There is little in the literature about diving and psychoactive medications of any kind. What we have to do is to extrapolate known dangers to divers in general with the effects and possible side effects of these drugs. We published several articles in 'Alert Diver', a publication of DAN, Divers Alert Network; Psychological Issues in Diving, DAN's 'Alert Diver', Sept-Dec, 2000) . This is reproduced in our web site at
http://www.scuba-doc.com/psych.htm .
For example; seizure activity is a major risk for divers as it invariably leads to drowning. This known due to diving accidents that have occurred with the seizures of oxygen toxicity. Therefore, seizure activity is a contraindication to diving and medications that have a risk of causing seizures are also dangerous in this regard. (Prozac is one of these drugs). This includes a low but constant 0.2% risk for all anti-depressives and also other medications, including the anti-malarial, Lariam and bupropion (Zyban, Wellbutrin).
http://www.scuba-doc.com/epildv.htm
In addition, patients are warned not to take Prozac while operating machinery or driving. We have to also be aware of the possible additive sedative effect of nitrogen at depth or 'nitrogen narcosis', a real threat for divers who go below about 90 feet sea water. We have no literature on this subject. Only just recently do we have a RCT (random controlled study) of the drug 'Dramamine', that indicates a significant decrease in cognition (awareness)in divers (dry dives in a chamber). It is probable that if good studies were done with all medications, that we would find many that alter the ability to function underwater.
Diving is a multi-task sport, requiring constant concentration and attention to minutae. Any alteration in sensorium is dangerous to the diver and to his 'buddy', to the divemaster and to all other divers on the dive excursion.
In summary, one needs to consider the following guidelines to use in considering the relationships between drugs and diving:
---Consider the condition/illness/disease for which the medication is being given. Depression is one of the conditions that some diving doctors feel constitutes a contra-indication to diving. However, as with most 'fitness to dive' considerations, clinical judgement needs to be used.
---Are there any effects of the drug that alter consciousness or cause alteration in decision making ability? Are combinations of drugs additive in their effects, particularly when taken at depth with the added effects of nitrogen? .
---Consider complex relationships between drugs, the individual, other medications, diet and the conditions for which the drugs are taken.
These guidelines are particularly important in deciding if a person can be certified to dive while taking several medications - the usual situation with psychiatric patients.
