ADHD meds and diving

[DocVikingo]

You're being much too rational here, my good man.

We don't need any specialists, or doctors, or medical texts, or mainstream mental health thinking or even consensus.

We'll just let every person with a firing cortical neuron determine etiology, diagnosis, incidence/prevalence, treatment & public health policy regarding AD/HD for themselves.

Mercy, all those years that I wasted.

Best regards.

DocVikingo

 

[fins wake]

We'll just let every person with a firing cortical neuron determine etiology, diagnosis, incidence/prevalence, treatment & public health policy regarding AD/HD. Mercy, all those years that I wasted.

Hehe, you sound a bit like some diving MD friends of mine when they get exasperated on dive forums. I can certainly understand why. (Me, I just wish I hadn't quit med school all those years ago. )

The consensus I'm talking about is of course the one between you, Scubadoc and Dr Quigley. That is the only relevant consensus - it's by real experts and unanimous - and more than good enough for me. For what it's worth I hope people pay attention to this.

In that same vein, there a couple of people that I have read about in this thread that have to force themselves to pay attention to what they (or their spouses) are doing. This doesn't make them unable to dive unless the meds preclude it. Again, that is up to a doctor, not me.

Two problems here. First, I think anybody having to force themselves to pay attention to what they're doing shouldn't scuba dive. Second, the one area DocVikingo and Genesis were agreed on was that it is the diver him- or herself who needs to take the final decision based on informed opinion from the MD. The individual diver is always responsible for his or her actions. But I'm certainly glad the doctor's advice is heeded. That is usually the most sensible course of action.

Fins R Wake
With a newly inserted 'R' for 'rational' in the handle ...

 

[reubencahn]

While not being a physician myself, I have in a previous capacity worked extensively with children diagnosed with ADD/ADHD, and I'm very familiar with the effects of ritalin on these children. (Which incidentally is very different to that of ritalin on non-ADD/ADHD people.)

I believe this is inaccurate. The current thinking is that low dose stimulants act in the same manner in both ADHD and non-ADHD persons. Thus, Ritalin and other stimulants are not useful as diagnostic tools. That is, you can't decide if someone is ADHD by giving them Ritalin and seeing how it works. Of course, there are now non-stimulant ADHD medications, but I'm not sure what the thinking is regarding these.

 

[reubencahn]

I JUST read a book called "Driven to Distraction" by an MD with ADD (Dr. Edward Hallowell). I found it to be extremely informative, and it had loads of outside references. (Even about early ADD studies from 1902. It just hadn't been given a name yet!) It's a great source for learning more on the topic, written in a organized, well-informed manor. I would expect even those who didn't "believe" in this condition would be very interested on what the "other side" has to say. This may be a great place to start. Sometimes being fully informed can be an unbelievable eye-opener!

Thanks everyone! :54:

I agree this is a great book. It might also be worth looking at "Ritalin Nation." I'm not necessarily recommending this book, but it does provide an alternative point of view.

 

[Genesis]

Second, the one area DocVikingo and Genesis were agreed on was that it is the diver him- or herself who needs to take the final decision based on informed opinion from the MD. The individual diver is always responsible for his or her actions.

Agreed.

The problem I have arises when people want to make decisions for others about "fitness to dive."

IMHO, that is simply nobody else's business - except for the diver involved and those who are his or her consenting buddies - if any.

Yes, I know the counter-arguments - they've been hashed over a thousand times here and elsewhere on the board. My opinion remains the same - its my life, its my enjoyment, its my choice (and consequences.)

To those who argue "but the boat operator should have a say", I reply "I am buying transportation. When you step on a ferry boat, do they screen you for a possible coronary?" Of course they don't. That's because they're providing transportation - which is exactly what I am buying when I step on a charter boat.

Evaluate your own situation, and seek the counsel of those whom you trust, then make your decision. More information is always good.

 

[diverbrian]

Agreed.

The problem I have arises when people want to make decisions for others about "fitness to dive."

IMHO, that is simply nobody else's business - except for the diver involved and those who are his or her consenting buddies - if any.

Yes, I know the counter-arguments - they've been hashed over a thousand times here and elsewhere on the board. My opinion remains the same - its my life, its my enjoyment, its my choice (and consequences.)

To those who argue "but the boat operator should have a say", I reply "I am buying transportation. When you step on a ferry boat, do they screen you for a possible coronary?" Of course they don't. That's because they're providing transportation - which is exactly what I am buying when I step on a charter boat.

Evaluate your own situation, and seek the counsel of those whom you trust, then make your decision. More information is always good.

... but until then, if the diver-to-be (as in Ber Rabbit's case) doesn't have a medical release, then it is against any liability coverage that I know to train them, much less certify them. If there is a problem the instructor will be held liable and it will be out of his/her own pocket. So, in a case like this, the instructor does have the right and obligation to not allow them to proceed with training as a scuba diver.

The charter boat argument is another thread and doesn't belong here. You know my opinions on that. But diving with meds should definitely be checked out by a doctor.

Another source, if you want layman's terms on this (and ADHD meds are mentioned), check the IANTD Technical Diver Encyclopedia, Chapter 6 (starts on pg. 90) for an article by Dr. Bruce Voss, MD. There are many side effects to these drugs that divers don't think about. He also states that in many instances, it's up to the diver to determine the risk.
While not being an absolute contraindication to diving, they are at a minimum a relative contraindication. By the way, the information about contraindications to diving is also in my DiveCon manual. These things are just mentioned as food for thought. Take them or leave them as you like.

 

[fins wake]

I believe this is inaccurate. The current thinking is that low dose stimulants act in the same manner in both ADHD and non-ADHD persons.

And I'm stating that the kids whom I worked with who were given ritalin clearly and visibly became much calmer, not more agitated. If for some reason the ritalin wasn't given at the regular time, the kids (none of whom were checking their watches, assuming they had any in the first place) become progressively and clearly more agitated in separate ways. I'm not arguing with you, just stating what I've experienced myself over several years of working with these kids (who BTW in the main were a great bunch as most children are).

Thus, Ritalin and other stimulants are not useful as diagnostic tools. That is, you can't decide if someone is ADHD by giving them Ritalin and seeing how it works.

I don't think anybody on this board has suggested that these stimulants be used as diagnostic tools. However, I'm not a physician, so I really cannot evaluate your statement myself.

I think this thread is really going off on a tangent, and if we start discussing DSM-IV vs, DSM-III criteria for other afflictions, we're even more off on a tangent. All these are interesting discussions in their own right, but very off-topic on a diving board.

The main issue - and very relevant on this board - which the diving docs are trying to stress is that if you are diagnosed with ADHD, that in itself is likely to be an absolute contraindication to diving. The medication may further - in itself - constitute another contraindication. I believe this is the answer to the original question from all the diving docs referenced.

 

[Genesis]

The main issue - and very relevant on this board - which the diving docs are trying to stress is that if you are diagnosed with ADHD, that in itself is likely to be an absolute contraindication to diving. The medication may further - in itself - constitute another contraindication. I believe this is the answer to the original question from all the diving docs referenced.

And my point - and the main issue - is that by this criteria about 30% of the males over the age of 30 should not be "able to dive", because that's about the percentage of kids in many areas that are "diagnosed" with ADHD.

This is one of the most-abused diagnoses in the book, to the point that IMHO it is worthless as an indicator of actual disability, particularly when we're talking about people of an age where they can dive in the first place.

 

[reubencahn]

And I'm stating that the kids whom I worked with who were given ritalin clearly and visibly became much calmer, not more agitated. If for some reason the ritalin wasn't given at the regular time, the kids (none of whom were checking their watches, assuming they had any in the first place) become progressively and clearly more agitated in separate ways. I'm not arguing with you, just stating what I've experienced myself over several years of working with these kids (who BTW in the main were a great bunch as most children are). I don't think anybody on this board has suggested that these stimulants be used as diagnostic tools. However, I'm not a physician, so I really cannot evaluate your statement myself.

I think this thread is really going off on a tangent, and if we start discussing DSM-IV vs, DSM-III criteria for other afflictions, we're even more off on a tangent. All these are interesting discussions in their own right, but very off-topic on a diving board.

The main issue - and very relevant on this board - which the diving docs are trying to stress is that if you are diagnosed with ADHD, that in itself is likely to be an absolute contraindication to diving. The medication may further - in itself - constitute another contraindication. I believe this is the answer to the original question from all the diving docs referenced.

My point was that a low dose stimulant will make almost any child appear more calm. What it will really do is increase his/her focus and lessen impulsivity. The effect is the same with any human being. The difference is that someone who is ADHD is more in need of aid to focus and to act less impulsively. There was previously a belief that Ritalin, etc., acted differently in ADHD and non-ADHD persons, so that if you gave a person Ritalin and they became calmer and more focused, you could effectively diagnose them as ADHD. This is simply not true. However, in no way am I asserting that ADHD is not real or that Ritalin is not at times an effective treatment.

Beyond that, I would disagree with the statement that ADHD is "an absolute contraindication" to diving. It is an issue to be considered but not an absolute barrier. As always, the treating psychiatrist or neurologist is probably in the best position to advise whether a particular individual's ADHD is sufficiently severe to bar them from diving.

 

[fins wake]

And my point - and the main issue - is that by this criteria about 30% of the males over the age of 30 should not be "able to dive", because that's about the percentage of kids in many areas that are "diagnosed" with ADHD.

That seems such an incredible and mind-bogglingly high figure, that I honestly - and respectfully (since I do respect Genesis of course) - must be inclined to disbelieve the statement unless statistical or other proof is given (e.g. peer-reviewed references in medical literature).

My point was that a low dose stimulant will make almost any child appear more calm.

Disinclined to believe this, but I've never seen an undiagnosed child take ritalin so I don't know. (Any such field tests would probably be highly unethical).

What it will really do is increase his/her focus and lessen impulsivity.

Yes, this is how we were explained the effects of ritalin on the diagnosed and medicated children.

The effect is the same with any human being.

This I don't agree with. I've seen the effects specifically of ritalin and other similar stimulants on adult non-ADHD "lab rats". I won't go into specifics, just suffice to say I didn't participate in this in any way, shape or form for various ethical, moral and legal reasons.

The difference is that someone who is ADHD is more in need of aid to focus and to act less impulsively.

Yes.

There was previously a belief that Ritalin, etc., acted differently in ADHD and non-ADHD persons,

I'm personally inclined to agree with this view based upon my own experience, but I'm happy to stand corrected if suitable references are given.

Beyond that, I would disagree with the statement that ADHD is "an absolute contraindication" to diving. It is an issue to be considered but not an absolute barrier. As always, the treating psychiatrist or neurologist is probably in the best position to advise whether a particular individual's ADHD is sufficiently severe to bar them from diving.

Yes, I suppose I agree here. I think this is the point Genesis and DocVikingo found common ground on. Of course, this presupposes that a psychiatrist or neurologist is better placed to make such decisions than laymen such as most of us in this thread.

I happen to believe so. :54: