Dr. Vikingo's published article on this subject in DAN's Alert Diver sheds light on the entire topic of emotional conditions in America and prescription medications to treat them, and the relationship of scuba diving to these situations. I read it several times, so that I may now become more versed on the subject.
Personally, I am still not sure that I would trust a non-diving physician or non-diving psychiatrist to make the call. But I do agree that it would have been helpful had the course director and I contacted DAN directly for more guidance in advance.
I now believe that the right answer is to query the student as to the exact drug name and exact drug dosage, and then to contact DAN directly for advice. I still believe it to be an instructor call, but I will admit to insufficient evidence, with the benefit of hindsight being 20-20.
Dr. Vikingo's DAN article puts a lot of emphasis on dosage levels.
There is also the possibility that a patient who desires to enter scuba diving needs to consider changing physicians and psychiatrists to a new doctor who is well versed in diving science, normally a diving doctor. I'll toss that out, as food for thought.
I am somewhat amazed that our instructor association did not focus on this growing area of emotional conditions and prescription medications. It does focus really hard on such other contra-indications to diving such as asthma, diabetes, emphysema, epilepsy, chronic heart disease, and a host of other conditions on a two page instructor questionnaire.
I plan to follow up with the student in question, and refer him back to his psychiatrist, for a more formal consultation between the two of them, regarding the dosage considerations, and timing of the dosages. The issue now, of course, is his continued diving, and the possibility of dosage changes, and the daily timing of those dosages.
Dr. Vikingo, to answer your point, as to whether I was comfortable with the way we handled this originally, please understand, if I had been totally comfortable with it, it probably would not have been nagging at me these past months, and I probably would not have thought to ask about it, at my first opportunity, for which I give great credit to this scuba board and the access we have to great experts like yourself.
Everyone makes mistakes. Looks like our Course Director may have made a big one. Looks like I should have questioned his judgment as well, and I did not, and that was my own mistake.
I need to go back and clean up this mistake now, diplomatically, and I will not make this particular mistake again. However, being human, I reserve the right to make other mistakes in the future.
I did in fact learn that scuba diving successfully is great therapy for a person who otherwise has an emotional condition. But there is a procedure that we instructors should have followed, that we overlooked.
I do not particularly agree with MikeF's view of the legal world, that you refer all your thinking decisions to a medical expert, and let them carry the ball. However, I do respect Mike's expertise as an IANTD tech instructor, and his right to any view of the world that works for him. And I'm not saying he is wrong in his views.
I will confess that there is also a trap for techical divers who teach ordinary recreational diving, in thinking that NDL rec diving is easy to teach and to learn, and that even in the worst conceivable circumstances, a one-on-one relationship with a student and an instructor can overcome any problem in the water. Dr. Vikingo's DAN article dispels this notion, now, for me. Particularly the part about dosage-related underwater siezures. That sounds like the PO2 issues of Ox-tox, and technical divers can certainly relate to that.
