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Guidance/Advisory Criteria — Conditions

Bipolar Mood Disorder

Mood disorders are characterized by their pervasiveness and symptoms that interfere with the ability of the individual to function socially and occupationally. The two major groups of mood disorders are bipolar and depressive disorders. Bipolar disorder is characterized by one or more manic episodes and is usually accompanied by one or more depressive episodes.

The onset of manic episodes may be sudden or gradual. Symptoms include excessively elevated, expansive, or irritable moods. During a manic episode, judgment is frequently diminished, and there is an increased risk of substance abuse. Some episodes may present with delusions or hallucinations. Treatment for bipolar mania may include lithium and/or anticonvulsants to stabilize mood and antipsychotics when psychosis manifests.

Symptoms of a depressive episode include loss of interest and motivation, poor sleep, appetite disturbance, fatigue, poor concentration, and indecisiveness. A severe depression is characterized by psychosis, severe psychomotor retardation or agitation, significant cognitive impairment (especially poor concentration and attention), and suicidal thoughts or behavior. In addition to the medication used to treat mania, antidepressants may be used to treat bipolar depression.

Other psychiatric disorders, including substance abuse, frequently coexist with bipolar disorder.

NOTE: Cyclothymia is a mild form of bipolar disorder that causes brief episodes of depression or elevated mood, but typically does not cause marked impairment. Treatment may include medication.

Certification/Recertification — Bipolar Mood Disorder

Determination is not based on diagnosis alone. The actual ability to drive safely and effectively
should not be determined solely by diagnosis but instead by an evaluation focused on function
and relevant history.

Waiting period

Minimum — 6 months symptom free following a nonpsychotic major depression unaccompanied by suicidal behavior

Minimum — 1 year symptom free following a severe depressive episode, a suicide attempt, or a manic episode

NOTE: If more than one waiting period applies (because of multiple conditions or other comorbid diseases), examine the driver for certification after the completion of the longest waiting period.

Decision

Maximum certification — 1 year

Recommend to certify if:

The driver:

  • Completes an appropriate symptom-free waiting period.
  • Complies with treatment program.
  • Tolerates treatment without disqualifying side effects (e.g., sedation or impaired coordination).
  • Has a comprehensive evaluation from an appropriate mental health professional who understands the functions and demands of commercial driving.

Recommend not to certify if:

The driver has:

  • Active psychosis.
  • Prominent negative symptoms, including:
    • Substantially compromised judgment.
    • Attentional difficulties.
    • Suicidal behavior or ideation.
    • Personality disorder that is repeatedly manifested by overt inappropriate acts.
  • Treatment side effects that interfere with safe driving.

Monitoring/Testing

At least every 2 years the driver with a history of a major mood disorder should have evaluation and clearance from a mental health specialist, such as a psychiatrist or psychologist, who understands the functions and demands of commercial driving.

Advise the certified driver with a major mood disorder to report any manic or severe major depressive episode within 30 days of onset to the driver's employer, medical examiner, or appropriate health care professional and to seek medical intervention.

Follow-up

The driver should have annual medical examinations.

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