Returning to diving after antidepressants?

[oranget]

My girlfriend and I got into diving less than 1 year ago. We logged 20 dives southeast Asia and became PADI Advanced Open Water certified.

About 7 months ago I experienced some ongoing neck pain. I saw a specialist that indicated it was most likely due to poor posture and anxiety/stress. I'm an expat at a fast paced high demand job and in front of the computer most of the day, so this seemed like a likely reason.

In addition to some basic instructions for exercises and stretching, he prescribed me 20 mg Deanxit (10mg in the morning and again at night), and 10 mg Amitriptyline at night. I was a bit surprised at the prescription of two antidepressants for neck pain, but I continued this medication 6 months and the pain mostly subsided. I've found that swimming and lifting weights do help, more so than the medication by itself.

I had booked and put down a deposit for a 6 day liveaboard trip for the end of September. I also signed up for a PADI Refresher course before the trip. About a week after putting down the deposit I noticed that the dive operator had a policy against antidepressants. There's also a lot of controversy on diving while on antidepressants. I brought this up with my doctor and tapered off the Deanxit over a period of 5 weeks. After 2 weeks I will be off the Amitriptyline as well. The doctor wants to see me after two weeks and see how I am before signing off the dive form for the refresher course, since I will still have meds in my system at this time. He also recommended only shallow diving.

I called DAN and they don't have a recommended minimum waiting time after stopping antidreppressants, but the medication should be completely out of my system after 2 weeks time.

I plan to see a dive doctor before the trip. I thought it may be prudent to stick with the Open Water group during the liveaboard for the first few days to see how I feel. However if I wanted to be 100% safe I should stick to snorkeling.

What would you do if you were in my shoes? Appreciate your feedback.

 

[Kilili]

I can only add my own personal experience regarding such. Now retired, I had a similar type of job. I started diving 20 years ago and began taking anti-depressants about 23 years ago. Without them, I would have never started diving in the first place, as I was absolutely terrified of being in the water. I take three different ones, and have done so for every one of my dives.

When I started diving, I worried about what others might think of my situation, but never kept it a secret, and quit caring about such long ago. I see no problems here, don't know why your doctor even expresses concerns.

In my opinion, use your own best judgement, and don't worry about the matter. I know others may think differently, but personally would not let such dictate my own actions. Besides, your root issue isn't depression anyway, and would probably be astounded if you knew how many people take meds such as this.

 

[AfterDark]

I've always taken the stand that nobody knows better how I feel than me. Unless the doctor gave me hard evidence (not some study) that the meds could harm me while diving, I'd do what I felt good doing and NOT TELL ANYONE CONNECTED with a course or a charter about any of my PRIVATE medical issues. I answer NO to all questions on the medical release form unless yes is the answer they're looking for to a question. That's me.
Do you drive a car? Is that safe with these meds? Why not diving?

 

[terrylowe]

I see no problems here, don't know why your doctor even expresses concerns.

I agree with this. If you are doing well off of the medications, then you should be good to go.

If you have a severe anxiety problem, however, an underwater panic attack could be bad. IF this is an issue, then if I were your dive buddy, I'd rather you be ON meds.

Being on antidepressants is not an absolute contraindication to diving.

---------- Post Merged at 09:19 AM ---------- Previous Post was at 09:07 AM ----------

I've always taken the stand that nobody knows better how I feel than me. Unless the doctor gave me hard evidence (not some study) that the meds could harm me while diving, I'd do what I felt good doing and NOT TELL ANYONE CONNECTED with a course or a charter about any of my PRIVATE medical issues. I answer NO to all questions on the medical release form unless yes is the answer they're looking for to a question. That's me.
Do you drive a car? Is that safe with these meds? Why not diving?

I can see your point of view. Your medical conditions are yours and no one else's....

However.......
I have had people ask me to clear them for diving with issues such as a previous big stroke, active seizure disorder, etc. There are some illnesses that put you at increased risk when you dive although your body is telling you that "everything is OK". It is really really hard for a doctor to give you "hard evidence". Decisions are made more based on statistics, logic, and what has happened to other people in similar circumstances than with hard evidence.

I know it is your body, your life and you can decide how to live and how to die, etc. However, some divers need to think about the effects (financial, emotional, psychological, even physical if there is a heroic attempt at rescue) on the dive operator and the impact of years of litigation the dead diver's family will bring against the dive op.

There is a big difference between driving at 1 atmosphere and diving at 2 atmospheres of pressure.

 

[AfterDark]

I agree with this. If you are doing well off of the medications, then you should be good to go.

If you have a severe anxiety problem, however, an underwater panic attack could be bad. IF this is an issue, then if I were your dive buddy, I'd rather you be ON meds.

Being on antidepressants is not an absolute contraindication to diving.

---------- Post Merged at 09:19 AM ---------- Previous Post was at 09:07 AM ----------



I can see your point of view. Your medical conditions are yours and no one else's....

However.......
I have had people ask me to clear them for diving with issues such as a previous big stroke, active seizure disorder, etc. There are some illnesses that put you at increased risk when you dive although your body is telling you that "everything is OK". It is really really hard for a doctor to give you "hard evidence". Decisions are made more based on statistics, logic, and what has happened to other people in similar circumstances than with hard evidence.

I know it is your body, your life and you can decide how to live and how to die, etc. However, some divers need to think about the effects (financial, emotional, psychological, even physical if there is a heroic attempt at rescue) on the dive operator and the impact of years of litigation the dead diver's family will bring against the dive op.

There is a big difference between driving at 1 atmosphere and diving at 2 atmospheres of pressure.

Agree completely. Heart attacks, big strokes, active seizure disorders are a far cry from a couple of anti-depressants. If those or like conditions were present I'd probably stop diving on my own.

 

[TSandM]

Given that your original prescriptions were for control of chronic pain, and that you will have been off the medications altogether for at least two weeks, I think that as long as your pain problems don't interfere with diving, you should be fine.

My only concern would be that I found a mention that long-term use of one of the components of Deanxit may cause seizures in some patients. "Long-term" use was not defined, nor was the frequency of this side effect cited. I'd be careful about Nitrox, if you are using it, and not push MODs at all.

 

[mattoau]

I've just signed off an OW diver who was taking antidepressants. She'd had a full dive medical and been given clearance, so my advice would be to speak to a doctor in the know.

 

[drbill]

Certain;y speak with a doctor knowledgeable about diving before making a decision. With that said, I've been on antidepressants for decades and dive constantly (80 dives last month alone) with no apparent problems. However, different drugs have different effects and different people have different physiologies so I can't really extrapolate from my own experience.

 

[TSandM]

It really isn't possible to make a blanket recommendation about antidepressants. For example, some are well-known to lower the seizure threshold, which would be an issue for Nitrox divers. And the severity of the condition being treated with the medication has to be considered, as well; mild to moderate depression, well-controlled, wouldn't be a contraindication, but some antidepressants (eg. Paxil) are used for panic disorder, and people with that condition may not be good candidates for diving at all. In the OP's case, the meds were for chronic pain, so the condition causing the pain has to be evaluated. Per his description, it's well under control off the medications.

In general, with the exception of a very few specialized meds (like chemotherapeutic agents), once medications have been cleared from the body, past use of them should not affect diving. It is important to know the kinetics of the medication, though, to know how long it takes to clear it completely. Some drugs have quite long half-lives.

 

[oranget]

First I'd like to sincerely thank everyone for taking the time to share their input. It's not every place that you can get people to share their time to give advice to a random stranger. It's also hard to summarize you're life into a message board post so I hope I gave enough information. For whatever reason I became adamant against diving on antidepressants. There was enough information online to make me think of it as an unnecessary risk. I appreciate the reassurance that I'm taking appropriate and conservative steps forward.

By the time of diving I will have been off Deanxit for 4 weeks and Amitriptyline for 2 weeks. My dosage was also at the low end. From what I've read as a layman, the high-end half-life of these drugs is around 50 hours. At 5.5 half-lifes (11.5 days) they should be mostly if not completely gone from my system.

My doctor did advise caution to watch my anxiety levels over the 2 weeks after stopping Deanxit. I believe that was his reasoning for waiting for a follow up visit to sign off on the health form. If it was my medical practice I would probably have done the same thing.

The first day off Deanxit I felt a bit dehydrated, so I've consciously made the decision to give up caffeine during this period and up my water intake. I'm also eliminating all alcohol, but I was down to around one drink a week or less while on medication anyway.

I have noticed a slight increase in tightness of my neck. It's a good thing massages are cheap in southeast Asia. I have also been lifting once a week and getting at least 30 minutes of cardio a night between running and swimming. That has been enough to relieve any tension. Hopefully I will be able to continue this approach to pain management. It may just be my imagination but I also feel much more focused and alert as of late.

The PADI refresher course is scheduled, and I've notified the dive operator that I want to dive with the Open Water group, at least at first, to literally get my feet wet again. I will not be using Nitrox. The trip is now completely booked so I can sit back and relax

---------- Post Merged on September 4th, 2012 at 12:09 AM ---------- Previous Post was on September 3rd, 2012 at 11:59 PM ----------

The PADI refresher course is scheduled, and I've notified the dive operator that I want to dive with the Open Water group, at least at first, to literally get my feet wet again. I will not be using Nitrox. The trip is now completely booked so I can sit back and relax

Oops, jumped the gun on this one. Last thing on the list is dive insurance. I plan on buying the "Master" plan for Asia-Pacific.

Dumb question. I assume this qualifies as a "Pre-existing Medical Condition." What exactly do I declare?