Diving after tiny dose of valium

[Iralub]

Hi all,
I'm wanting to get some perspectives on a situation.

I have been diving for more than 10 years while using an antidepressant (venlafaxine). No side effects, no problems. More recently, as I've been trying to reduce the antidepressant dose, my GP prescribed some valium, to assist with breakthrough anxiety symptoms.
The dose prescribed was 7.5mg per day, which is close to the minimum recommended adult dose.
I take a maximum of 1.25mg on any one day and not every day, but on an as needs basis. So about one sixths of what was already a low prescribed dose.
At this dose, the medication does not cause any sedation or drowsiness and does not interfere with judgment - it just takes the edge of anxiety, so that I can approach situations or problems rationally, rather than with my mind racing from stress or a sick feeling in my stomach. I have had no problems driving or doing anything else (and would never get behind the wheel if I felt my responses were not what they should be).

On a recent dive trip, my buddy found out that I occasionally take the small valium dose and told me that if I took any, they would not dive with me. Fortunately, on that trip, I never reached the level of stress/anxiety that required me to take the medication.

From my point of view, people dive all the time on medications that can, in some people, have effects that are contraindicated for diving, including antihistamines, antidepressants, betablockers etc. If deleterious side effects are not experienced by the individual, there is no contraindication to diving. On the other hand, excessive anxiety can be problematic underwater. I find that, if I'm feeling unduly anxious, my bouyancy, trim etc is adversely affected. Same with air use.

Does anyone have any experience with or insight into whether diving after a small dose of valium or similar, without any discernable sedation, presents a problem? Is there an absolute contraindication on diving in this situation?

 

[Boarderguy]

Call DAN...

Now that that is out of the way I think with such a benign dosage you'll be fine. I was taking 5mg twice a day for facial spasms for a long time. When I increased to 10mg twice I had to ensure I wasn't doing anything that required me being attentive. I eventuality got all that under control via other means so i have had Valium in 6 years and didn't ever dive while on it. Valium can hit you like a ton of bricks when changing or increasing doses so be aware of that.

 

[MB NZ]

From DAN: Psychiatric Fitness to Dive.

Other articles seem to say the same thing. There is no room for nuance (i.e. your very low dose and the risks associated with anxiety). I suppose someone might say that you shouldn't be diving at all. My medical opinion* and reality check, don't worry about it. Find a nicer buddy and go diving. I'd rather dive with you than someone who was on the piss all night before a dive trip.

* Medical advice on the internet is worth what you pay for it.

 

[Duke Dive Medicine]

Hi all,
I'm wanting to get some perspectives on a situation.

I have been diving for more than 10 years while using an antidepressant (venlafaxine). No side effects, no problems. More recently, as I've been trying to reduce the antidepressant dose, my GP prescribed some valium, to assist with breakthrough anxiety symptoms.
The dose prescribed was 7.5mg per day, which is close to the minimum recommended adult dose.
I take a maximum of 1.25mg on any one day and not every day, but on an as needs basis. So about one sixths of what was already a low prescribed dose.
At this dose, the medication does not cause any sedation or drowsiness and does not interfere with judgment - it just takes the edge of anxiety, so that I can approach situations or problems rationally, rather than with my mind racing from stress or a sick feeling in my stomach. I have had no problems driving or doing anything else (and would never get behind the wheel if I felt my responses were not what they should be).

On a recent dive trip, my buddy found out that I occasionally take the small valium dose and told me that if I took any, they would not dive with me. Fortunately, on that trip, I never reached the level of stress/anxiety that required me to take the medication.

From my point of view, people dive all the time on medications that can, in some people, have effects that are contraindicated for diving, including antihistamines, antidepressants, betablockers etc. If deleterious side effects are not experienced by the individual, there is no contraindication to diving. On the other hand, excessive anxiety can be problematic underwater. I find that, if I'm feeling unduly anxious, my bouyancy, trim etc is adversely affected. Same with air use.

Does anyone have any experience with or insight into whether diving after a small dose of valium or similar, without any discernable sedation, presents a problem? Is there an absolute contraindication on diving in this situation?

Best practice would be to refrain from diving while taking diazepam. Subtle changes in judgment and reaction time due to benzodiazepines like diazepam and other CNS depressants can be hard to detect. The effects can also combine with nitrogen narcosis if you're diving to depths where that is a factor. I would also recommend that you wait to dive until you're stable on the new dose of venlafaxine.

Best regards,
DDM

 

[heftysmurf]

Certainly NOT medical advice and absolutely concur with @Duke Dive Medicine. My primary dive buddies are vets like myself who more or less have similar issues and I occasionally dive after taking .5mg of clonazepam (to take the edge off) as I have anxiety. Again, some say no one should dive with anxiety but my doc signed off and diving has done wonders for my stress and anxiety. HUGE CAVEAT is that I've been taking this for 20+ years so I am aware of the effects and how I handle them.

On another note -- good on you trying to titrate off of antidepressants. I've tried to wean off sertraline multiple times over the last two decades and my body just isn't having it -- so, lowest dose possible for me with acceptance that it is what it is.

 

[rgkv]

I think only you can be the judge

 

[MB NZ]

I think only you can be the judge

I agree. Doctors and other experts can only give advice based on experience and best evidence. Some questions get a clear yes or no answer. Other issues are nebulous and the individual concerned may want to make up there own minds. If they don't want to take that responsibility, they can default to medical advice. DDM (who I respect) has given the perfect textbook and medico-legally defensible answer.

 

[BoltSnap]

I would go with medical advice given by the diving medicine specialists, such as DAN/Duke medical, nobody else. I definitely would NOT dive with anyone who is taking any of the medications mentioned above even at the lowest doses. The last thing I'd want is to deal with somebody who has such issues and chooses to dive. I have dealt and witnessed what happens when people with medical issues either ignore or choose to withhold information from their instructor or dive buddies and dive but end up in serious situations exposing all who they are diving with to serious injuries and potential legal implications.

Personally, I undergo VERY intensive/extensive medical evaluation every single year way beyond what is required by diver training agencies. I don't want to get hurt or, worse, cause somebody else to get hurt because I ignored medical issues I may have and chose to ignore.

For me, any medical issue that has to do with heart/circulation, brain/nervous system, pulmonary system, diabetes and mental health are show stoppers. I'd go with the conservative medical advice.

/

 

[Tim Clark Diving]

Definitely follow doctor's advice. I had to do CPR on a diver who I found out was on antianxiety meds. I was leading the dive and looked back to find a couple divers assisting her with her regulator. Somehow the mouthpiece had detached from the regulator. She was very calmly signaled that she was out of air. I gave her my alternate and she signaled she still couldn't breathe. I gave her my primary, purged it for her, and she still couldn't breathe. She passed out as I brought her to the surface. Got her to the surface and fluid poured out of her lungs. She survived, but the thing that got me was how calmly she drowned. Never had the typical wide-eyed panic that we are used to seeing in distressed divers. I later found she was stressed on our first dive, so had taken anti-anxiety meds for the second dive. So, I hope you find a way you can safely dive because the underwater world is amazing. However, follow the advice from doctor's knowledgeable in dive medicine like Duke Dive Medical. There are times when you should be panicked, and you don't want something keeping you from knowing when you are in real danger.

 

[NW Dive Dawg]

I think only you can be the judge

I completely agree that only you can be the judge on the final decision on how to handle your life. But some basic self education and advise / input from YOUR doctor is probably a good idea in making that decision.

Personally, I think that the low dose Valium is no big deal and far less impactful to safety than the thousands of divers in the tropics who dive every morning with a dehydrated hangover..