14.8 MOOD DISORDERS (DEPRESSION, MANIA)
AEROMEDICAL CONCERNS:
Mood disorders are associated with decreased concentration, inattention, indecisiveness, fatigue, insomnia, agitation, and psychosis, all of which are incompatible with aviation duties. Risk of suicide is 15%, the highest of all mental disorders. There is a strong association with substance abuse.
WAIVER:
• Major Depression
• Dysthymia
• Depressive disorder NOS
The above diagnoses are disqualifying for aviation. Treatment should be considered under the auspices of a Limited Duty Medical Evaluation Board. Waiver may be requested when the member has been completely asymptomatic in a “Fit for Full Duty” status for a minimum of six months after completion of all treatment, including both medication and psychotherapy. A current psychiatric evaluation is required to document complete, sustained remission of all symptoms, and shall be included with the waiver request. Further recurrences are CD, waiver not recommend.
• Bipolar Disorder:
The above diagnosis is disqualifying for aviation, and the member is not eligible for a waiver. The member should be referred to central Physical Evaluation Board for determination of fitness for general duty / retention. INFORMATION REQUIRED.
1. Psychiatric evaluation and treatment summary
2. Medical Board reports (if applicable)
TREATMENT:
Psychotropic medications and psychotherapy for depressive/manic symptoms are not compatible with aviation duties.
FOLLOW-UP REQUIREMENTS:
Psychiatric follow-up is at the discretion of the mental health provider. Mood disorders are generally seen at least monthly early in therapy or while on limited duty. After the member has been completely asymptomatic in a “Fit for Full Duty” status for a minimum of six months after completion of all treatment, including both medication and psychotherapy, a waiver can be requested. A current psychiatric evaluation is required to document complete, sustained remission of all symptoms and shall be included with the waiver request.
DISCUSSION:
15% of depressed patients eventually commit suicide. 50-75% of affected patients have a recurrent episode. Acute major depression is treatable in 80% of patients. 20-30% of dysthymic patients develop subsequent depression or mania.
ICD-9 CODES:
296.2 Major Depressive Disorder, Single Episode
296.3 Major Depressive Disorder, Recurrent
296.0 Bipolar Disorder
300.4 Dysthymic Disorder
311 Depressive Disorder, not otherwise specified
