Adderall and diving

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What a pity that this thread is descending to continue the common illusion that ADD and ADHA is a mental illness and that such patients are “defective”, retarded and incapable of a complete and “normal” life. This thread could have included meaningful information and helped to break the ridiculous ideas held by society in general about such conditions.

Why couldn’t the OP have been advised to have her friend call DAN to find a local physician who is qualified to asses her condition, help her understand the risks, teach her to manage her medications and conditions and develop a clear plan that might well include diving if her specific case warranted it?

For the good doctor: the possible side effects you list are clearly printed on the package inserts. As you well know, many of those side effects happen with such low frequency during trials as to be questionable or are hedges against what might happen. Insulin, not a psychotropic by any standard, can cause “…tingling in the fingers, tremors, muscle weakness, blurred vision, cold temperature, excessive yawning, irritability, and loss of consciousness…” (MedNet.com). Aspirin can cause vertigo, ringing in the ears (tinnitus), and lightheadedness. The terrifying list of potentially dangerous maladies goes on and on.

While I applaud your many efforts to share your passion and knowledge of medicine and diving with us on this forum and have thoroughly enjoyed your many posts and contributions, I am sorely disappointed in your reply in this case.

The stereotyping and mass-hysteria surrounding ADD and ADHD diagnosis needs to end. Four years ago, my wife and I were told that our youngest son would not be capable of graduating from high school and we should think about a certificate program. Last Friday evening, he threw his cap in the air with all of his classmates as a member of the graduating class of 2008. He also received the “2008 Change for the Better Award”. One of his teachers wrote that he had never seen such a huge change in any student in his 35 years of teaching.

In my opinion, diving has helped him learn self-sufficiency, planning and control.

To the OP: the variables surrounding a diagnosis of ADD and the medications used to treat the condition are such that providing much information over the internet is virtually impossible. I would advise you to counsel your friend to call DAN to request referral to a local physician qualified to assist her Psychiatrist in making a proper evaluation of her ability to dive. That evaluation may mean that, in her case, diving is contraindicated. It may also mean that as long as the condition is responding well to the treatment and that the management of her ADD and her medication has been successful for a period of time, diving, within certain limitations, may well be possible. Zen’s son, my son and I are examples of the later possibility.
 
For the good doctor: the possible side effects you list are clearly printed on the package inserts. As you well know, many of those side effects happen with such low frequency during trials as to be questionable or are hedges against what might happen. Insulin, not a psychotropic by any standard, can cause “…tingling in the fingers, tremors, muscle weakness, blurred vision, cold temperature, excessive yawning, irritability, and loss of consciousness…” (MedNet.com). Aspirin can cause vertigo, ringing in the ears (tinnitus), and lightheadedness. The terrifying list of potentially dangerous maladies goes on and on.

Hi ianw2,

Informative. However, the truth remains that stimulant drugs like Adderall in fact are designed to act on the central nervous system, specifically on the brain, and are specifically designed to affect behavior. And they unquestionably are psychoactive and psychotropic by any reasonable standards:

1. From Shire Pharmaceuticals, the manufacturer of Adderall:

"Amphetamine and dextroamphetamine is a central nervous system stimulant. It affects chemicals in the brain and nerves that contribute to hyperactivity and impulse control."

2. From Wikipedia:

"A psychoactive drug or psychotropic substance is a chemical substance that acts primarily upon the central nervous system where it alters brain function, resulting in temporary changes in perception, mood, consciousness or behaviour."

3. From Substance Abuse and Mental Health Services Administration (SAMHSA):

"Psychotropic drugs have different uses and are broken into four major groups: hallucinogens, antipsychotics, depressants and stimulants."

4. From MedicineNet.com:

Psychotropic drug: Any drug capable of affecting the mind, emotions, and behavior.

As regards
While I applaud your many efforts to share your passion and knowledge of medicine and diving with us on this forum and have thoroughly enjoyed your many posts and contributions, I am sorely disappointed in your reply in this case.
, my replies thus far were simply to quote an earlier posting by a world-recognized diving medicine expert, Dr. Ern Campbell, and to clarify ZenDiver.3D's blatant misstatements. It's too bad that these actions seem to have disappointed you so.

Regards,

DocVikingo
 
Hey guys.... the information that you have given (on both sides) has been very informative, and I absolutely will have her work with her physician prior to diving.

However, my intent was not to get into the details of the drug or the DX of ADHD.

I KNOW that there are people out there that are on Adderrall that dive(right, wrong or indiffernt). I was specifically looking for people that have experience either currently or in the past, with diving while on the drug, and did they have any personal adverse effects.

I also know that each person metabolizes drugs differently. Even if 100 people responded that they had been diving while on the drug and had had no adverse effects, that I would still need to monitor my friend since she is unique (just like everyone else). :D

Thanks again for all your input.
 
Hi The Surly Mermaid,

I fully appreciate that your intent was not to get into a punch up over the proper terminology for referring to Adderall's pharmaceutical classification, nor about the diagnostic issues involved in ADHD-spectrum disorders.

The amount of highly questionable advice and even outright misinformation that appears on the Diving Medicine forum is of considerable concern. For example, it is alarmingly common for recommendations for specific treatments to precede the establishment of a reasoned working diagnosis, and for terms to be misused. It seems that because some posters had a SCUBA diving great aunt with diabetes they fancy themselves experts on the topic, or once had a headache hours after SCUBA and now consider themselves knowledgeable in diving headaches.

In any event, I'm sure you understand that the Diving Medicine forum addresses issues of great importance to the health and medical well-being of divers. Because the forum is of such a nature, those of us (e.g., BillP, TSandM, myself) who are qualified and knowledgeable professionals occasionally have to spend much time correcting misinformation. Unhappily, this often destroys the continuity of a thread. Sadly, your inquiry get snared in this all too frequent, ongoing problem.

Getting back to the topic at hand, some time ago I wrote an article for DAN's Alert Diver magazine on diving with mood disorder. Although ADHD is a separate psychiatric entity, I believe the conclusions of that piece are applicable to your inquiry as well. Here they are in a slightly edited form appropriate to ADHD:

Where does this leave the recreational diver with ADHD and those advising him or her about safe scuba?

There appear to be 3 basic approaches to this question:

1. Assume that ADHD and the drugs used to ameliorate it do not pose a danger to scuba great enough to advise against diving:

This position is not defensible simply given what we know about the potential topside dangers of both ADHD and the stimulant drugs used to treat it. Because of a dearth of research and necessary reliance on theory, a number of dive medicine experts have expressed serious reservations about the wisdom of diving while suffering from ADHD, especially while medicated. The popularity of modern stimulant drugs and their wide prescription by physicians not expert in their use suggests a somewhat cavalier attitude about these medications. Such an attitude can have grave result when it comes to pursuits like scuba.

2. Assume that ADHD and the drugs used to ameliorate it pose a danger to scuba great enough to advise not diving until the condition has entirely lifted and medication discontinued:

Qualified medical professionals rendering their best judgment in the absence of supportive science should not be too readily faulted for possibly erring on the side of caution. Liability issues no doubt contribute to this stance, but at the least it does seem prudent and ethical medicine, whose overarching dictum is, "First, do no harm." While it can be argued that this position is unduly conservative, it is not entirely without a defense.

3. Assume that ADHD and the drugs used to ameliorate it do not preclude diving provided that:

(a) mental status examination and longitudinal observation of behavior demonstrate the condition to be well controlled; (b) the diver on medication has been on for an extended period and side effects worrisome 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 suspect that most divers will find this last perspective the most appealing, and it is the one I’d want applied to myself if affected. It also seems to be gaining increasing credence within the dive medicine community.

In all such deliberations, it is important that the diver be entirely honest with treating sources, training agencies, dive ops, dive buddies and himself.

The jury is still out on diving with ADHD or on stimulant medication. For the foreseeable future, decisions on the recreational diver with ADHD will remain individual determinations meager of science and rich of professional judgment.

Helpful?

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice.
 
I wonder what kind of information a research study involving an ADD/ADHD evaluation of adult certified divers with no previous ADD or ADHD test or diagnosis would reveal about the topic. There are plenty of divers out there who grew up before this condition was given a name.
Ber :lilbunny:
 
I wonder what kind of information a research study involving an ADD/ADHD evaluation of adult certified divers with no previous ADD or ADHD test or diagnosis would reveal about the topic. There are plenty of divers out there who grew up before this condition was given a name.
Ber :lilbunny:

I know. I am one of them. :rofl3: They just used to call us scatterbrained, and there was no medication, other than failure, to correct the problem. I've had to re-train my brain as I've gotten older to be safe and successful. Especially when diving.
 
From a purely scientific point of view, it is unfortunate that there is a dearth of research. (The ethics behind a true double-blind type research project to answer the question at hand are even more unfortunate). Therefore, any such study can, at best, be a collection of anecdotes.

There is a sort of wisdom on the good Doc’s part in erring on the side of caution as a general rule. While I understand that this position is born of the rubric of the Hippocratic Oath and “…do(ing) no harm…”, it gives little comfort.

It is certain that ADD and ADHD became the diagnosis of choice when confronted by an unruly child. It is also unfortunate that the drugs prescribed for the condition are rather synonymous with street drugs that have had devastating effects. The hysteria has been even further amplified by our society’s view of any condition that stems from brain chemistry.

ADD and ADHD are not on the spectrum of mental retardation. In a recent article, many of the founders and CEOs of major corporations and respected research scientists could be diagnosed with ADD. As Ber Rabbit noted, the diagnosis was not available when we were children.

It would in deed be interesting to see some anecdotal study of divers and potential ADD and ADHD diagnoses. However, it would not shed much light on the potential effects of the drugs of choice for treating the conditions.

I would have liked to see responses of this sort:

ADD and ADHD are not diagnosis that, in and of themselves, are contraindications to diving. The conditions stem from a difference in brain chemistry between those properly diagnosed with ADD and those who are properly diagnosed as not having the condition. The conditions do not indicate lessened mental capacities of any sort. The difference is in the way outside stimuli are processed by the brain. Those who have been diagnosed with the condition and have learned non-medicating coping mechanisms would likely be quite safe participating in recreational diving.

The problem with blanket statements of the safety of the various drugs used to treat ADD is that their effects at depth are not understood and there are no definitive studies providing answers. The conservative thought would be that the current theories as to the mechanisms of action of drugs such as Adderall, Ritalin, Concerta and other methylphenidates and analogues is that hyperbaric pressures may well change the behavior of these drugs.

However, the level of ADD and ADHD, the individuals experience in self-monitoring their condition and the drug therapy being used are all variables too great to make any definitive statements regarding contraindications to diving.

This is one condition in which the individual and their psychiatrist should be frank with each other and determine the possible dangers on a case by case basis.


And, Ber, I’d bet dollars to donuts that a good slice of the diving population probably have ADD and ADHD. The activity defines itself as being one for individualists and adventurers.

My drug of choice in treating my ADD is caffeine. I used to use nicotine heavily, too. Anyone remember the old Jacques Cousteau specials? Remember how much coffee and how many cigarettes he went through on the shows?

Does anyone have any references to the effects of caffeine at depths?
 
3. Assume that ADHD and the drugs used to ameliorate it do not preclude diving provided that:

(a) mental status examination and longitudinal observation of behavior demonstrate the condition to be well controlled; (b) the diver on medication has been on for an extended period and side effects worrisome 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 suspect that most divers will find this last perspective the most appealing, and it is the one I’d want applied to myself if affected. It also seems to be gaining increasing credence within the dive medicine community."

Hi Ian,

My last post to The Surly Mermaid covers the three decisional options as I see them and are there for each individual's consideration.

Based on a careful reading of the above quoted material, it was my intention to, and my impression that I in fact did, endorse the most reasoned choice, #3. Option #2 is the one that may err "on the side of caution."

BTW, thank you for you endeavors to keep this a civil and thoughtful thread.

Regards,

DocVikingo
 
Hey, Doc!

I did pick up on your "endorsement". Obviously, that is the "optinion" I choose as well.

Thanks for your efforts and your knowledge in this and other threads!

Ah well... I need to get another cup of coffee and get back to work.:D

Ian
 
I have been on Adderall XR (20mg twice a day)for a few years. I'm a new diver so I only have a few dives under my belt but I have had no problems diving while on Adderall. A long time ago, before I was treating my ADD with medication, I tried to get certified in SCUBA and I struggled with every task and failed the written test. I was so discouraged that it took me 15 years to try the course again. I'm so glad I did though. The difference was like night and day. I had the same concerns when I started skydiving too but no problems there either.
 
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