Adderall and diving

[The Surly Mermaid]

I have a friend that is planning on getting certified in the next month. She is currently taking Adderall regularly and has had no odd side effects. I have not been able to find any formal studies done on the effects of diving and Adderall, so I am reaching out to anyone that has dove with people that are taking it, or take it yourself and dive. Wondering if you know of, or have experienced, any adverse effects at depth that we need to be aware of.

 

[ZenDiver.3D]

She takes adderall for ADD or ADHD, right? My son takes it daily and dives often. His doctor was emphatic that he take it especially while diving, as it allows him to focus and curb his low impulse control. People who are add or adhd should stay on their meds. There used to be the thought of taking them off of it when on summer break and on the weekends, but that has been proven to be a big mistake. This is when they need more help as structure is different and input is varied.
I would tell her to take it as usual. No side effects or problems have been noted that I know of.

 

[Web Monkey]

I have a friend that is planning on getting certified in the next month. She is currently taking Adderall regularly and has had no odd side effects. I have not been able to find any formal studies done on the effects of diving and Adderall, so I am reaching out to anyone that has dove with people that are taking it, or take it yourself and dive. Wondering if you know of, or have experienced, any adverse effects at depth that we need to be aware of.

As far as I know, no recreational agencies will accept a student taking psychoactive drugs unless a doctor signs a release, and sometimes not even then.

Underwater is a bad place to have chemically altered metal processes.

Terry

 

[DocVikingo]

Hi The Surly Mermaid,

Here's a response by Scubadoc to an earlier inquiry on this forum regarding diving while on medication for ADHD:

"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."

Regards,

DocVikingo

 

[The Surly Mermaid]

Thanks to you all. Will have her talk to her doctor prior to certification. Guess the question remains, is it better/safer to certify an adult that has AADD and is on medication, or one that is not on medication. From an attention standpoint seems like it would be safer to certify someone on medication. However, without the published studies being done for how this drug reacts at depth (especially over 40 feet) it is hard to tell.

 

[ZenDiver.3D]

Adderall is not a psychotropic or psychoactive drug. It is an amphetamine based drug that was, originally prescribed for weight loss.. It is amphetamine and dextroamphetamine. For those of us not add, it is an upper. People with add are not wired the same way, and any stimulant actually acts in reverse to whatever degree and type strength they take. Please see the info below:

"Amphetamine Mixed Salts
Brand Name: Adderall

Overview
Adderall contains amphetamine and dextroamphetamine, which are stimulants. This drug is used to:

Improve a patient's attention span.
Increase his ability to follow directions.
Decrease distractibility among children ages three and older.
Decrease impulsivity, stubbornness and aggression.
An advantage of Adderall is that it is effective for most patients when taken once or twice a day. This makes it convenient for patients, parents and caregivers. Adderall may help some patients for whom other medications, such as Ritalin have not been effective. The effects of Adderall can be felt after a few doses. It may take additional time to achieve the full effect and this may require adjusting dosages. Most people can achieve maximum benefit in 3 to 4 weeks.

Why is this drug prescribed?
Adderall is used to treat Attention Deficit Disorder with Hyperactivity (ADHD). It is prescribed for the following symptoms in children:

Moderate to severe distractibility
Short attention span
Hyperactivity
Mood swings
Impulsiveness
When these symptoms first appear, other factors should be considered, such as neurological signs, learning disability, abnormal EEG and central nervous system dysfunction.

Warnings and Precautions
Amphetamines have a high potential for abuse. Administration of amphetamines for prolonged periods may lead to drug dependence. There is a danger of obtaining amphetamines for non-therapeutic use or distribution to others."

There are also varied levels of add or adhd.
And not all doctors can prescribe this medication. They require extensive testing, and monitoring. If your friend takes adderall, she has been under long-term doctor care to maintain the lowest safe treatment levels. Anyone who has add or lives with people who do, know this is not something that should inhibit activities.

I would trust my other child or a family member to dive with my son. Adderall does not impair him in any way. Quite to the contrary. But, it also has to do with how much add he is. It can be more or less severe or mild from person to person. And, by the way, my son is now a 13 year old tenth grader(he skipped two grades), attending an honor's academy. Not your typical kid anyway.

And as we began his dive career, we got our doctor to do his homework and clear my son as needed by the medical release form. Adderall is Nothing like zoloft or other drugs like that. Adderall cannot be compared to them. Have your friend clear it with her doctor. Don't take my advice or anyone else's here as written in stone. Go to the doctors and go see a doctor who specializes in dive releases. There are plenty.
Good luck.

 

[ianw2]

The OP posted:

I have a friend that is planning on getting certified in the next month. She is currently taking Adderall regularly and has had no odd side effects. I have not been able to find any formal studies done on the effects of diving and Adderall, so I am reaching out to anyone that has dove with people that are taking it, or take it yourself and dive. Wondering if you know of, or have experienced, any adverse effects at depth that we need to be aware of.

Where in that post does anyone come up with the fact that this prospective diver did not properly or truthfully fill out their medical release?

I have been diagnosed with ADD. I do not choose to take meds due to a life time (just celebrated my 50th birthday) of “self-medicating with over the counter drugs such as caffeine and nicotine (quit smoking over 2 years ago). In my experience, there is a considerable amount of absolute twaddle in print/conversation about ADD and the chemical stabilization of the condition.

My two biological sons are also diagnosed as ADD with my youngest son having the added label of ADHD. The older son also chooses not to medicate. The younger son has been taking ADD/ADHD medications since he was diagnosed at age three by a wonderful psychiatrist. My son just graduated with a diploma from high school last night. (Sound of buttons poppging - we were told by his school to track him toward a certificate rather than a diploma because of his "condition".)

We ALL dive and have had absolutely no problems.

DocVickingo: one of the most frustrating things about hearing comments from mainstream medicine such as “…there is no definitive diagnosis for ADD…” is that it is complete hogwash! The underlying condition that manifests as ADD is a chemical difference in the brain of an ADD patient as opposed to non-ADD patient.

Methylphenidate and similar amphetamines used to treat ADD help to restore that imbalance (simplistic model but it gets the point across). In those who are not ADD, the drugs act as stimulants; in those of us who are ADD, the drugs act as calming agents. Anecdotally, my son’s dosage was higher than mine. I once took one of his pills and promptly fell asleep.

There IS a definitive test for ADD: application of a low dosage of methylphenidate. Those who are ADD will experience some degree of relaxation; those who are not will experience some degree of stimulation. Yes, I understand the ethics of such a diagnostic. (House does it all the time. :smiley)

It is unfortunate that this class of drugs is very similar to the street drugs that have caused so much pain and loss to so many. However, just as with opiates for pain alleviation, there are beneficial medicinal uses for many street drugs. Ritalin, Adderall and Concerta are NOT crystal meth!

Society has a distorted view of medications. I, too, shared that distortion early on. When my son was first prescribed Ritalin, I was very upset at his taking “psychotropic drugs” everyday (methylphenidates are NOT psychotropic, BTW). His physician took me aside to discuss the problem I had. He asked me if I would be upset the same way if my son had to take insulin to treat diabetes. Obviously, I would not. The physician’s response: the only difference is that the organ targeted by insulin is in the gut while the organ targeted by Ritalin is in the head.

The phrase “This drug may impair the ability to drive or operate machinery.” is probably the most repeated phrase on drug insert sheets ever. It is a catch all phrase designed to help with the defense against the “Twinkie” lawsuit more than anything.

In short, any potential diver who has been diagnosed with ADD and/or ADHD should be under the care of a competent physician; have established a proper dosage of their drug regimen; have a sufficient period of time to develop experience with their body’s response to the regimen; have the blessings of their physician before starting classes; and dive with buddies who are completely cognizant of the situation.

This would be my exact expectations of any diabetic or anyone on long-term medication regimens.

I am not a physician and this does not constitute medical advice.

I won’t apologize for the length of the post. This subject is, obviously, a very personal one for me. It is also a subject that is so misunderstood by so many.

 

[Web Monkey]

Methylphenidate and similar amphetamines used to treat ADD help to restore that imbalance (simplistic model but it gets the point across). In those who are not ADD, the drugs act as stimulants; in those of us who are ADD, the drugs act as calming agents.

Whether the drugs act as stimulants or sedatives is irrelevant, since both actions are undesirable while diving, especially during an emergency.

Terry

 

[ianw2]

Whether the drugs act as stimulants or sedatives is irrelevant, since both actions are undesirable while diving, especially during an emergency.

You've missed the point.

I liken ADD to trying to listen to a radio station at the edge of its range. The static is often overpowering the signal. Methylphenidate and similar amphetamines is like having a very effectiove gain knob on the radio. I can dial out most of the static so I can hear the radio station.

In an person with ADD, the action of the drug acts to focus the mind. This is a good thing in a crisis.

In any case, the bottom line is to work with a physician who understands your case and understands diving medicine. Being diagnosed with ADD is not necessarily a contraindicator to recreational diving.

 

[DocVikingo]

Adderall is not a psychotropic or psychoactive drug. It is an amphetamine based drug that was, originally prescribed for weight loss.. It is amphetamine and dextroamphetamine.

Hi ZenDiver.3D,

You are quite mistaken there, ZenDiver.3D.

Amphetamines, including dextroamphetamine, most assuredly are psychotropic and psychoactive. Adderall is described by the manufacturer as a sympathomimetic amine, or psychostimulant.

From the National Institute of Health's MedlinePlus: Medical Dictionary:

1. Psychoactive=affecting the mind or behavior. Stimulant drugs like Adderall were specifically designed to affect behavior (e.g., improve attention span, increase ability to follow directions, decrease distractibility, and decrease impulsivity, stubbornness and aggression) and most certainly do so.

2. Psychotropic=acting on the mind. Stimulant drugs like Adderall were designed to act on the central nervous system, specifically on the brain, and most certainly do so. After all, side effects can include "emotional changes, anxiety, dizziness, restlessness, hallucinations and unusual behavior."

Also, I would vigorously argue with your assertion that there are "plenty of" doctors who specialize in dive releases. Actually, there few relatively practicing physicians who are specially trained in diving medicine, and even fewer psychiatrists and pediatricians who are so trained.

This forum addresses issues of critical, even vital, information regarding individuals' health and well-being. It is not an appropriate place for the expression of opinions by those who cannot accurately define the terminology they are using and have misunderstandings of the facts.

Regards,

DocVikingo