Diving with OCD/Anxiety + taking lexapro?

[mstevens]

Does DAN try to get toxicology reports from fatal cases to see what medications were in the victim's blood?

Back when I was an autopsy tech, the pathologists would request toxicology screens and levels of therapeutic drugs the patient was known or suspected to have been taking. The screens were quite general, and were limited to common drugs of abuse (some of which were also therapeutic drugs such as barbiturates or benzodiazepines). Sometimes, heavy metal panels or insecticide screens were requested.

Too many drugs exist for it to be practical to screen for every possibility at autopsy or clinically, so a tox report will only ever let you know if specific drugs that were looked for actually showed up, not a "real" answer to the question of what drugs were in the system.

You might also be surprised at how very few autopsies are performed. Many "ME cases" aren't even necessarily autopsied.

 

[pearl21]

Hi pearl21,

My pleasure.

1. (Q) "Do you have any idea if the percent of people taking SSRIs in the general population is the same percentage as in certified divers?"

(A) This has not been directly studied. However, based on studies of the number of active divers with affective and anxiety-mediated disorders, the percentages might be expected to be somewhat similar.

Doc,

If the percentages are similar, and given that those percentages are not trivial, wouldn't it be reasonable to assume that SSRIs and diving mix pretty well? If they did not you'd probably hear of a lot of problems/accidents. Would you agree that's a reasonable assumption?

If not, why?

Thanks

 

[H2Andy]

If they did not you'd probably hear of a lot of problems/accidents.

only if someone were tabulating whether the injured or dead divers were on any sort of anti-depressant

that is not done, so no one really knows

 

[pearl21]

only if someone were tabulating whether the injured or dead divers were on any sort of anti-depressant

that is not done, so no one really knows

The 2006 DAN report shows 88 (reported) diving fatalities involving US/Canadian citizens. 88 is a very small percentage of US/Canadian certified divers, whereas the percent of all US/Canadian certified divers taking SSRIs is most likely not a small percentage. If there was a serious SSRI problem, you'd expect to see a lot more deaths.

Comments on that logic?

 

[H2Andy]

i agree with your logic

i'm just saying, there's no real way of knowing

 

[fisherdvm]

An anology of this is the suicide rate in patients who used accutane. It is so low, that it is not statistically significant. But to the average dermatologist, like myself, you do see patients who flip the switch and act abnormally.

Because of the low incidence of diver death, and the poor collection of data - it is only reasonable for physicians and diving organizations to make conservative recommendations.

There are medicines that doctors tell their patients not to use while they are pregnant, but the same doctors willl use these medicines on themselves during pregnancy. The risks might be so small and theoretical, but with litigation a major issue, I don't think you'll get any professionals to tell you what you want to hear - ie. that they think SSRI is safe to mix with diving.

Based on what DocVikingo posted, I would say, SSRI is not safe to mix with diving. But what I do myself if I were taking SSRI is my own personal decision.

 

[DocVikingo]

Hi pearl21,

IMHO, both fisherdvm & H2Andy make excellent points.

The numbers are incredibly small and would be beyond the reach of any clinically meaningful statistics even if we did know the number of divers on SSRIs who were harmed while on scuba, which we don't. Then, there is the issue of whether the injury or death was the result of an SSRI, another concurrently administered psychotropic (combination drug therapy is common), the mental disorder itself, some combination of the aforementioned, or an unrelated cause. It will be a long while before this specific question is answered.

In the meantime, I again refer to the concluding section of my article which examines approaches to making the call on diving with a mental disorder, and in particular:

"3. Assume that depression (or anxiety-mediated disorder) and the drugs used to ameliorate it do not preclude diving provided that: (a) mental status examination demonstrates the condition to be well controlled; (b) the diver on medication has been on for an extended period and side effects dangerous to scuba are neither reported nor observed upon careful examination; (c) there are no other contraindications in the clinical picture; and, (d) the diver feels he is up to it and fully comprehends the remaining risks."

This perspective should be examined with the diver's psychiatrist and medical clearance for scuba discussed.

Given medical clearance, and that the diver is upfront with dive ops and buddies, it largely boils down to the degree of risk the individual is willing to assume.

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.

Regards,

DocVikingo

 

[Spratman]

As with the others, I take several different medications for my depression/bipolar 2 disorder. (Zoloft, Trazadone and Trileptal) I have been diving for three years in several different environments without any problems. Sometimes the issue of diving with depression does not get clearly defined. Diving with depression untreated is a no brainer. BAD!

I've read Doc V's articles and agree with fisherdvm and H2Andy as well. If anyone should want start a project regarding testing on divers with depression, I'd gladly volunteer. I think garnering some actual data on this matter would be useful to all.

Having said that, it's got to be a doctor/patient discussion and a diver/dive doctor discussion as well. I'm quite comfortable with underwater training and responding to emergency situations. I believe that it goes on a individual basis. Your buddies need to be aware of it and comfortable with diving with you as a buddy. The guys I dive with believe that I'm a safe and stable diver, and would dive with me anytime.