ADHD meds and diving

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The acronym "ADD" has been used in the past, and is still seen bandied about in the popular media, but in fact is not at present a recognized diagnosis per any major professional or advocacy organization. In latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) behavioral abnormalities of this type are classified as Attention-Deficit/Hyperactivity Disorder. Even the Attention Deficit Disorder Association refers to the actual condition as AD/HD.

Also, AD/HD really only comes in 3 "forms:" AD/HD, Combined Type; AD/HD, Predominantly Inattentive Type; AD/HD, Predominantly Hyperactive-Impulsive Type. Now, if one means "severity," yes, there is a range.

As regards AD/HD "enhancing multitasking," while persons with AD/HD may indeed endeavor to focus on multiple tasks within a short temporal span, to the best of my knowledge there is no consistent body of evidence showing that they are adept at this. In fact, the research of which I am aware suggests that they are rather poor at multitasking in an effective manner.

Drugs currently used to ameliorate the signs & symptoms of AD/HD come from classes of chemicals that impact on dopamine or norepinephrine, or both, levels in the brain.

The determination of whether an individual carrying a diagnosis of AD/HD is fit to dive is a complicated one, and must be made on a case by case basis. It is also a matter to be shared with dive buddies & others who may be adversely affected by the disorder.

The individual with AD/HD serious enough to warrant a diagnosis & drug treatment should not be surprised if medical clearance to dive is denied.

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

Best regards.

DocVikingo

PS: For those who have yet read Scubadoc's contribution above, I recommend that you do so.
 
OK, I ain't a MD, but I'm rather seriously embroiled in the controversey regarding ADD/ADHD, particularly with regards to kids and teachers trying to force medication down kids' throats, as I do a lot of work in the area of kid's rights advocacy.

First, understand one thing up front - what we now call "ADD/ADHD" used to, 20 years ago, be called "being a boy." At least for the 90th+ percentile of so-called "diagnosed" individuals. (Yes, I recognize that there ARE exceptions!) There are many medical folks who in fact believe that nearly all of the people diagnosed with these disorders don't really have any chemical brain imbalance at all.

There is major controversey on this claimed disorder, and a lot of money being made turning kids into zombies. And before someone flies off the handle about that comment, let me point out that a nephew in my family was diagnosed with this "disorder", and he was indeed turned into a zombie by the medication that was effectively shoved down his throat when he was too young to understand or object. The long-term effects that this will have on him are yet to be determined, as he is just now entering adulthood.

Second, let's not forget that the folks who guard the DSM's inclusion and exclusion lists recently tried to have pedophilia removed from the DSM as a "disorder"! No, I'm not kidding, they really did. Now you would say "how is this related to the discussion here", to which I reply "it speaks volumes as to the credibility of things described therein."

So let's look at the symptomology instead. If you cannot demonstrate reasonable mental acuity and the focus necessary to dive, you shouldn't be diving. That's covered in all the standards of the various agencies, so nothing specific related to ADD/ADHD is required here.

When it comes to the drugs, I, like Doc, have serious concerns. Ritalin and its "cousins" are all amphetamine derivitives, as he noted. These drugs are proven to cause permanent changes in brain chemistry, just as does the abuse of amphetamines. (You don't even want to get me started on the "wisdom" of giving CHILDREN drugs that cause permanent brain-chemistry changes when they are unable to understand these things and give PERSONAL consent to them!)

As such all of these substances appear to be able to potentiate abnormal EEG activity (read: increased OxTox risk.) As such I would not be diving in any environment where your PO2 would exceed a well-padded safe margin (the common recreational advise is 1.4; I would, if I was taking such a drug, stay WELL below that - say, 1.0 to 1.2 max) as an added precaution. Remember, an O2 hit is PROBABLY going to be fatal.

This is ultimately a matter of personal risk assessment and is not simple to evaluate.... I'd have a long, serious talk with your personal physician and make that decision based on an INFORMED understanding of the risks involved.
 
As one whose spouse was diagnosed (ADHD Inattentive) at 38, well after obtaining c-card, I have some informal qualifications in this area. Diving with someone who is so easily distracted can be scary. Yes - he has been cleared to dive, repeatedly, by qualified dive neuro's & ENT's, but they aren't down 60-100 feet w/ us when he 'blinks'. A casual observer may never even notice, but a focused buddy may sense something not quite right.

As mentioned, there is great range in functioning, even within the individual. It can vary, and external factors can contribute. Too much 'input' (stimulating anything - lights, music, color) can be taxing &/or distracting. If you are diving w/ someone w/ diagnosed ADHD, make sure they are at their A game pre-dive. (And have taken their meds - I can always tell when a dose has been missed.) Morning diving seems to work best - focus & attention span wan as the day progresses. If you are ADHD, be up front w/ potential buddies, have them do some reading so they understand what you are about.

Equipment - make extra sure you check your AD/HD buddy. He's gone off sans weights (10 minutes in he realized they were missing), mask (wearing sunglasses), snorkel in (on a backroll off a boat).

A higher then expected incidence of co-existing conditions including dyslexia, learning disabilities, depression/dysthemia, compromised executive functioning, auditory processing deficiencies, autism & other neuro 'things' seem to go hand in hand w/ ADHD. Obviously, these co-existing conditions can also impact ones' ability to dive. You're right DocV - there is no formal diagnosis, rather many are arrived at by excluding other 'organic' causes. Sorry Lloyd - I don't buy the hyperactivity flavor enhances the ability to multitask. Some people/therapists would tell you even those of us who think we multi-task well are really giving less then deserved attention to any 1 of the tasks. (At least my therapist tells me this - I still tell her I multi-task darn well, thank you!)

On a side note, I try to make a conscious effort not to refer to the condition(s) as 'abnormalities', it does nothing to the already fragile self-esteem many AD/HDer's possess. I'm guessing you may fit in here PharmGirl - referring to yourself as a 'space cadet' & your comment "did THAT explain alot". Prior to diagnosis I once described our 'differences' as being due to the way we were hardwired, little did I know how close I was to the truth. May be helpful for those out there w/ ADHD spouses, buddies, etc. (Either that or call my Type-A personality an abnormality as well. Maybe it is, but just doesn't carry the same connotation as ADHD. Think about that.)

Spot on adder - of course these 'conditions' existed in the past. I worked in the mental health field 20 yrs ago & ADD (as it was deemed then) existed, it was a childhood malady, something that was outgrown. What were we thinking? Of course it didn't go away, it went into hiding & manifested itself in other insidious ways. ADHD'ers are masters at coping skills! There is one book out there that attributes ADHD to the HUNTER persona - the hyper, driven in search of prey sort of thing & the 'normals' are boring farmer/gatherer types. Not big on this book.

Good luck PharmGirl, try the meds - they did make a difference w/ my spouse, don't rule out therapies - a skills coach can help with organizational, work & social issues, neurologist can help determine proper meds & effectiveness, psychologist (find one w/ experience in adult ADHD) can be a tremendous help. As an example, my husband found his meds would peter out around 2:00 pm & he would crash. His therapist & neuro worked to better coordinate a dosing schedule preventing the afternoon meltdown. I've heard other therapists suggest adult ADHD doesn't exist. (I would avoid them. Or let them move into my house for a week, then talk to them.) Read all you can. There are tons of books available at your local Borders & Barnes & Noble.

Nothing scientific here, no medical advice, just some of my experiences over the past 3 yrs. post-diagnosis.
 
In trying appreciate your points, the sentence "There are many medical folks who in fact believe that nearly all of the people diagnosed with these disorders really have any chemical brain imbalance at all" does not seem to make sense. Is this actually how you meant to phrase it?

Best regards.

DocVikingo
 
DocVikingo:
In trying appreciate your points, the sentence "There are many medical folks who in fact believe that nearly all of the people diagnosed with these disorders really have any chemical brain imbalance at all" does not seem to make sense. Is this actually how you meant to phrase it?

Best regards.

DocVikingo

Insert "don't" between "disorders" and "really".

Keyboards. I hate 'em sometimes :D

Original message edited...
 
Check out this article for some info on adult ADHD. http://www.cmaj.ca/cgi/content/full/168/6/715

The statement I made about multitasking should be qualified. It is based on my son's physciatrist, a prof. of pediatric phsyciatry, and her partners observations. They believe adults who successfully compensate for their ADHD, such as other physicians, gravity towards fast paced situations. She has several parents of her patients who are physicians and have ADHD. They seem to gravitate to high risk sports and enjoy a seemingly chaotic, multitasking environment.

This is only a small subgroup of ADHD patients who have been selected by their educational process for certain traits. Some others may fall apart when they multitask. Others keep from getting bored and losing focus by jumping from task to task. Because of this range of behavioral manifestation, each person should evaluate their fitness to dive.
 
Some comments upon your posting:

1. "OK, I ain't a MD,..."

Yet, you go on from here talking like you have a very intimate knowledge of at least one area of medicine, psychiatry, including arguing diagnosis and commenting on the effects of drugs and their appropriate & inappropriate applications.

2. "First, understand one thing up front - what we now call "ADD/ADHD" used to, 20 years ago, be called "being a boy." At least for the 90th+ percentile of so-called "diagnosed" individuals."

I agree that this classificatory rubric has been to some degree subject to abuse of the type you suggest. I have as yet to see any consistent, solid figures on the extent of misdiagnosis, but would be very surpised if the problem was of this magnitude. From what scientific study(s) did you glean the 90th%tile+ figure?

3. "...the DSM's inclusion and exclusion lists recently tried to have pedophilia removed from the DSM as a "disorder"! No, I'm not kidding, they really did."

I don't believe that is an accurate characterization of what was done. In the DSM-III, merely acting upon one's sexual urges toward children was considered sufficient to generate a diagnosis of pedophilia. A few years later the text was revised, and in the DSM-IV persons who demonstrated sexual activities toward children could be considered to have a psychiatric disorder only if their actions "caused clinically significant distress or impairment in social, occupational or other important areas of functioning."

The APA explicitly stated that pedophilic behavior appropriately remained illegal & immoral. However, it had some years prior decided that to the extent possible it should avoid medicalizing behavior that was simply illegal/immoral and without intrapsychic or functional impairment.

3. "When it comes to the drugs, I, like Doc, have serious concerns. Ritalin and its "cousins" are all amphetamine derivitives, as he noted. These drugs are proven to cause permanent changes in brain chemistry, just as does the abuse of amphetamines."

Perhaps I have missed it, but I find nowhere in this thread where either Scubadoc or DocVikingo make any statement regarding "permanent changes in brain chemistry." I would add that the only research on this of which I am aware was conducted on rats. Of course, if you can provide references to human studies I'd be most interested.

4. "As such all of these substances appear to be able to potentiate abnormal EEG activity (read: increased OxTox risk.) As such I would not be diving in any environment where your PO2 would exceed a well-padded safe margin (the common recreational advise is 1.4; I would, if I was taking such a drug, stay WELL below that - say, 1.0 to 1.2 max).

You are using rather precise figures here for your recommendations on diving while on Ritalin-like drugs. What demonstrable science have you to support them?

5 "This is ultimately a matter of personal risk assessment and is not simple to evaluate.... I'd have a long, serious talk with your personal physician and make that decision based on an INFORMED understanding of the risks involved."

Finally something that we can agree on.

Best regards.

DocVikingo
 
Funny how ADHD causes controversy everywhere I look!
I have ADD inattentive type, but my ability to hyperfocus on things like my air don't make me a danger. I am curious about the effects of something like ritalin at depth, but no-one has really addressed that here, except to say "This drug may impair the ability to drive or operate machinery" which frankly sounds like BS to me (or a drug company covering its a##). Millions of people drive everyday with Zoloft, Ritalin, Prozac, etc in their blood streams and if these drugs were causing accidents it wouldn't pass un-noticed. But do the effects of these drugs change with depth? Is this known to happen with ANY other drug? Do any drugs effect oxygen toxicity (not that I ever dive deep enough to worry about that). There must be some information or research on this. I could see how the effects of nitrogen might enhance the effect of CNS depressants, and maybe anti-depressants, if they are sedating, but what else would depth do?
I am not taking ritalin yet, but expect to start shortly. I’m not sure if I am going to take it when diving or not - I will wait and see how it makes me feel before I decide - but I will use common
sense.
 
DocVikingo:
Some comments upon your posting:

1. "OK, I ain't a MD,..."

Yet, you go on from here talking like you have a very intimate knowledge of at least one area of medicine, psychiatry, including arguing diagnosis and commenting on the effects of drugs and their appropriate & inappropriate applications.

2. "First, understand one thing up front - what we now call "ADD/ADHD" used to, 20 years ago, be called "being a boy." At least for the 90th+ percentile of so-called "diagnosed" individuals."

I agree that this classificatory rubric has been to some degree subject to abuse of the type you suggest. I have as yet to see any consistent, solid figures on the extent of misdiagnosis, but would be very surpised if the problem was of this magnitude. From what scientific study(s) did you glean the 90th%tile+ figure?

Do you really expect me (or anyone else) to believe that suddenly this "disease" called ADD/ADHD magically appeared in people 20 years ago?

Doc, the entire ADHD/ADD thing doesn't pass the sniff test. What it does pass is the big pharma marketing test, and the teacher union "I don't wanna actually have to work at my job" test.

Until and unless you have seen a kid that has been "diagnosed" and the radical changes in behavior that show up when the magic ritalin is applied, you simply don't have the basis for comparison here. I've seen it in my family. The entire goal is to make these kids "complient" with what teachers want.

The problem is that an awfully large percentage of these kids simply aren't challenged by the environment they are in. So they get bored, and ultimately that feeds bad behavior. Get a few of them in the same place and you get a "feeding frenzy" going, and now you have what people call an "out of control" classroom.

What's really going on is that we've dumbed down the curriculum and are more interested in not offending anyone by giving their kid an "F" - so those who get it in the first 5 minutes get to sit through the rest of the hour and do NOTHING.

Now if you turn the overachievers into zombies, your "problem" as a teacher goes away.

Gee, you know what Doc? If you look at the statistics, we do just fine in terms of student achievement vis-a-vis the rest of the world until the fourth grade. The defecit by that point has begun to accumulate, and by the time the kids are out of high school its huge.

Of course regressing to the mean has the effect of calming down the classroom, but that's not (supposed to be) the point, is it? Or is it?

By any CURRENT definition I would have been subjected to this garbage when I was a kid. IMHO it is nothing more than ritualized child abuse and the people responsible should be in prison for felonious drug trafficking on top of it. Never mind that essentially ALL of these kids end up on these drugs at the "urging" of a teacher or other school administrator - in some cases, upon their demand. I have yet to see a PhD in psychiatry on the wall of any of these teacher's back rooms, yet they seem to be effectively prescribing these drugs.

It has gotten SO bad that actual legislation is now either on the books or pending in many states to actually ban and criminalize this practice. IMHO no new law was needed - this stuff is, absent a pre-existing prescription, a Scheduled drug, and as such any teacher "pushing" such a drug on Johnny has already committed the offense of attempting to dose a kid with an illegal, scheduled mind-altering substance and should do his or her 20 in the hole for same.

3. "...the DSM's inclusion and exclusion lists recently tried to have pedophilia removed from the DSM as a "disorder"! No, I'm not kidding, they really did."

I don't believe that is an accurate characterization of what was done. In the DSM-III, merely acting upon one's sexual urges toward children was considered sufficient to generate a diagnosis of pedophilia. A few years later the text was revised, and in the DSM-IV persons who demonstrated sexual activities toward children could be considered to have a psychiatric disorder only if their actions "caused clinically significant distress or impairment in social, occupational or other important areas of functioning."

Nice tap-dance there Doc.

Now perhaps you can tell me exactly what kind of "acting on sexual urges" towards children one can practice without it being important to your functioning? Or, for that matter, how you can perform any of these acts without breaking the law? (and exactly how you can break the law and not have that result in "impairment" of important areas of functioning - like your freedom, for instance!)

The APA explicitly stated that pedophilic behavior appropriately remained illegal & immoral. However, it had some years prior decided that to the extent possible it should avoid medicalizing behavior that was simply illegal/immoral and without intrapsychic or functional impairment.

This is when the APA went from being a respected medical group to a bunch of cranks and quacks intent on feathering their own nests at the expense of society.

IMHO, of course.

Nor is the pedophilia flap the first time these folks have taken a stroll off the deep end.

3. "When it comes to the drugs, I, like Doc, have serious concerns. Ritalin and its "cousins" are all amphetamine derivitives, as he noted. These drugs are proven to cause permanent changes in brain chemistry, just as does the abuse of amphetamines."

Perhaps I have missed it, but I find nowhere in this thread where either Scubadoc or DocVikingo make any statement regarding "permanent changes in brain chemistry." I would add that the only research on this of which I am aware was conducted on rats. Of course, if you can provide references to human studies I'd be most interested.

Are you volunteering for the dosing and autopsy?

These drugs are new enough that animal studies are all we've got (its kinda hard to get permission to rip open kid's skulls and have a look around), but they've demonstrated significant and permanent brain chemical changes at human dose levels (mg/kg) in animals. After we have a few thousand more kids go off the deep end and we get permission to autopsy them once they whack themselves, we might be able to prove that the animal studies cross over.

Never mind that the brain chemistry changes that HAVE been documented in those studies are almost identical in form and substance to that observed when those very same animals are dosed with methamphetamine - and we KNOW what that does to people who abuse it, as evidenced by the splats below bridges and other fun events demonstrate from time to time.
4. "As such all of these substances appear to be able to potentiate abnormal EEG activity (read: increased OxTox risk.) As such I would not be diving in any environment where your PO2 would exceed a well-padded safe margin (the common recreational advise is 1.4; I would, if I was taking such a drug, stay WELL below that - say, 1.0 to 1.2 max).

You are using rather precise figures here for your recommendations on diving while on Ritalin-like drugs. What demonstrable science have you to support them?

None. I calibrated MY risk - I said that IF I WAS TAKING SUCH A DRUG I would stay within a given range. I did not say YOU should stay within such a range.

Indeed, I do not believe that ANYONE - you, I, or anyone else - can calibrate such a risk for anyone else, as the science is not in. What we do know is that drugs with similar chemical activity in the body do potentiate O2 hits, because DAN HAS done those studies and there is some (albiet anecdotal) evidence that a few actual field O2 hits have been caused by such substances. This is where DAN's tap-dance on pseudoephedrine comes from, among others.

5 "This is ultimately a matter of personal risk assessment and is not simple to evaluate.... I'd have a long, serious talk with your personal physician and make that decision based on an INFORMED understanding of the risks involved."

Finally something that we can agree on.

Best regards.

DocVikingo

Yep.

Unfortunately, there are way too many people out there who want to categorically stamp "DENIED!" on someone's desire and decision to dive.

In a few cases this can be medically defended. In THIS case, however, such a categorical denial appears to be forthcoming without any science to back it up.

Just like the legions of zombies in our classrooms are.

Sorry for the heat here Doc, but this is a subject that I have done a LOT of work on. The doping of our kids, and the reasons behind it, is a serious impediment to our future competitiveness as a nation and their functioning as productive members of society.
 
... I'll make a couple of quick comments here.

I was put in a gifted program in fourth grade for the reasons that Genesis mentioned. I don't know about intelligence, but my memory is far better than average for what I read and what I hear. This is even true when I am multi-tasking and I sometimes do that just to kill boredom.

I was starting to be problem child (I got bored easily and had a teacher that believed in repetition to no end) and thank God this was before prescribing the meds was standard procedure. The gifted program teacher heard about me and fought to get me in her program. It made a huge difference socially and otherwise. I still have some problems but I was put back in standard classes later and simply turned into the tutor when teachers learned that I love to teach/instruct. This solved the "boredom" problem and gave them some help with slower student.

Oh, by the way, this is another disorder in DSM (I have read the books myself when my excellent therapist told me about her diagnosis.) but it is something else. It may be a mild chemical imbalance, but it is more related to some things that happened from when I was young.

As to diving with these meds in the system, that is for a doctor to say. But, I know that my internist has no problem with me diving on the mild anti-depressants that I take now and he did sign the dive physical. I sometimes wish that he would pull me off of them until I run out and the pharmacy is closed for the weekend. And I am far from a zombie on them. He kept the dosage at just above the minimum dosage for a tablet and we worked for about three months to make that happen. There again, this was/is more related to environmental factors (IMO), than a true chemical imbalance, but if it works for me, I won't gripe.
 
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