venlafaxine/desvenlafaxine	Broadest list: adds vortioxetine, unrestricted venlafaxine/desvenlafaxine
ADHD path if untreated 4+ years	Fast Track, often same-day AME issuance	Individual case review	Individualized; 6-month symptom/treatment-free benchmark referenced in tribunal rulings	Individualized; neurocog assessment required
ADHD path if medicated	Standard Track: 90-day washout + full neuropsych eval	Individual case review	Individualized case review	Diagnosis and medication generally treated as incompatible
Review body	AMCD, Oklahoma City (centralized)	National aviation authority	CASA or authorised DAME	Transport Canada Civil Aviation Medicine

This table reflects publicly available guidance and third-party practitioner summaries as of mid-2026. Every one of these parameters is subject to change, and several (particularly the Canadian and Australian figures) come from CAME/DAME practice guidance rather than a single consolidated regulatory document, so confirm current specifics with your own examiner before making decisions based on this table.

What This Means If You Fly Under More Than One Authority

A few practical takeaways if this applies to you:

1. Your stability period is set by the regulator whose certificate you're seeking, not by where you live or trained. A pilot with dual US/Australian citizenship pursuing an FAA certificate follows the FAA's 3-month window, not CASA's 6-month one, even if their prescribing physician is in Australia.

2. "Approved medication" lists don't transfer between regulators. Vortioxetine being acceptable to Transport Canada doesn't tell you anything about FAA acceptability, and the FAA's list is genuinely narrower than Canada's in places.

3. Documentation standards are more portable than the underlying rules. A well-documented psychiatric history, stable-dose timeline, and prescriber letter is useful across every one of these systems, even though the thresholds differ.

4. The research direction is converging even where the rules diverge. EASA's MESAFE work and the broader academic interest in continuous, technology-assisted mental health monitoring suggest that "periodic testing at fixed intervals" may not be the permanent shape of any of these systems, a trend worth watching regardless of which regulator you answer to.

What to Do Next

If you're navigating an SSRI or ADHD history under FAA jurisdiction specifically, our guides on the FAA ADHD Fast Track and Standard Track pathways and LRPV scoring walk through what to expect once you're referred for CogScreen-AE. Familiarizing yourself with the test mechanics ahead of time through PilotPrep's practice modules won't change which regulatory timeline applies to you, but it can reduce the unfamiliarity-driven anxiety that shows up during the evaluation itself, regardless of which country's rules got you there.

References

1. FAA Guide for Aviation Medical Examiners, Antidepressant Protocol: https://www.faa.gov/ame_guide/app_process/exam_tech/item47/amd/antidepressants
2. FAA ADHD Fast Track Evaluation: https://www.faa.gov/ame_guide/media/ADHD_fast_track_eval_general_info.pdf
3. EASA MESAFE Project, D-1.1 Report on the Review of Diagnostic Measures: https://www.easa.europa.eu/sites/default/files/dfu/mesafe_-_d-1.1_-_report_on_the_review_of_diagnostic_measures.pdf
4. British Psychological Society, "Pilot mental health evaluation": https://explore.bps.org.uk/content/report-guideline/bpsrep.2017.pp11/chapter/bpsrep.2017.pp11.7
5. "European and US Aeromedical Authority Guidance for Neurocognitive Evaluation of Airline Pilots With Mental Disorders," Aviation Psychology and Applied Human Factors: https://econtent.hogrefe.com/doi/10.1027/2192-0923/a000271
6. CASA Depression and Anxiety Safety Fact Sheet: https://www.casa.gov.au/resources-and-education/publications-and-resources/aviation-medicine-fact-sheets-and-case-studies/depression-and-anxiety-safety-fact-sheet
7. CASA DAME Clinical Practice Guidelines, Depression: https://www.casa.gov.au/licences-and-certificates/medical-professionals/dames-clinical-practice-guidelines/depression

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This article is provided for educational purposes by Dr. Jordan "Coach" Keller, an AI aviation education persona developed by PilotPrep LLC. Dr. Keller is not a real person and does not provide individualized medical, legal, or regulatory advice. Regulatory guidance changes frequently and varies by individual case; always confirm current requirements with your AME, DAME, CAME, or equivalent examiner before making certification decisions. PilotPrep is a preparation and familiarization tool for the FAA's CogScreen-AE and is not the official test, a diagnostic device, or a guarantee of certification outcome.