Author: Dr. David Thorpe
Recently, I have received a number of inquiries concerning depression in the trucking industry, much like in the general population where it appears to be on the rise. What is different for truckers is that they are exposed to added stressors in life and are often driving alone, which make dealing with depression even more difficult. To add to the stress of trying to cope with one’s depression, a driver who suffers even a mild form of depression can have a delay in the medical certification. Therefore, staying on top of your depression and understanding how to manage it is essential in keeping you healthy and on the road! Remember – when you are not on the road, you are not making a living.
WHAT ARE THE STATISTICS?
The Centers for Disease and Control estimate that that 1 out of 10 adults in the U.S. report that they suffer some form of depression. For truck drivers, a 2008 (www.nswtwu.org/health_report.pdf) study noted that 13% of drivers suffer some degree of depression and greater than 90% do not seek treatment.
Truck drivers experience a greater amount of stressors in their occupation than in the general population. Not only do they have the same day to day stress of being on the job, but they also experience long hours, tight turn around and pick up times, and a barrage of regulations that make their job more challenging and difficult. Add to this the added pressure of being away from home, family difficulties and more, no wonder drivers suffer depression more than what is seen in the general population.
WHY DON’T DRIVERS SEEK HELP MORE FREQUENTLY?
For starters, it isn’t always easy to recognize and accept. Most people, drivers included, avoid the thought that they may suffer from depression. Couple this with the fact that most truck drivers are men, and you also have the male ego getting in the way. It’s something that effects most men….the thought that we can handle it ourselves (Trust me – i’ve been there!). Is it a wonder why truckers don’t frequently seek help?
Add to this the fact that many drivers have limited time to schedule appointments, go for any testing, and follow up with a doctor’s advice further compounding the problem. Those that can make it don’t always follow through with taking medication or going to counseling where needed. There just isn’t enough time.
Finally, it’s also common place in our society for family doctors to prescribe low level antidepressants even when there may not be a real need, in an attempt to help the trucker who has a hard time getting home. Therefore, in an attempt to be of help it ends up creating an issue with the drives medical certification. Just a part of the everyday life for the average trucker.
DOES DEPRESSION HAVE DIFFERENT KINDS OF SEVERITY?
Those suffering from depression may experience symptoms you actually may not recognize it. Being in a “blue mood” sometimes is a normal part of life. If you lose a loved one, or lose a job, it is natural to be sad. When those feeling become persistent, and begin to interfere with life, this is referred to as situational depression. It may last a few days, but can be prolonged for a few weeks or more.
When depression symptoms simply do not go away, this is a cause for concern. They can assume many types of feelings from not only sadness and emptiness, but irritation, anxiety, frustration and anger. Fatigue and decreased energy frequently accompanies these symptoms. It can affect your eating habits, concentration and memory. It can even cause difficulty with sleep, such as insomnia or even lead to sleeping more than usual. It can assume many different severities and cause significant issues in a driver’s day to day existence.
Men with depression are more likely to suffer anger, aggression drug/alcohol abuse and risk-taking behavior because of their depression. Women on the other hand are 70% more likely to suffer depression, and will be more likely to suffer withdrawal from life activities, irritability, sleep problems and a general loss of interest in the normal activities of day to day existence.
When depression symptoms simply will not go away and it begins to interfere with your life and work, this is called a “clinical depression” or “major depression”. In the event that a person gets to this point it is imperative to seek help, sooner rather than later. If left untreated, the symptoms can continue to escalate, and eventually lead to thoughts of suicide or wanting to hurt one’s self or others. If it reaches this point then it is inevitable that a person will need to be hospitalized and not only treatment medically, but also counseling to help pull themselves out of a severe depression such as this.
HOW DOES DEPRESSION AFFECT THE TRUCK DRIVER SPECIFICALLY?
As you might expect, the FMCSA has regulations and guidelines that can cause difficulty with driver medical certification. Medical examiners cannot certify a driver if they suffer a mental, nervous, organic or function disease or psychiatric disorder likely to interfere with his/her ability to drive a commercial motor vehicle. They also must work with treating providers in making a final decision on certification. This is not only a good idea but is required of the medical examiner. If a driver suffers even the mildest form of depression, the medical examiner should seek clearance from the treating provider (usually it’s the drivers family doctor).
A good medical examiner will not only review what you list in your history concerning depression and ask many questions, but they are also looking at your behavior before and during your exam. They will take notice of your dress and hygiene which often will give them clues as to your mood and the possibility of any psychological disorder.
They will also review your medications with you, and ask questions relating to what the meds are used for. In treating depression, there are some medications that are typically allowed (second generation anti-depressants such as SSRI’s and SNRI’s), and some that are not recommended (First generation such as tricyclics, and MAOI’s). Meds like Prozac are Zoloft and Effexor are typically prescribed and are 2nd generation.
The key for the driver to remember, is regardless of however mild your depression might be, you will always be required to provide “written” clearance from your treating provider for not only the depression but also the medications (because of side effects). The absence of taking a medication does not eliminate the need for clearance also. Always obtain the clearance before you go into your exam if you do not wish to have any delay in certification.
ARE THERE ANY OTHER ISSUES IF A DRIVER HAS SUFFERED FROM MAJOR OR SEVERE DEPRESSION?
The answer is yes. The driver will have a waiting period that will last anywhere from 6 months to up to 1 year based on severity and behavior. Those who have attempted suicide, or suffered a psychotic episode will have to be symptom free waiting period of 1 year before being considered for certification.
Other requirements will include compliance with treatment, toleration of treatment without side effects that will interfere with driving, and the driver will have to consult with a mental health professional and not simply the family doctor to obtain the required clearance.
Drivers who suffer and are treated for depression may only be granted a certification time of 1 year. This however can return to 2 years if the treatment of depression is not needed and the driver remains stable and without issue. That decision would be up to the medical examiner however, and will be on a case by case basis.
SO WHAT’S A DRIVER TO DO?
It is important to have contact with others as much as possible if you begin to notice some of the signs and symptoms of depression. Regular phone calls to family and friends (or webcam) is important. Add in regular emails and other communication (send a gift to a loved one for example), will do wonders to help you feel better. You should also get more exercise, even a walk once per day is helpful. Being in the sunshine is also something that will improve your mood.
Most importantly, if your symptoms continue, and/or if they worsen, it is important to seek help sooner rather than later. At least contact your family doctor to discuss this. Catch it when you first notice the symptoms, and you can prevent more serious problems later. Lastly, remember to get your clearance for even the most minor depression before your next exam!
