Help: 40mg of SSRI and Diving?

[Theprincessandthespy]

Hello to Diving Doctors and Diving medical specialists:

THANK YOU For reading this! Would really appreciate if someone could advise if I should be scuba diving taking 40mg of citalopram/celexa (SSRI) daily. I’ve been taking the same dose for two years now and the side effects (on land) are sleepiness and forgetfulness. I take it for an Obsessive compulsive disorder/anxiety condition. I’ve finished my confined pool dives for PADI certification (one of my biggest achievements since I’m usually easily anxious) and am quite confident I can calm myself down for the open water dives in tropical waters on my vacation. However, I’ve been reading web articles that people with daily dose of 40mg of citalopram/celexa incur high risk of potential side effects/brain issues when going past 30 or 40 ft?

Could someone please advise:

1. If that last statement is true?
   
   
2. If so, what side effects? Do you recommend I still proceed with scuba diving?
   
   
3. If I’m only allowed to dive to a depth of 40 ft, is it still worth it getting certified? Since most of the really interesting stuff in Hawaii are probably past 40 ft? should I just stick to snorkeling?
   
   
4. With only my confined pool certification (not open water), am I still able to scuba with an dive master (1-1) to a level of 40 ft in open water without going through open water certification?
   

Thank you SO MUCH for your help!! Really appreciate it. I am going to my family doctor but she isn’t an expert in diving so has no idea how to advise me as she’s not familiar with how pressure affects my medication.



Looking forward to hearing from you! Thanks.

 

[scubajoe123]

The very best thing you can do is go see an M.D. that specializes in dive medicine.

Please note that I'm not a medical professional, and my reply should not be interpreted as medical advice.

With that said, how psych meds effect a person under pressure is not something there is much(if any) research on. I can give you a quick run-down of some things I've read over the last couple of years.

SSRI(especially in high doses) are known to cause seizures in some people. You might also recall that too much oxygen can cause central nervous system toxicity ( a symptom of which is also seizures). Does the medication make you more susceptible to oxygen toxicity? Maybe, maybe not, I don't believe anyone really knows.

With that said, I'm aware of two incidents involving Citalopram:

1) A diver in Egypt who was taking the SSRI citalopram suffered symptoms of “serotonin storm” – a syndrome of confusion, agitation, sweating, palpitations and hallucinations. This understandably prompted a flurry of visits and calls to LDC. The theory in this case was that the combination of depth and the drug led to the event. There is some evidence in animals that hyperbaric exposure renders the brain more susceptible to the effects of SSRI drugs such as citalopram, so this might be a plausible mechanism, but to my knowledge this is an isolated case. Usually this type of presentation is only seen in SSRI overdose, if the drug is combined with another psychotropic medication.

2) More recently, another diver suffered a heart attack while diving on Citalopram. This diver had an extremely high amount of the drug in her blood. It was thought that this was caused by two other drugs she was on known to be toxic to the liver. It was conjectured that the extremely high Citalopram level and the mammalian diving reflex may have caused the heart attack. Note that Citalopram does affect the QT-cycle(how nerve impulses travel) in the heart.

On the flip side, I personally know someone on a low dose (10mg) with 50+ dives that suffers no side effects above or below the water. However, this person also got clearance to dive from a medical professional. It's my impression that each situation is personal and different.

So coming back full circle: Just go see a dive medicine specialist!

 

[Theprincessandthespy]

Thanks so much scubajoe. That was really nice of you to reply so quickly. It's kind of too late to see a dive doctor since i'm leaving next week so I think what I'll do is snorkel this time and see if i'm really not satisfied with what I see. I'm going to ask the dive centre in hawaii if they would certify me at a shallow depth (30-40ft) as well. Thank you!!

 

[Duke Dive Medicine]

Hello to Diving Doctors and Diving medical specialists:

THANK YOU For reading this! Would really appreciate if someone could advise if I should be scuba diving taking 40mg of citalopram/celexa (SSRI) daily. I’ve been taking the same dose for two years now and the side effects (on land) are sleepiness and forgetfulness. I take it for an Obsessive compulsive disorder/anxiety condition. I’ve finished my confined pool dives for PADI certification (one of my biggest achievements since I’m usually easily anxious) and am quite confident I can calm myself down for the open water dives in tropical waters on my vacation. However, I’ve been reading web articles that people with daily dose of 40mg of citalopram/celexa incur high risk of potential side effects/brain issues when going past 30 or 40 ft?

Could someone please advise:

1. If that last statement is true?
   
   
2. If so, what side effects? Do you recommend I still proceed with scuba diving?
   
   
3. If I’m only allowed to dive to a depth of 40 ft, is it still worth it getting certified? Since most of the really interesting stuff in Hawaii are probably past 40 ft? should I just stick to snorkeling?
   
   
4. With only my confined pool certification (not open water), am I still able to scuba with an dive master (1-1) to a level of 40 ft in open water without going through open water certification?

Thank you SO MUCH for your help!! Really appreciate it. I am going to my family doctor but she isn’t an expert in diving so has no idea how to advise me as she’s not familiar with how pressure affects my medication.



Looking forward to hearing from you! Thanks.

Good morning,

SSRIs do have the potential to reduce the seizure threshold but I'm not sure where the 30 or 40 foot figure would have come from. @DocVikingo is the local expert here on this so you may want to send him a PM, but if you have been on the medication for two years without significant ill effect then it's unlikely to cause you harm when diving. That said, scubajoe123 made an excellent point about the potential for QT prolongation (a delay in the time it takes the ventricles to go through their electrical cycle), which can lead to sudden cardiac arrest. You have to be especially cautious with other medications that may have the same effect, e.g. diphenhydramine (Benadryl) and dimenhydrinate (Dramamine). Nitrogen narcosis could be synergistic with the side effects you're reporting so I would follow scubajoe123's recommendation to see a physician with training and experience in examining divers before continuing, but if you're otherwise healthy I think it's likely you would be cleared. If you PM me your location I can give you some contacts - it's not impossible to get seen before you leave. We frequently see patients within a day or two of their appointment request.

Best regards,
DDM

 

[DocVikingo]

Hi Princess.

You might find the following informative --> Of possible interest to diver's taking Celexa (citalopram) or another SSRI.+

I believe that DDM has provided sage advice here. BTW, I also have no idea where the 30 or 40 foot figure would have come from, and frankly I can not see any scientific basis for it. Sounds like poppycock to me.

Regards,

DocVikingo