ADHD meds and diving

[Ber Rabbit]

What is the consensus on someone with ADHD (don't know what type) taking Dexadrine (spelling error possible here) and diving? Person also takes Zoloft for anti-social behavior (extreme shyness). The meds don't produce noticeable side effects on the surface, is there any concern about taking them and diving?
Ber

 

[scubadoc]

Hello Ber Rabbit:

Here is an answer that one of my consultants (Martin Quigley, MD)wrote to a similar question from a diver about his son that is quite apropos to your query.

"Answers to questions are for information only, do not imply diagnosis or treatment and should always be used in conjunction with advice from your personal physician.

I am afraid that my answer is not going to give you the help for which you are searching.

First, I would be very concerned about the instructor who certified your son with this condition and on these particular drugs. Training agency standards require medical clearance (the relevant portions of the PADI questionnaire are inserted below) and also restrict the maximum depth of dives to 40 feet.

" Please answer the following questions on your past and present medical history with a YES or NO. If you are not sure, answer YES. If any of these items apply to you, we must request that you consult with a physician prior to participating in scuba diving. Your instructor will supply you with a PADI Medical Statement and Guidelines for Recreational Scuba Diver's Physical Examination to take to a physician.

____ Are you currently taking medications that carry a warning about any impairment of your physical or mental abilities?

____ Do you have a behavioral health problem or a nervous system disorder?

There are two areas of medical concern in you son's case. First are the medications he is taking and second are the conditions for which he is taking the medications.

At the bottom of this reply, I have attached the label warnings and listed side effects for ritalin (similar to dexedrine and all amphetamine -like drugs) and Zoloft. Please note that all say in one way or another 'This drug may impair the ability to drive or operate machinery'. Very few drugs have been studied under hyperbaric (increased pressure - for example, when diving) conditions. One of the effects of increased pressure is "nitrogen narcosis", an effect similar to alcohol intoxication that may intensify the psychological side effects of drugs. Even though you son may tolerate his medications without side effects on the surface, there's no way of predicting what side effects they may have with increasing depth and time.

My principal area of concern is your son's underlying condition. The following is the latest requirements for the diagnosis of ADD (or ADHD):

DSM-IV Criteria for ADHD
The use of DSM-IV criteria to diagnose ADHD is the current state of the art and allows for greater uniformity in communication across such wide sectors as health, mental health, and education. DSM-IV criteria for ADHD require the identification of at least 6 out of 9 behaviors to a degree that is maladaptive and inconsistent with developmental level, in either or both of the dimensions presented below:

(1) Inattention
Often fails to give close attention to details or makes careless
mistakes in schoolwork, work, or other activities
Often has difficulty sustaining attention in tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish
schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
Often has difficulty organizing tasks and activities
Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
Often loses things necessary for tasks or activities (eg, toys, school assignments, pencils, books, or tools)
Often easily distracted by extraneous stimuli
Often forgetful in daily activities

(2) Hyperactivity-impulsivity
Often fidgets with hands or feet or squirms in seat
Often leaves seat in classroom or in other situations in which remaining seated is expected
Often runs about or climbs excessively in situations in which it is
inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
Often has difficulty playing or engaging in leisure activities quietly
Is often "on the go" or often acts as if "driven by a motor"
Often talks excessively
Often blurts out answers before questions have been completed
Often has difficulty awaiting turn
Often interrupts or intrudes on others (eg, butts into conversations or games

Most good instructors would have great concerns in certifying as an independent diver an individual who "often...makes careless mistakes", "often has difficulty in sustaining attention in tasks", "often does not follow through on instructions" or "often loses things necessary for tasks". Scuba diving is very task loading, and inattention to details (such as tank air remaining and depth/time limits) can be fatal.

There are certainly risks involved in all activities. But a scuba diver puts not only himself at risk, but also his buddy and/or and individuals who might become involved in a rescue effort. Numerous good instructors have made the tough choice to deny scuba training to teenagers with ADD on medications. It's a tough decision, because these potential students are usually very bright and enthusiastic. However, I feel that the risks to themselves and others are not worth the benefits to be obtained from recreational diving. There are many other recreational activities available where the symptoms of ADD and the medications' side effects would not be potentially life-threatening.

Ritalin , Dexedrine and amphetamines in general:
This drug may impair the ability to drive or operate machinery. Use care until you become familiar with its effects. Methylphenidate should be used with caution in patients with a history of seizures and/or EEG abnormalities. There is some evidence that the drug may lower the seizure threshold in patients with a history of seizures, in those with prior EEG abnormalities in the absence of seizures, and, very rarely, in those without a history of seizures and no prior evidence of EEG abnormalities.

Adverse Effects List from First DataBank

CARDIAC ARRHYTHMIAS severe
FALSE SENSE OF WELL-BEING
INSOMNIA
IRRITABILITY
NERVOUSNESS

--------------------------------------------------------------------------------

Zoloft

This anti-depressive (Sertraline) has a low but definite incidence (0.1%) of causing seizures - which would be fatal if occurring underwater.

Adverse effects that might be dangerous to diving

ANXIETY
DIZZINESS
DROWSINESS
HEADACHE
TIREDNESS/WEAKNESS
TREMORS"

Obviously, I fully agree with Dr. Quigley, who is an Endocrinologist as well as a scuba instructor.

 

[Ber Rabbit]

I told the student I cannot certify him because the risk is too great due to the meds he's taking. He said he understood. I told him I'd like him to stay in the class since it's a college course and you don't need to get certified to pass. My mentor suggested a skin diver certification at the end of the class. I'm not sure he can meet the requirements, needs A LOT of work on swimming with fins. Just hasn't gotten the hang of the required movement yet. I'm going to have him work with a kickboard, hopefully that will help. I am, however, determined to try to make him a proficient skin diver. I've got 7 more weeks, wish me luck!
Ber

 

[bluebanded goby]

Hi Ber,

Just a comment about trying to make your student a proficient skin diver. As one who freedives frequently, I know that freedivers are leery of taking stimulants such as pseudoephedrine (Sudafed) to control sinus problems because they raise heart rate and shorten bottom time (i.e. the amount of time you can stay submerged on a given breath-hold). I'm not a medical person, but I wouldn't be surprised if other stimulants such as dexedrine have a similar effect. I know you won't be expecting your students to dive like Pipin Ferreras or Mandy Cruikshank to pass your course. But you might want to be mindful that your student's breath-hold ability may be affected by the medication.

 

[Ber Rabbit]

You're right, I'm not expecting him to dive like a pro. I'd be happy with him developing the ability to get to the bottom of the pool (14 feet) long enough to doff/don and clear his mask! I'll show him the NAUI requirements to achieve the skin diving certification and let him decide if it's something he wants to go for. If not I'll just focus on getting his kick strong enough to execute a proper surface dive that will take him to the bottom of the pool. Academically he seems to have the ability to pass the course and he's had no problem with mask/snorkel clearing he just can't kick with fins on. You can see how hard he works just to move a few inches at a time (literally inches). When he fins on the surface his body is completely rigid, his legs move about 3 inches and his arms move along with his legs, like Mr. Roboto swimming. Time to break out the kickboard and try to get him to relax!

He's not afraid of the water, he can even pull another skin diver on the surface by staying upright and stomping with his fins. I do hope he won't drop the class, we'll see how he does when we start on scuba next week.
Ber

 

[Pharmgirl]

I just wanted to add something here. I was just diagnosed with Adult ADHD (boy did THAT explain alot!). I feel that the condition was the main reason I failed to stay on top of my air supply doing my first drift dive last year in Cozumel. When I remembered to check it again, it was time to go up....now. I have given that incident a great deal of thought since then, and my diagnosis helped me realize that I'm not just a "space-cadet".

That said, I fully intend to pursue ADHD medications and still intend to dive. ADHD doesn't ever "go away", and without medications, I feel like I might risk additional careless mistakes. I can't give up diving forever. Obviously, these are things I will be discussing with my doctor prior to beginning medications, but this is where my mind set is now. And according to some of my research, most ADHD meds only stay in your system 4-12 hours, so I guess if there were overwhelming risks associated with diving on the medication, you could skip the days you were diving and just employ a little additional support from your buddy to make sure you're not doing anything careless.

I'd be interested to hear from anyone else who has been diagnosed and how they deal with that while diving. Thanks!

 

[adder70]

and my diagnosis helped me realize that I'm not just a "space-cadet".

I'd be interested to hear from anyone else who has been diagnosed and how they deal with that while diving. Thanks!

I haven't been diagnosed, but I have learned to live with what is almost definitely ADD/ADHD. My 2 step sisters both have it, and I have many of the same symptoms, though usually to a lesser degree.

I think you can still dive with these sypmtoms, but you just have to be extra careful and establish core needs. Have I forgotten weights? Just did that last dive. Have I forgotten film in my driveway, and then realized AFTER buying film (at Ginnie prices!) that the camera battery was dead? Yep.

Do I carry extra batteries for my lights and check my dive bag 4 times before every dive day? Also yes, and I have only once forgotten anything safety related for a dive, and mistakenly took my buddy's advice not to surface immediately. (WHen you forget your computer, and then get separated from your buddy just when you need to surface, you realize that you NEVER make any dive without your own depth gauge. Sure, I used the bubbles to gauge my ascent rate, but I was very nervous the whole time, and never want to do that again.)

I often annoy pepole with my slow prep for a dive, but due to my tendency to forget things, I always check everything carefully multiple times to avoid any mistakes. My last dive was a cavern dive and I took my camera with me. It only took about 2 minutes before I realized I had no businees with a camera in a cavern, so I simply had an unnecessary piece of equipment that I only used after safely out of the cavern. It still comes down to judgement, and im my opinion, ADD/ADHD don't affect your judgement, they affect your ability to implement your judgement. This is why an ADD diver may take longer but can still dive safely provided they know and respect their limitations.

 

[adder70]

I'm not just a "space-cadet".

I think you actually are "just" a space cadet, as am I to a likely lesser degree. I think many diagnoses of "new" diseases are of conditions that have been around for centuries, they just weren't meticulously documented and given scientific names.

I don't humans suddenly developed behavioral issues such as ADD and ADHD. It's not like they are new bacteria or viruses. They were around and not uncommon. Look at the definition of symptoms for ADD in particular. That, to me, says "space cadet" and people have learned to live with the condition for centuries, some better than others. This is no way diminishes my sympathy for sufferers or my feelings about the need for medication in many situations, just increases my respect for those who managed to live with the conditions in the past without the extensive pharmaceutical management presently available. Besides, I could be considered to have self medicated for most of my life (Caffeine is a stimulant, as is Ritalin, in many people, but I find I sleep better with caffeine than when I abstain for the day.) by drinking amazing amounts of Coke over the years.

 

[Lloyd]

I would worry about the meds lowering the threshold for an 02 hit and causing seizures. As far as the behavioral aspects, ADD/ADHD comes in so many forms it is impossible to make a generalized statement. Many successful people have learned to deal with their ADD. They even gravitate towards fields which seem chaotic and allow them to multitask. Since some forms enhance multitasking, it could enhance your ability to handle situations which are going down the tubes. I know many people with ADD who love high adrenaline situations since it enhances your ability to focus. The newer meds work on a simular principal by increasing the level of norepinephrine in your brain. The fitness to dive should be made on an individual bases with people aware of the persons behavior such as parents and doctors.

The book about he father and son who died while diving the uboat shows behavior which is unsafe in diving. I forget the books name.

Lloyd

 

[DocVikingo]

The Last Dive: A Father and Son's Fatal Descent into the Ocean's Depths by Bernie Chowdhury.

Best regards.

DocVikingo