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
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
should not be determined solely by diagnosis but instead by an evaluation focused
and relevant history.
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.
Maximum certification — 1 year
Recommend to certify if:
- 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
- Treatment side effects that interfere with safe driving.
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.
The driver should have annual medical examinations.