Mental Health Medication And Diving

[Yasemin Beygo]

Hi all, I have recently been diagnosed with depression, PTSD and anxiety and I am due to be put on medication within the next week or so. I have read various articles stating that diving whilst taking medication such as anti-depressants can impair judgement and have DCI like side effects, so much so that certain medication is allowed to be taken if the diver accepts to stay above the 20m mark and in some cases, diving is completely ruled out. Diving is my passion and my job. Understandably, I cannot do much in a dive centre if I cannot dive. I was wondering if anyone had any clearer information on this case and what the best option for me would be?
(Postponing diving is not an option- I would rather just not take any medication)
Thank you all in advance and happy diving

 

[dlofting]

It will depend a lot on the individual medications that you end up taking and the side effects they have on you. I take 30 mg of Paxil daily and have never had a problem diving. I also took 25 mg of seroquel daily for about a year and dove without incident during that time. I have also taken benzodiazepines at certain times in my life, but never during a time when I was also diving......I would probably avoid diving while being on these types of drugs due to the sedative effect they have. Best thing is to check with your doctor, or better yet, a pharmacist to see if any of your medication is contraindicated for diving.

 

[decompression]

A call to DAN should answer most questions, my good friend and military dive doc worked there for 3 years. They have a wide knowledge base for that.

 

[DevonDiver]

In respect to diving (especially working in diving).... the RSTC medical statement asks the following question:

Have you ever had, or do you currently have:

Behavioral health, mental or psychological problems (Panic attack, fear of closed or open spaces)?​

Based on your initial post, the matter would have to be referred to a doctor to authorize you to dive; regardless of whether you chose to take your medications or not. For that reason...as well as possible contra-indications of a given medicine... it'd be best to consult directly to a qualified diving doctor.

If "working in diving" includes supervisory responsibility for divers - then I'd strongly suggest that you get firm medical support for continued diving before continuing in that capacity. I can sympathize that it's not advice you'd want to hear - but if you have a duty of care to others, then you must act ethically as a professional. Do also consider the liability issues, should an incident occur and your medical situation became known (as it very well might) during a subsequent accident investigation.

The issue of PTSD has been raised with PADI; and I know that some thought is going into the issue in respect of the diving medical guidelines.

 

[BertStevens]

There will be an adjustment period while your body gets used to the medication. Some meds and dosages are ramped up or down, not stopped or started 'cold turkey'.

I take 150mg of Effector XR and 200mg of Wellbutrin SR once a day. I have been on it for over 15 years and have never noticed a side effect while diving. Brain chemistry is an individual thing and others may have different experiences.

 

[DocVikingo]

Hi Jasemin,

In a nutshell, all divers must show attention, concentration, decision making capacity, impulse control and behavioral modulation that are fully adequate to meet the demands of scuba. These faculties may be compromised in persons diagnosed with depression, PTSD & anxiety depression. Treatment with mood stabilizers, anti-convulsant meds & anxiolytic agents adds other dimensions of concern.

Before returning to SCUBA, it would be prudent that: (a) mental status examination demonstrates the condition(s) to be well controlled; (b) the diver who is taking medication(s) has been on them for an extended period and side effects dangerous to scuba are neither reported nor observed upon careful examination; (c) there are no other contraindications, mental or physical, in the clinical picture; (d) the diver feels he is up to it and fully comprehends any additional risks; (e) the diver has been cleared for diving by his physician; (f) the diver makes full disclosure to the dive op (which likely will want to see written clearance) and to his/her dive buddy.

More extended treatments of this topic can be found in already posted threads such as:

Doc Vikingo's Depression & Diving

PTSD & Diving ?

In the meantime, diving in any commercial or professional capacity would be quite ethically questionable & raise serious liability issues.

Regards,

DocVikingo

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. Consult with your physician before diving.”

 

[kelemvor]

A call to DAN should answer most questions, my good friend and military dive doc worked there for 3 years. They have a wide knowledge base for that.

Have you ever called them with a question? Last time I did, they just told me "go ask your doctor" and didn't give me an answer at all. I was quite disappointed given their reputation. Still, it's good insurance (I hope), so I keep them.

I was simply asking them about standard seasickness meds (I asked about dramimine, scopalomine, meclizine). Good luck getting DAN to comment on actual prescription antidepressants.

 

[DocVikingo]

I appreciate your input, Kelemvor.

It begs the question, if "call DAN" is the answer, what is the purpose of this Diving Medicine forum?

If I might, I'd like to offer a few words about the "call DAN" reflex. While it often is a wise idea to inquire of DAN, a world-recognized organization, one needs to appreciate the likely limitations of doing so.

For example, when one contacts DAN they first, and often only, speak with a paraprofessional (e.g., registered nurse, diving EMT). These folks often simply thumb to DAN's medical FAQs (Scuba Diving Medical FAQ Articles — Decompression Illness — DAN | Divers Alert Network) and read or email a paraphrasing to the individual. They frequently are quite busy and give the briefest possible reply. For understandable reasons, DAN provides very limited direct physician access. As such, the answers received from one of the experts on the Diving Medicine and Ask Dr Deco forums are likely to be longer and more informative than the responses from DAN, even when both are in essence correct.

Also, these scubaboard.com forums typically afford more opportunity for rapid give and take between participants than is the case with DAN. Finally, links to previous board threads on the topic, professional magazine and journal articles on the subject, and other reference sources are often given on this forum, another nicety not usually provided in a DAN reply.

And, DAN does occasionally gives a rather shaky response. For example, their reply to an inquiry about the possible effects of massage on divers seems to be quite weak and disappointing (Pre/Post Dive Massage Therapy).

It would seem wisest to pose diving medicine inquiries to a range of sources and see how the opinions rank based on the factual and theoretical support given an opinion, the thoroughness and clarity of the response, and other relevent factors.

DAN is a very worthy and valuable organization, but it in fact is not the be all and end all of diving medicine fact and opinion. While it is an excellent resource for acute diving injuries, and their website has quite a few good articles on it about medical conditions and medications. But I don't think in the case of something like the present question, which is not an emergency, that there is anything wrong with asking for advice from other sources, and turning to DAN if you can't get the information you need elsewhere.

Regards,

DocVikingo