depression and diving

[jazzie129]

hi all

i've recently been diagnosed with depression and prescribed citalopram (20mg per day). should i stop diving?

regards

danny

 

[The Iceni]

Hi Jassie129,

Firstly welcome aboard. Sorry to hear about your problems, sadly very common nowdays.

I very much doubt you would get any doctor to give you the complete all-clear simply because we know so little about the effects of pressure on the pharmacological action of any medication, particularly those that are psychologically active.

There are two factors to consider when assessing whether any individual is fit to dive or not. Firstly do they have a condition that makes them an unacceptable danger to themselves or others. The second is does the treatment lead to a side effects that would make them a danger to themselves or others.

You have not given an adequate history for any doctor to even make a stab at giving you advice and this forum is really not the place to offer such consultations. Unhelpful, I know, but you really must seek advice from a diving doctor, in person.

I personally very much doubt such selective serotonin uptake inhibitors will have any effects on the risks of DCI. However, from first principles I would strongly uspect that such mood altering drugs, at a minimum, will have an effect on narcosis, which is ever present to a certain degree. In addition it may effect you ability to cope in an emergency, so it would be sensible for you to be very wary indeed.

I apologise that this post is not really much help to you but if you do intend to dive when taking such medication you are really duty-bound to inform the dive marshal or you may find you are not insured.

You may not like his decision. BSAC's recommendations are "If any psychotropic drug (including tranquillisers, sedatives and hypnotics) have been used, the candidate should not dive for at least 3 months after complete cessation of therapy without the consent of the medical referee." :doctor:

 

[jazzie129]

thanks paul. i am trying to get in touch with one of the medical referees at the moment as it happens, but thought i might get an indication of the likely verdict here.

regards

danny

 

[DocVikingo]

You may want to consult the Apr/May '03 issue of "Alert Diver" magazine as it contains a piece on diving & depression. I am doing a more detailed follow up article on the subject that is scheduled to appear in the Jun/Jul '03 edition. It focuses more directly on the actual decision making process involved in fitness to dive while on SSRIs like citalopram (e.g., Cipramil) and other antidepressants.

If you do not get this publication, you may e-mail me and I'll give you a contact at DAN who will send you free copies of those issues.

In short, there are many considerations in diving with depression, and the possible effects of medication, although quite important, are not the only ones. The mood disorder itself can impair certain mental and physical faculties necessary for safe diving.

As regards citalopram, adverse reactions such as nausea & vomiting, insomnia, fatigue, drowsiness, dizziness, agitation, weakness & others have been reported. Understandably, the manufacturer cautions to "avoid participating in activities requiring complete mental alertness, judgment, and physical coordination - such as driving an automobile or performing hazardous tasks - until you are reasonably certain that treatment with citalopram does not affect you adversely." On the bright side, 20mg/day is at the lower end of the recommended dosage range and this should minimize side effects.

Obviously, a diver would at the least want to be confident that he was free of these before doing scuba. This means stopping diving until the medication has been given a fair trial topside. During that period, the diver should consult with a medical referee who can gather the information required to make a supportable fitness to dive decision.

Having just recently spoken with several senior physicians within the UK Sports Diving Medical Committee system, I see no reason to be unduly pessimistic about your prospects. The prevailing wisdom seems to be to decide situations such as yours based on the findings in the individual case rather than on some arbitrary & inflexible set of rules, although certain antidepressants, such as bupropion (e.g., Wellbutrin), are held as absolute contraindications to scuba due to such side effects as seizures. Hopefully, the medical referees out in the trenches will be as enlightened.

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.

Please do let me know what the referee decides.

Best regards.

DocVikingo

 

[voidware]

I have been on Zoloft for several years and it has completely changed my life. I have had no adverse reactions (the side-effects for SSRIs are all about the same). The main problem is that users can be unstable until one adjusts the dosage correctly. You should have no trouble obtaining medical approval provided you are stable. I have also talked to DAN. The physician on staff said that their main concern would be using diving as a method for suicide, but that usually isn't a concern for divers (or anyone for that matter). I urge you not to stop diving rather, take a break and get your life under control. This is not a suitable barrier to diving in your future.

brandon

 

[jazzie129]

hi all

thanks for the advice. i've now spoken to the medical referee and he's given me the following (which wasn't a huge surprise)

"It is not recomended to dive with depression as it may affect your judgement. Also the drugs can have unpredictable effects at depth. I would recomend not diving because of both the condition & the medication.

"If the medication is needed to control the depression long term, then it may be possible to reconsider this."

given this i've decided to suspend myself for a bit until the longer-term becomes a bit clearer. it's a shame but better safe than sorry...

regards to all

danny

 

[DocVikingo]

Sorry to hear that, Danny, but given his direct examination of you the medical referee is in the best position to make the call. You seem to have a good attitude about this undoubtedly disappointing news.

Hopefully, you will respond quickly & completely to treatment, and be back in water in the not too distant future.

Best of luck.

DocVikingo

 

[The Iceni]

DocVikingo once bubbled...
You may want to consult the Apr/May '03 issue of "Alert Diver" magazine as it contains a piece on diving & depression.

A good article, DocVikingo!

. . . In short, there are many considerations in diving with depression, and the possible effects of medication, although quite important, are not the only ones. The mood disorder itself can impair certain mental and physical faculties necessary for safe diving. . . The prevailing wisdom seems to be to decide situations such as yours based on the findings in the individual case rather than on some arbitrary & inflexible set of rules, although certain (drugs) are held as absolute contraindications to scuba due to such side effects as seizures. Hopefully, the medical referees out in the trenches will be as enlightened.

I am glad to see that common sense prevails. When assessing an individual's fitness for any undertaking it really does indeed boil down to two simple rules.

1) Does this condition make the candidate an unacceptable danger to themselves or others.

2) Does any treatment lead to any side effects that would make them a danger to themselves or others.

Only the experts in any particular field can make a true value-judgement and it is better to be safe than sorry.

Being unable to dive is depressing enough but I am sure things will work out fine for you, Danny.

Best wishes.

 

[DocVikingo]

Don't want to take any credit where it's not due. The Apr/May '03 "Alert Diver" article is not mine. The upcoming Jun/Jul '03 piece will be.

I hope that you'll find it worthy of an equivalent kudo.

Cheers.

DocVikingo