PTSD & Diving ?

[dad-the-diver]

Sheeper, with you 100%. as an Ex British soldier with a few tours of non-holiday destinations behind me I had a few PTSD-like symptoms. Bad Dreams, insomnia & a fondness for my ol-mate JD! But, my two oldest boys are A) in the Army & B) Scuba Divers. I started diving so I could go with them. And while I still have the odd "sleep-on-the-couch" night. Most of the time its all good. I was double lucky, I was taught to dive my a husband & wife team. They were BOTH ex-Army. Best therapy I ever did was to take to the sea. When eather of my lads come back off a tour we head off for a weeks diving. I watch them slowly unwind, they're smiles become less strained & we laugh, A LOT!!! Because of this we all do a bit of fund raising for Deptherapy | a revolutionary approach to rehabilitation through Scuba Diving. who use scuba to rehabilitate ex forces guys. They do a lot in the Florida Keys. Last trip they had half USMC guys & half British Royal Marines. By all accounts it was a blast. Best gag of the trip goes for sure to one the US Jarheads (who saddly had lost both his legs) on seeing on one of the Britsh Bootnecks had lost a foot was herd to say "Buddy, thats just a ****ing papercut!!" LOL!

 

[Mothball]

I see that I am in VERY good company Thank you for your service and your help with this... Here's my situation...

I started diving about 10 years ago. Basically, it became a passion. Like some have mentioned here, I liked the challenge, focus, attention-to-detail, and most of all, the serenity, peace and soothing of the soul. By all accounts, I was (and probably am still considered) to be a very conservative, competent, over-trained, over-prepared, safe diver.

About five years ago, I decided that I really needed talk to someone, so I went to the VA. They immediately diagnosed me with an obvious/severe case of PTSD, as per the DSM IV (posted above). They immediately started me on a regiment of meds to get me to sleep and to slow me down a good bit. I didn't "sleep" well for over 15 years, and as some may have experienced, "my hair was always on fire". It seemed that if I "slowed down under 200 mph", I wasn't even aware that I was still alive.

When I began the regiment of meds, I immediately contacted a DAN physician to see what the dive risks had changed for me. Doc, said that I was taking some meds that affected my CNS, and that the possibility of getting narced in water as shallow as 20'-30'. Even though, there is much to see at those depths, I decided that I wouldn't put my dive buddy(ies) at risk, so I hung up my regulator. I miss it, but at the time, that was the only info available - safety first...

Since then, I have actually slept, and gotten some very much needed rest which has helped in many areas of my life. I can't go into a Wal-Mart without being fully drugged, but I can walk around Home Depot/Lowe's without any problems. I will admit that I usually go out at off-hours, but being in places such as open buildings, parking lots and moderate crowds are almost non-problematic compared to where I started.

The biggest item that has changed lately, is that I had the opportunity to take my niece (through marriage) to Disney World this past fall. At first I was a bit concerned because usual stuff - open space, lots of people, a 15 year old girl that I had seen 3-4 times before... I just wasn't to sure about the idea. When my wife said that they would drive there by themselves, I felt obligated. Long story short, my wife was miserable the whole time, and my niece and I had the time of our lives. After we returned, my wife (who is still fuming about the trip to this day), mentioned how well I did out there. I took my meds as usual, but I didn't feel like I needed them, even if I was late with a dosage - and, I did forget to take them on two occasions. While out there, my niece mentioned that she was interested following in some of my footsteps including SCUBA diving, riding motorcycles, skydiving, private pilots license and such disciplines. I don't want to get all mushy, but I'd like to pass on some knowledge and skills to someone that is fun and I don't mind being around.

Anyway, in my mind, the meds are still of great concern to me. No one needs to see me get narced or take on oxygen hit. So, again, any research data, personal experiences, etc. would be greatly appreciated. Being in good company, and the seriousness of the subject I'll list my meds in case others may not want to share...

Lexapro 20mg (Anti-Depressant) M N
Lamotragine 100mg (Mood Stablizer) M N
Alprazolam 2-3mg as needed (Anxiety, usually 2 at bedtime - it keeps the racing thoughts to a minmum)
Lisinopril 2.5mg M (Blood Pressure, it's been less than 125/85 for about 6 months now)
Tizanidine up to 4mg N (for sleep - no jumping jacks or push ups during the night)
Trazidone 100mg N (for sleep - it knocks me out)

I see that there are some veteran dive programs where vets with TBI and PTSD are being put in the water. I shot a couple of emails out to the orginazations inquiring about any of their findings with the med usage, dosages, depth limits or any other notable items.

Well, I think I've spilled all of my beans. I hope my situation will help others and hopefully I can get a bit more light shed on the situation.

Many thanks,

Dave

 

[Mothball]

Short update:

I shot an email to DAN, and they say that they don't have any research results for diving and PTSD meds. They said that they have shot out some emails to these vet organizations and will try to get some info from them.

I also found some more organizations that deal with vets with disabilities and shot them some emails. Hopefully I'll get some responses soon. I also hope they are positive answers, because my wife has been hounding me about us getting back into the water since I stopped diving in '07. She's been getting very excited about me looking into getting started again. I hope she doesn't get disappointed...

I'll pass on anything else I find out...

Dave

 

[DocVikingo]

Lexapro 20mg (Anti-Depressant) M N
Lamotragine 100mg (Mood Stablizer) M N
Alprazolam 2-3mg as needed (Anxiety, usually 2 at bedtime - it keeps the racing thoughts to a minmum)
Lisinopril 2.5mg M (Blood Pressure, it's been less than 125/85 for about 6 months now)
Tizanidine up to 4mg N (for sleep - no jumping jacks or push ups during the night)
Trazidone 100mg N (for sleep - it knocks me out) (sic)

To the best of my knowledge, there is no published research on these medications as they relate to diving; there simply isn't funding for such studies.

Nevertheless, these drugs can have side effects of concern to the diver. These include:

- Lexapro (20mg), AM & PM. This drug typically is well-tolerated at lower doses (e.g., 10mg), but at 20mg it can cause dizziness, drowsiness/tiredness, dry mouth, headache light-headedness (especially upon standing or sitting up), and nausea/stomach upset/diarrhea, and stuffy or runny nose.

- Lamotrigine (100mg), AM & PM. This is a modest dose. Dizziness, drowsiness/tiredness, headache, nausea, coordination problems, visual disturbances, and stuffy or runny nose.

- Alprazolam (2-3mg), as needed. This is an average dose for PTSD given that "as needed" doesn't exceed twice a day at equally spaced intervals. Diarrhea/nausea, dizziness, drowsiness/tiredness, dry mouth, and light-headedness (especially upon standing or sitting up), and stuffy nose

- Tizanidine (up to 4mg), PM. This is about an average dose for insomnia. Dizziness; drowsiness/tiredness, dry mouth, and muscle weakness.

- Trazodone (100mg), PM. This is about an average dose for insomnia. Diarrhea, dizziness, drowsiness/tiredness dry mouth, headache, lightheadedness (especially when sitting up or standing); muscle aches/pains, nausea/stomach discomfort, blurred vision, and stuffy nose. Even though taken for sleep, side effects may last into the day.

This is a substantial regimen and interactions among these medications would be expected. Specifically, the side effects profiles of these drugs may be additive/potentiate one another. They also may be additive/potentiate the effects of nitrogen narcosis.

It is quite important that such a regimen be given at fully adequate trial topside to observe for worrisome side effects and that if medical clearance to dive is received that SCUBA profiles been appropriately conservative.

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.

 

[Mothball]

Thanks DocV!

I'm getting two consensus' developing. One is the medical side, which states the above, and I tend to take heed. The other consensus is the (for lack of better term) the "ginnie pig" approach, which, according to several disabled vets/dive organizations, all say, "we're putting guys in the water all the time, and there have been absolutely no problems encountered as far as medicines are concerned".

Sooo... I guess I might try to slither into the water slowly. Maybe some pool work might be in order, and if all goes well, maybe a 15' dive at a quarry.

I know everyone is different, but, what depth limits are you folks diving. Are you using standardized limits? If not, how severely are you modifying them in general?

Thanks,

Dave

 

[DocVikingo]

Hi Dave,

I have no doubt that there are folks with PTSD and on similar drug regimens who are diving successfully. You should not be told in no uncertain terms that you can't dive.

You need to gather credible information, talk to knowledgeable individuals, and be aware of the risks and weigh them with care.

As implied in my initial post, an individual diagnosed with and being actively medicated for PTSD would be a candidate for return to SCUBA given 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) s/he feels he is up to it and fully comprehends any additional risks; (e) s/he has been cleared for diving by an appropriate physician; (f) and s/he makes full disclosure to the dive op (which likely will want to see written clearance) and to his/her dive buddy.

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.

 

[Duke Dive Medicine]

I might be careful with benzodiazepines as they can act synergystically with nitrogen and increase narcosis at depth. Alprazolam's half-life is 11 hours, so even if it's taken in the evening it could become problematic on a dive the next morning.

 

[Mothball]

Hey Docs!

I am definately taking what you're telling me to heart. I saw my primary physician at the VA this morning. I presented him with a "cleared to dive" form and your above assessments of each of my medications. He did not shrug me off with the usual "go ahead and dive" attitude this time. I guess since he had to sign his name to my life, he took a bit more heed when I explained the information to him. I told him about DAN and their, understandable conservative advise, and that some vets in simular situations to mine are being put into the water with seemingly positive, successful results. He's going to research it more and get back to me.

I will see my psychiatrist in two weeks and will present him with same information along with the mediacal release form, and see what he thinks. I'll update both docs with your additional comments for their cosideration.

DDM, I'd be interested in getting more information on each of my medications as you have educated me with the alprazolam above. My wife has been telling "just stop taking your meds for a day or two before the dive day". My counter-comment has always been, "just because I'm crazy doesn't mean that I'm stupid" - she knows I'm almost too safe, but she hounds me about it anyway. I am interested in learning how these other meds "act" also. Again, thanks for any other information and advise you can provide. I really do want to make a well educated decision.

I'm going to get all my gear serviced, if for any reason, just to sell it and be done with it. Of course, if I can only make 20' max depth dives, I'd be grateful. 20' dives in Bonaire are wonderful. We'll see though...

Thanks again,

Dave

 

[Duke Dive Medicine]

DDM, I'd be interested in getting more information on each of my medications as you have educated me with the alprazolam above. My wife has been telling "just stop taking your meds for a day or two before the dive day". My counter-comment has always been, "just because I'm crazy doesn't mean that I'm stupid" - she knows I'm almost too safe, but she hounds me about it anyway. I am interested in learning how these other meds "act" also. Again, thanks for any other information and advise you can provide. I really do want to make a well educated decision.

Dave,

DocV has pretty well summarized the common side effects of the psychoactive meds and given some excellent advice about what to look for before diving. One problem, as Doc pointed out, is that there isn't a whole lot of data out there about how pressure and oxygen interact with medications.

In general, anything that affects your judgement or mentation should not be taken before diving. Also, any medication that increases cerebral blood flow can increase the risk of O2 toxicity. Celexa (citalopram), which is in the same class of medications as Lexapro, can have varying effects on cerebral blood flow: Response-dependent differences in regional cerebr... [J Nucl Med. 2006] - PubMed - NCBI (couldn't find anything on Lexapro). @ DocV, do you have anything more specific on the effects of any of his meds on CBF?

With apologies to your wife, who I'm sure has your welfare at heart, I'm on your side as far as stopping medications. Do NOT discontinue any medications without consulting with the physician who prescribed them, especially not an SSRI like Lexapro, which needs to be tapered down slowly. However, if you can avoid taking PRN (as-needed) sleep meds before diving, that's one less thing to worry about.

You may already be doing this, but I think it's worthwhile to look into non-pharmacological interventions as well. As some of the other posters have pointed out, diving can fit the bill. Also, numerous hospitals have mindfulness-based stress reduction (MBSR) programs which may also be of benefit.

Of course, nothing I've said here is a clearance to dive or should be taken as such. Your physicians are in the best position to judge that.

Best regards,
DDM

 

[Mothball]

Another Update:

After some long discussions with, and questioning by my primary physician, he is confident that I have a good chance of diving safely and successfully, and has cleared me to dive. His advise to me is much like, if not exactly, the advise given above. I'd like to thank everyone for your input, opinions, and experiences. I've started watching my PADI OW vids, rereading my basic OW books and reviewing the use of the RDP, Wheel and the new eRDP. I'll start praticing my 20 demonstaration skills in the pool as soon as all of my gear has been serviced. I have some shallow quarries I can practice in afterwards. Although my and wife and niece are jumping up-and-down, doing their "we're going diving" jigs, I'm cautiously optimistic, but excited. Any other advise or cautions are still welcome.

Thanks again,

Dave