Prozac And Scuba

[DeepTechScuba]

I certified a dive student who had asked me if taking prozac would be harmful for scuba diving. I passed the question onto the course director, who directed me to teach this person in a private setting slowly with low stress. The student accomodated our recommendations and met the additional private teaching financial commitment. He did great, and he felt like he got his money's worth. On his subsequent dive club trip to the Caribbean, he said his training had served him well, and he had enjoyed the diving with no mishaps.

I further recommended to the new diver that he always keep his diving depths to 70 ft or shallower, since depth can have a major impact on the effect of prescription as well as nonprescription drugs.

I am new to this scuba board. Since you are a M.D., can you answer my original questions more specifically?

1) Is there a given depth limit for Prozac in particular?

2) Neither the course director nor I are M.D.'s. Did we do the right thing, in your opinion?

 

[brizzolatti]

Hi. I'm not an MD so these are just my thoughts and opinions. But I do have several years experience of taking an anti-depressant of a similar type to Prozac.

DId you ask the student why he was taking Prozac, how long he'd been on it, how he was feeling on it, how he was feeling about diving? I ask because I am intrigued at your response of having a private setting with low stress. I think I can understand what you were thinking when you did this but depending on the answers to the questions I suggested, it may not have been necessary and could even have been counter productive. There can be many reasons for being on Prozac and people have different stressors - I think we'd need to know a lot more about the individual's circumstances, presentation and state of well-being before we could pass an opinion on whether or not you did the right thing.

Re the depth thing, I can only speak from personal experience that going to 100ft didn't seem to exacerbate anything for me. But different people will have different physiological responses to depth and to drugs. Also could depend on the dosage rather than just the fact you are taking drugs. The standard dose for the drug I'm familiar with is 50mg a day but some people can take up to 200mg. Side effects could be compounded at higher doses. Also length of time you've taken the drug - at the start you coudl have side effects that go away after a period. You can also have side effects coming off the drugs and lowering the dose! It all depends - which is why you really need to know a lot more and presumably get a medical opinion. Before you take on the student maybe? Though you don't suggest that you sought any medical advice before or that you asked the student for a medical note clearing him to dive.

Good thing was the student did the course and enjoyed it.

 

[DocVikingo]

Given the evidence provided, it is not possible to say whether or not the correct thing was done. There is not even a diagnosis, merely identification of a drug (dosage not specified) that is prescribed for a range of psychiatric conditions, including but not limited to depression, obsessive compulsive disorder & bulimia nervosa.

As regards the depth restriction issue, science has not yet determined what are safe limits for particluar drugs. Still, conservatism in dive profiles is a prudent approach when medical risk factors are present. Given clearence to dive to begin with, 70' probably is within conservative limits, although when in doubt the shallower the better for obvious reasons.

Clearly medications like Prozac impact on brain chemistry at ambient atmospheric pressure. It is therefore not unreasonable to suspect the possibly that their effects could be potentiated by increased partial pressures of nitrogen and additive with those of nitrogen narcosis.

As regards depression & diving, I suggest that at your leisure you read the "Depression & Diving: Part II. Making the call on recreational diving" article in the Jul/Aug '03 issue of DAN's "Alert Diver" magazine. This piece can be found at http://scuba-doc.com/alertdiver2.html As you will see, factors related to the disorder itself as well as to its treatment must be considered.

IMHO, the right thing to do would have been to secure a written statement regarding fitness to dive from the student's treating or other physician prior to any in-water training or activities on scuba.

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.

Best regards.

DocVikingo

 

[DeepTechScuba]

Thanks, Brizzo and Doc, for your thoughts.

Doc, the reason we did not send him back to his doc with a waiver request is that there are very few docs who scuba dive. In our local area, we know of 2 or 3, and none of them is a phychiatrist.

Additionally, we were not focused on legal liability. We were more focused on actual diver risk.

Further, this student was short on time to get certified, and our upcoming class was barely going to make it with his own time frame for joining his dive club at work on this Caribbean trip. A further delay to get an appointment for a waiver did not seem like the right thing to do, given the time constraints.

The course director and I are both ADV TMX certified, and we know about the medical effects of extreme depth on drugs only because that was covered in our tech training. And that was our only clue. We are not M.D.s ourselves. And we only trust M.D.s who are scuba divers themselves.

Brizzo, thank you for your personal insights. Since becoming a scuba instructor, I have learned that up to 10% of the Western World are recipients of prescription medications for emotional or similar medical conditions. This was an area of modern life that I was totally unaware of before. We did not cover it in our ITC. The reality caught me totally by surprise. That means at any given time, up to 10% of my students could or should be on some sort of prescription medication.

No, I did not ask a lot of questions of the student. I was glad he was honest in filling out the medical questionnaire. I simply did not expect the answer that I was given, and I was not prepared for it. I was worried about depth and the effects of increased N2 partial pressure on the prescription. And I was also worried about the stress of ordinary learning in a crowded scuba class.

The course director and I threw our best efforts into dealing with these givens and unknowns, not being diving physicians ourselves. It worked out well, but it is still an area of scuba training and scuba diving that I am trying to learn more about.

Thanks again to you both.

 

[MikeFerrara]

DeepTechScuba once bubbled...
Thanks, Brizzo and Doc, for your thoughts.

Doc, the reason we did not send him back to his doc with a waiver request is that there are very few docs who scuba dive. In our local area, we know of 2 or 3, and none of them is a phychiatrist.

As far as I know all agencies require the sign off of a doc prior to in-water activities if the student is taking prescription medications. The standards requirement is a requirement regardless of the avalability of a doctor who knows diving.

Additionally, we were not focused on legal liability. We were more focused on actual diver risk.

Without the opinion of a real doc, how could you possibly assess the risk to the student.

Further, this student was short on time to get certified, and our upcoming class was barely going to make it with his own time frame for joining his dive club at work on this Caribbean trip. A further delay to get an appointment for a waiver did not seem like the right thing to do, given the time constraints.

Getting the approval of a real doc was the only right thing to do and nothing else should have even been considered for a second. A silly vacation isn't worth risking a students health and maybe even their life.

The course director and I are both ADV TMX certified, and we know about the medical effects of extreme depth on drugs only because that was covered in our tech training. And that was our only clue. We are not M.D.s ourselves. And we only trust M.D.s who are scuba divers themselves.

The worst MD would be far more qualified than you even with your trimix cert. LOL

Brizzo, thank you for your personal insights. Since becoming a scuba instructor, I have learned that up to 10% of the Western World are recipients of prescription medications for emotional or similar medical conditions. This was an area of modern life that I was totally unaware of before. We did not cover it in our ITC. The reality caught me totally by surprise. That means at any given time, up to 10% of my students could or should be on some sort of prescription medication.

No, I did not ask a lot of questions of the student. I was glad he was honest in filling out the medical questionnaire. I simply did not expect the answer that I was given, and I was not prepared for it. I was worried about depth and the effects of increased N2 partial pressure on the prescription. And I was also worried about the stress of ordinary learning in a crowded scuba class.

There is a very real possibility that one or more of the conditions treated with this med is a contraindication for diving. I really can't believe I'm even reading this.

The course director and I threw our best efforts into dealing with these givens and unknowns, not being diving physicians ourselves. It worked out well, but it is still an area of scuba training and scuba diving that I am trying to learn more about.

Thanks again to you both.

In this case your best efforts don't mean a thing. You have no idea if it worked out well. Only the students class is over not his dive career.

Are you really an instructor? This is just a troll isn't it? You wouldn't want to give me your full name or your insructor number and agency would you?

 

[DeepTechScuba]

Mike, would you not rather have the full name and cert number and agency of the Course Director who I brought the issue to?

 

[MikeFerrara]

DeepTechScuba once bubbled...
Mike, would you not rather have the full name and cert number and agency of the Course Director who I brought the issue to?

Actually I don't want either but the standards are very clear on this. Wouldn't you agree? If your course director made the decission and you have first hand knowledge of it, standards require you to report it. right?

We have students in almost every class who are planning things at the last minute and have to rush to get a doctors appointment. It's never convenient, but with a "yes" on the medical form and without a doctors approval in writting they don't get in the water. It's the only way to protect them and yourself.

 

[DeepTechScuba]

Like I said, the Course Director made the call.

And like I said, I was not worried about legal liability. I was worried about making sure we did everything we could to minimize actual diver risk, not legal risk.

 

[DocVikingo]

I'm a little exasperated with this inquiry, myself.

DeepTechScuba:

Your original post inquires, "Neither the course director nor I are M.D.'s. Did we do the right thing, in your opinion?"

In response, I, as well as brizzolatti (and later Mike Ferrara), suggested that you neither had the information/knowledge nor the medical opinion/clearance necessary to do the right thing.

Your reply to this was to rationalize, support & defend your actions in accepting this trainee.

Hey, if you're comfortable with what you did, why seek reassurance here?

As an aside, I might add that I don't find your reasoning very compelling.

E.g.:

1. "very few docs who scuba dive. In our local area," "no psychiatrist"

Maybe you don't have the luxury of a scuba diving psychiatrist, but some professional in the neighborhood is prescribing the Prozac, right? It's very likely that person knows more about the drug than you or the course director, and even if not his or her opinion should have been sought. You could even have suggested that they contact DAN.

2. "Additionally, we were not focused on legal liability. We were more focused on actual diver risk."

The course director would benefit from a bit of risk management training. Once a student admits to a medical disorder, you have an obligation to act in a medically prudent manner, and this does entail legal liability. The waiver is in everybody's best interest, the trainee medically & the training personnel legally.

3. "The course director and I are both ADV TMX certified,..."

That is admirable, but I'd venture to say that this training involved little or no familiarization with the pharmacokinetics & pharmacodynamics of fluoxetine.

That you even ask, "Is there a given depth limit for Prozac in particular?," is prima facie evidence of an inadequate knowledge base in this area.

4. "Further, this student was short on time to get certified, and our upcoming class was barely going to make it with his own time frame for joining his dive club at work on this Caribbean trip. A further delay to get an appointment for a waiver did not seem like the right thing to do, given the time constraints."

The inappropriateness & wrongness of this rationalization is so obvious that I won't even offer any further comment.

I really do not enjoy coming down on you this hard, nor do I wish to discourage you from seeking information on this forum, as I suspect that you are sincere & well-meaning. However, IMHO what you did was improper, and your response to guidance defensive.

Best regards.

DocVikingo

 

[blacknet]

Hello,

Just thought i'd pipe in here and say one key factor was overlooked. DocVikingo briefly hit on the underlying cause not the drug but no one brought up that scuba diving experience, if done correctly, can be a very positive experience and uplifting one; all in all it helps the underlying condition. I personaly feel we get to caught up in the wrong areas and overlook what's best for the patient.

Ed