Can I Take Antidepressants and Dive?

[wolfgirl]

Hello- I have just started my first open water diving class this week and I need some straight medical answers on whether it's okay to dive while on antidepressants. I do plan to talk to my doctor next week, but I'm afraid that I might be told it's not a good idea simply because they don't want any liability or they're being overly conservative.

I've been on Paxil (10mg/day) and Wellbutrin (150mg 2x/day) for about a year after an episode of depression. I haven't had an episode of depression in the past year, was not suicidal, and didn't have frequent occurences of major depression before that (i.e., I'm doing very well depression-wise and would not be considered "unstable" or anything). However, it is standard procedure for doctors to keep patients on these meds for at least a year after a depressive episode to be cautious, which is why I'm still on them. I actually rarely take the Paxil and usually only take 150mg/day of Wellbutrin-- partly because I forget to take the 2nd pill and partly because I've been fine for so long and hate to take medication when it's not needed.

I have researched this subject online and have found that there is very little information out there about the physiological effects of these medications combined with diving. Mostly, the articles I've found talk about how people who take these medications often have some serious underlying emotional problem that means they should not dive anyway, and, unfortunately they don't address the *physical* implications.

I know the frequency with which antidepressants are prescribed and taken in the US and I find it VERY hard to believe that there aren't many many divers out there who also take antidepressants. But, as you can imagine, it's not something people probably own up to very much.

I do not have side effects such as drowsiness, dizziness, light-headedness, or decreased mental capacity or judgement on these medications- I am fine driving and doing all other activities including many sports. I am otherwise healthy, athletic, a great swimmer, and 27 years old. I feel that I have very good judgement, I'm not a risk-taker in sports or other activities, and I am in very good shape physically and emotionally. What I really want to know is: are there any harmful *physical* effects that can come from diving while on these drugs.

If anyone can give me any information, or particularly if you or anyone you know dives and takes these medications and/or has already asked a physician about this subject, please respond. I have always wanted to dive, and I don't want this to be a problem.

Thanks a lot,
wolfgirl

 

[DocVikingo]

Hi wolfgirl,

IMHO, this discussion needs to begin with an honest evaluation of your current medication schedule. You indicate taking the Paxil only "rarely." While I do not know what this means in terms of actual frequency, I can tell you this drug was designed to be taken regularly. Almost certainly you will be better off not taking it at all than taking it "rarely." As regards the Wellbutrin, the 150 mg/day you report is at the far lower end, if not out of the therapeutic range for the majority of adults. Quite probably it is having little real effect on your mood.

Given this situation, plus your related perception that you are well & stable one year after your depressive episode, the prudent course would be to sit down with your doctor for a candid exploration of your present status. It is possible you two may agree to a trial off these meds altogether. If this period goes well, your doctor may decide you do not need to be on antidepressants as long as there is no return of signs & symptoms of affective disorder.

If you do this, and it is determined you should continue to take either or both of these medications as prescribed, I will be happy to discuss their implications for diving, including the "physical." Deal?

You are correct that there are many active divers out there on meds such as yours. Whether it is appropriate that you be among them is a matter for you & your doctor to decide.

I would add that if your doctor feels unable to make this call without more medical information, he may contact the DAN Medical Center at 919-684-2948 or our own scubadoc at scubadoc@scuba-doc.com for possible guidance.

Stay in touch.

DocVikingo

 

[Dr Deco]

Dear wolfgirl:

As one who has also taken antidepressant medications, I find that I am more pleased with the results obtained by physical exercise. This appears to release brain-derived neurotrophic factor the most abundant of the neurotrophins in the brain. A study from the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center, Durham, NC (Babyak et al.) found very positive results.

The advantage of physical exercise for divers is that it also builds the physical fitness requisite for the sport. One might want to check this out.
Dr Deco :doctor:

[sp]References

• Neustadt AA; Beard RC; Huang YM; Cotman CW Physical activity and antidepressant treatment potentiate the expression of specific brain-derived neurotrophic factor transcripts in the rat hippocampus. Neuroscience 2000;101(2):305-12
  
  Babyak M; Blumenthal JA; Herman S; Khatri P; Doraiswamy M; Moore K; Craighead WE; Baldewicz TT; Krishnan KR Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med 2000 Sep-Oct;62(5):633-8

 

[Mick]

While on this subject, I too have a question.
I have a perscription for those anti-smoking tablets (the name escapes me). I have not started taking them yet because there is no stock available for the next two weeks. From what I have heard, these are not a new drug as alot of people believe, but a widely used drug to treat depression.
My question is, how safe are these to take while diving? Should I not dive while taking them? Basically any informed comments on this drug would be appreciated.


Thanks

Mike

 

[wolfgirl]

Mike- One very popular anti-smoking medication, Zyban, is the same drug as Wellbutrin, which is also an antidepressant. The generic name of Wellbutrin & Zyban is bupropion hydrochloride. So if anyone gives me specific information about Wellbutrin, I would think it safe to assume you can use that information too.

wolfgirl

 

[Mick]

Zyban, that's the one !
Thanks wolfgirl.

Mick

 

[scubadoc]

Hello Wolfgirl:

As you have read, often the dangers of drugs and diving are not so much the medications themselves, but the condition(s) for which the drugs are being given. Depression, bipolar or not, is thought of by most diving medical professionals as a contra-indication to diving. These clinical situations vary greatly, however, and with the consent and collaboration of the treating physician/psychiatrist - some people can be found fit to be certified.

As you have probably surmised little is known about the interactions of nitrogen or depth/pressure on the effects of medications used to control various forms of mental illness.It is only speculated that the effects of nitrogen narcosis are additive to the effects of the drugs.

All antidepressants without exception carry a small but measurable risk of seizures. The cited risk is that 1/2000 patients will experience a seizure. Of the antidepressants, Wellbutrin is the worst. The risk with Wellbutrin regular preparation (not sustained release) at high doses is 1/250. This seems a little high to be diving. The risk of seizure on sustained release preparations approaches the 1/1000-2000 range. Therefore if you dive on this medication it would seem prudent to use only the sustained release form. This would be a major risk to the diver if it occurred underwater, possibly leading to drowning or near drowning and gas embolism.

As to the risk of taking antipsychotic medications while diving - DAN's figures did not list any of these drugs as being a factor in their report for Decompression Illness & Diving Fatalities for 1998 in their 2000 Edition. Of 58% responding, 18 dead divers used 28 total medications, none of which were psychoactive. (Responses from sources other than the divers - of course).

Here are some general advisories:

1. You should not dive if there is any possibility of seizures.
http://www.scuba-doc.com/epildv.htm

2. You should not dive if you exhibit difficulty in concentrating or following instructions.

3. You should not dive if you are suicidal or have suicidal thoughts or have psychiatric problems that
would deter you from interacting with your buddy, instructors or other divers.
http://www.scuba-doc.com/psych.htm

4. You should not dive if your medications cause any change in sensorium that might be worsened at depth.

DocVikingo has given some great advice regarding having a frank discussion with your doctor about your condition, medications and future needs. It would seem that you really need to have a lot sorted out before you contemplate any further diving lessons. We really want you to learn to dive - but safely!

 

[divepsych]

In 2000 I contacted all the pharmaceutical companies in the USA that manufactured antidepressant medications. None of them had any data whatsoever on their medication in a hyperbaric environment and none had any interest in pursuing the question. Most of the old written guidelines about antidepressant medications in diving relate to the sedating side effects of the older medications like the tricyclic antidepressants. These drugs have largely been replaced by the newer SSRI's and SNRI's which usually have fewer side effects. I have many patients on the newer antidepressant medications who dive and none have experienced a problem with them while diving. Lithium may pose a problem with divers who become severely dehydrated from excessive sweating in wetsuits or drysuits before or after they enter the water, resulting in elevated and potentially toxic levels of lithium. As always, it is best to consult your personal physician.

 

[DocVikingo]

Information intended for the original participants might be best communicated via an email or PM in case they are no longer following the discussion.

Regards,

DocVikingo

 

[successoutdoors]

I would talk to your doc, he will know you case best and can tell you if you can dive or not. He will have to do an eval for you anyway, you might as well kill 2 birds with one stone.

-Dan