Yes, this is the information that we need in order to move ahead.
Depression such as you describe is more common, and more painful, than many realize. Happily, a substantial number of people with this disorder show good to excellent response to medications such as Seroxat/Paxil (paroxetine), a selective serotonin reuptake inhibitor (SSRI).
This class of drugs doesn't really "produce" serotonin, but rather allows the body to make the best use of the serotonin that it has at the time. In due course, it is hoped that the level of natural serotonin will rise again, and that the SSRI can be gradually withdrawn. However, as seems to be the situation with you, in a number of cases discontinuation is not possible without the return of signs & symptoms. When this occurs, the drug must be taken chronically. There is nothing wrong with this as long as it has been objectively demonstrated that continuance is necessary.
As regards depression & diving, I suggest that at your leisure you read the "Depression & Diving: Part II. Making the call on recreational diving" article in the Jul/Aug '03 issue of DAN's "Alert Diver" magazine. This piece can be found at
http://scuba-doc.com/alertdiver2.html As you will see, factors related to the disorder itself as well as to its treatment must be considered.
That article concludes by examining several models for making decisions on fitness to dive with depression. The approach that I suspect the majority of divers will find the most appealing, and the one Id want applied to me if ill, reads as follows:
"3. Assume that depression and the drugs used to ameliorate it do not preclude diving provided that: (a) mental status examination demonstrates the condition to be well controlled; (b) the diver on medication has been on for an extended period and side effects dangerous to scuba are neither reported nor observed upon careful examination; (c) there are no other contraindications in the clinical picture; and, (d) the diver feels he is up to it and fully comprehends the remaining risks."
I of course have no way of judging the accuracy or completeness of what you have reported thus far, e.g., "In normal life I don't have any side effects, I have a normal job, occasionally I drink a beer like anybody else does, I don't have complaints about seizures, I am not suicidal or depressed." However, let's look at each of the points in the above decisional model as they seem to apply to your case:
(a) Your condition is well controlled;
(b) You are taking Seroxat 20 mg/day, a standard dose for most healthy adults. You have been on it for many years and do not report any side effects;
(c) You make no mention of other contraindications in the clinical picture; and
(d) You feel up to diving, and have been doing so for a couple of years without problem.
We now arrive at what seems to be the crux of your inquiry-- fully comprehending the remaining risks.
Seroxat is generally well tolerated. The most common side effects of potential significance for scuba include fatigue, nausea, sleepiness, dizziness, shakiness & nervousness Luckily, you do not report any of these, either topside or while diving.
Rare adverse reactions of potential significance to scuba include seizures and precipitation of a manic event (e.g., groundless or excessive feelings of well-being and happiness, racing thoughts, poor judgment, recklessness, easy distractibility). Both of these conditions have been reported in from 0.1 to 0.4 % of people taking SSRI's like paroxetine, although they are much more likely at the upper end of the dosage range. You also report no history of these. However, should either of these occur during scuba, the dangers are obvious. Just as an aside, a number of people experience their first seizure upon entering cold water.
Finally, although it has neither been studied nor demonstrated, there is at least the theoretical possibility that the known nervous system effects of increased partial pressures of nitrogen and of oxygen could be additive with those of paroxetine.
Given the cited "Alert Diver" article & the above discussion of paroxetine, you should have a general understanding of some of the remaining risks. Of course, the level of risk one is willing to incur by diving with any medical or psychiatric disorder is a personal one to be made after consultation with one's doctor(s).
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.
Best regards.
DocVikingo
