PTSD & Diving ?

[DocVikingo]

@ DocV, do you have anything more specific on the effects of any of his meds on CBF?DDM

Hey DDM,

I believe the research you cited reported that depressed subjects who improved in response to a trial of citalopram (e.g., Celexa) had a higher regional cerebral blood flow (rCBF) in the posterior cingulate area prior to treatment than did those who did not respond. However, after 4 weeks on the drug those who improved actually showed a decrease in rCBF in that cortical region. Do I have this correct?

If so, the finding is consistent with other research demonstrating that those who improved with the antidepressants nortriptyline (e.g., Pamelor, Aventyl) or sertraline (e.g., Zoloft) showed reduced (rCBF) in frontal regions following a month or two of treatment.

As you note, Celexa, like Lexapro (the "next generation" Celexa) and Zoloft, is a selective serotonin reuptake inhibitor (SSRI).

Regards,

Doc

 

[DocVikingo]

My wife has been telling "just stop taking your meds for a day or two before the dive day".

That would be unwise as it could result in the return of previously controlled signs and symptoms that pose risks for SCUBA.

Moreover, medications like Lexapro and Lamotrigine are not meant to be taken inconsistently or on as as needed basis, or discontinued without medical direction.

Regards,

DocVikingo

 

[jar546]

Mothball, Semper Fi Bro,

I too was diagnosed about 4 years ago. Unlike yourself, I am not currently on any medication and truly think that it was getting back into scuba diving that became my therapy. I wish you good luck with the management of your disease and hope you have a long and pleasant, happy life of enjoying scuba. My choice of therapy.

 

[Duke Dive Medicine]

Hey DDM,

I believe the research you cited reported that depressed subjects who improved in response to a trial of citalopram (e.g., Celexa) had a higher regional cerebral blood flow (rCBF) in the posterior cingulate area prior to treatment than did those who did not respond. However, after 4 weeks on the drug those who improved actually showed a decrease in rCBF in that cortical region. Do I have this correct?

If so, the finding is consistent with other research demonstrating that those who improved with the antidepressants nortriptyline (e.g., Pamelor, Aventyl) or sertraline (e.g., Zoloft) showed reduced (rCBF) in frontal regions following a month or two of treatment.

As you note, Celexa, like Lexapro (the "next generation" Celexa) and Zoloft, is a selective serotonin reuptake inhibitor (SSRI).

Regards,

Doc

Hi Doc,

I was looking at the changes in rCBF in non-responders:

"After 4 wk of antidepressant monotherapy with citalopram, responders showed only decreases in rCBF in the posterior cingulate (BA 23) and the inferior frontal cortex (BA 47), whereas nonresponders showed only increases in rCBF in the left posterior cingulate (BA 29) and the left putamen (nucleus lentiformis/BA 13). Comparison of the course of change over time revealed significantly different changes in rCBF in the posterior cingulate BA 29 and BA 31, the left inferior frontal gyrus (BA 47), and the left insula region (BA 13/putamen), with a decrease in the responder group and an increase in the nonresponder group, respectively, in these regions."

The way I read it, it looks like the non-responders showed increases in rCBF after using the medication, and responders showed decreases. I guess an individual's care team would not keep him/her on a medication that he/she wasn't responding to, but might there be a theoretical risk (emphasis on the theoretical) in a non-responder?

Best,
DDM

 

[DocVikingo]

Hi Doc,

I was looking at the changes in rCBF in non-responders: The way I read it, it looks like the non-responders showed increases in rCBF after using the medication, and responders showed decreases. I guess an individual's care team would not keep him/her on a medication that he/she wasn't responding to, but might there be a theoretical risk (emphasis on the theoretical) in a non-responder? Best,DDM

I was thinking: (1) the inquirer is a responder; (2) non-responders likely wouldn't be continued on the drug; (3) and non-responders would be less likely than responders to be medically cleared for diving.

Regards,

Doc

 

[Duke Dive Medicine]

I was thinking: (1) the inquirer is a responder; (2) non-responders likely wouldn't be continued on the drug; (3) and non-responders would be less likely than responders to be medically cleared for diving.

Regards,

Doc

Doc,

All good points. You pretty much addressed this in your original answer to him, i.e. he should be stable on and responding positively to his medications (to paraphrase). My speculations were just that, and not meant to apply specifically to him. Thanks for the insights!

Best,
DDM

 

[Mothball]

Hey Docs, just to clarify, I have had very positive responses to all my meds and been "on an even keel" for over 3 years. I should have pointed that out before. I know you are talking about this generally now, but I figured future readers might find it more insightful. Anyway, I still check in every few days to see if anything new arises.

Dave

 

[kenackr]

Sorry to be so late to the party, but I just joined up today.

DAN has done a recent article which can be seen here: Alert Diver | Scuba Rejuvenation While it doesn't talk a lot about PTSD, it mentions a preliminary study done by Johns Hopkins that looks at the therapeutic effects of diving for vets with spinal cord injuries who also had PTSD.

The JH study article can be found here: Scuba Diving Improves Function of Body, Mind in Vets with Spinal Cord Injury - 09/17/2011 It is very interesting to see that they saw an 80% reduction in PTSD symptoms for the study participants. The article did not say how long that reduction held up for.

At any rate, I too am a vet with a PTSD disability rating that started with me drowning and then pulled from the water unconscious & revived.

I too am a certified diver and can tell you that diving is a very positive thing for my PTSD symptoms. I know it's not the "cure", other work still needs to be done to help abate the PTSD symptoms.

I love diving because it can be thrilling & exciting at the same time it's relaxing because your focus is only in the moment - here & now.

Ken

 

[decompression]

Thanks fellas for this thread, I'm a vet with 7 tours and diagnosed 6 years ago. I'm on several meds and although there are highs and lows, I'm functioning. I work with many vets in rehab, both medically and vocationally in prep for release. I have a good friend and dive Doc that just finished a stint with DAN as well I'm working on a Canadian support group similar to SUDS. Any and all the info here is very usefull to all of us, I thank you.

 

[tracydr]

I'm also a veteran with PTSD. My only medication for my symptoms has been prazosin ( an alpha blocker usually used for benign prostatic hypertrophy) and topamax, although I've been weaned off the topamax. My main symptoms are hyperarousal around when falling asleep, nightmares and difficulty sleeping. A few other more minor symptoms. SSRI'S did nothing for me. The prazosin worked like a charm. Also, EMDR therapy worked fabulously to get through traumatic memories.
Welcome and I hope you're able to enjoy scuba as therapy! It's always been therapeutic to me, even before I had PTSD. When I was injured, I could hardly wait to get back in the water. I was snorkeling in the pool with a neck brace on while my neck fracture was still far from healed.