Diving & Antidepressants

[MGF1892]

Please read this thread it could save your life or a friends.

I've been diving for 13yrs, Advanced PADI, I'm BIG on safety even to the point of being anal - I'm O.K with that, after all its your life! Since 2006 I have been taking an Antidepressant called Citalopram at a dosage of 60mg per day. My G.P knew I was going diving when I set out on my latest diving trip to Sharm El Sheikh on 7th May 2009 where we had booked 6 days diving (2 tank boat dives a day). We completed Scuba reviews as my boyfriend hadn't done any diving for 3 years. On completing the Medical questionnaire I ticked NO to "Are you taking any Antidepressant medication", not because I was being clever, I ticked NO because I had already spoken to my doctor about diving and told it was O.K to dive, so thought I was doing the right thing as I'd sought medical advise??? AH NO!!!!!

We started our diving and as my boyfriend was PADI Open Water and restricted to 18metres I decided to stick with him and not go any deeper - this probably saved my life.

On our 5th day of diving I over-equalised on my last dive. On surfacing I had deafness in my left ear with a dull ache and pain. I was advised to seek medical attention which I immediately did so. I was taken by a member of my dive team to the Hyperbaric Medical Centre, Sharm El Sheikh where I was diagnosed, by a Diving Doctor specialist -Dr Adel Taher - to have an acute otitic barotrauma. (Basically damaged the tissue in my ear by over equalising - quite painful).
I was told No diving for 5 days and was given a list of medication to take. I then asked if any of the medication would affect my current medication of 60mg's of Citalopram.
Dr Taher told me that I should NEVER have been diving whilst on ANY Antidepressant medication. I informed him I had spoken to my G.P and Dr Taher stated that I should have consulted a Doctor who Specialises in Diving as G.P's do not have the Knowledge or experience of diving and the effects of Antidepressant medication.
Dr Taher then explained about the Brain Blood Barrier. I was told that whilst diving the Brain Blood Barrier is affected under pressure. The pressure from diving causes it to lift and in my case I was very lucky that my Brain Blood Barrier hadn't lifted which if it had would have caused a lethal dose of Citalopram into my Brain which would have rendered my unconscious and whilst diving would have killed me.
Dr Taher told me I was lucky to be alive and my presence on earth was clearly still required as I was still here!!! He meant what he said, I would see it in his eyes.

As I'm new to this site I'm not allowed to post the E mail address of Dr Adel Taher. I'm sure if you look on the net he will be well known in his field.

I'm not a melodramatic drama queen, I've taken time to join this website and write this post in the hope it will help anyone.

 

[Hickdive]

As you're in the UK you could have raised the issue of diving on medication with a referee from the UKSDMC even if you're not a member of the BSAC, SAA or SSAC.

UK SPORT DIVING MEDICAL COMMITTEE

The current UKSDMC guidelines on diving on anti-depressants are given here;

UKSDMC medical standards- depression

As may be seen citalopram is not a total contra-indication to diving but it needs to be discussed with a diving doc.

 

[Decker]

MGF

Thank you for sharing this very timely post. My OW instructor almost lost a student because of a perscription drug ok'd by the student's doctor. As a result of that event, he spends time in lecture and then again before the OW first dive reminding all of his students that:


1. Perscription drugs and diving should be mixed with caution.

2. Dive medicine is highly specialized and very few general practice doctors have the experience or training needed to understand the effects of pressure on drugs. Why would they?

3. When the least bit in doubt, call DAN (Diver's Alert Network). If they can't help you, they know who can! Thanks to HickDive, we now know we can check the UKSDMC too!

Thank you again for reminding us how important it is to be careful when mixing perscriptions and diving!

Decker

P.S. Have you checked with DAN about Citalopram?

 

[drbill]

Hmmm... I am NOT a medical doctor, just a lowly marine biologist. I have been diving for decades while on antidepressants (Paxil, Trazodone). That is not stated to suggest you shouldn't worry about it... maybe I should.

 

[drrich2]

It's my understanding (particularly from threads on this forum) that diving on antidepressants is somewhat controversial, due to alleged slight increase in seizure risk (I've read seizure risk on antidepressants is around 1 to 2 in 1,000; I didn't find what the background general population risk was though, and some med.s (like the first form of Wellbutrin that came out, particularly in high dosage) may carry higher risk).

As for diving compromising the blood brain barrier, is this a view held by the diving mainstream? Antidepressants or otherwise, this is something I haven't heard before.

Not everybody in the medical field holds the same opinion on every issue, even the experts in a specialty. I wonder if this is one of those issues.

Richard.

 

[flw]

The main problems with diving and anti-depressants is firstly how safe is someone with depression and therefore possibly at increased risk of overdose/suidcidal ideation diving to start with - which needs to be discussed on an individual basis with a diving dr.
Secondly. citalopram at 60mg is the maximum licensed dose of a drug that is known to decrease the seizure threshold - so a fit is more likely than in the normal population - most if not all antidepressants both ssri and tricyclic antidepressants do this. No drug company has ever done, or is likely to do a study of side effects caused by a drug under hyperbaric pressure. Therefore the risks of an individual drug are mostly just not known - hence caution is advised

 

[Garrobo]

Check with DAN.

 

[drrich2]

Skipping doses of a prescription antidepressant to go diving can lead to side effects (i.e.: SSRI withdrawal), and interrupts treatment of a condition judged to warrant their use.

The issue of potential suicidality comes up in such discussions, but it would be ill-advised for a suicidally distressed person to go diving regardless of whether taking antidepressants. These medicines have a wide range of uses (some on-label, some off-label), and many people taking them are healthy, high-functioning people.

It's kind of like saying if someone takes medicine for high blood pressure, then maybe he's at heightened risk for a hypertensive crisis and a stroke; yeah, maybe in theory, but I imagine there are many divers on such medication. Same basic issue; how serious is the individual's condition, and how effective is the treatment?

While I agree caution is advised, and we don't have large studies giving us great scientific data to draw on, diving poses some risk to anyone. I don't think making a blanket claim that no one should dive on antidepressants is warranted, and I'd like to see the evidence that interrupting their medication therapy is less risky than just diving on it.

I agree; that is quite a high dose of Celexa. If I were concerned about seizure potential, for instance, I might see whether a full face mask was an option. You can still drown if you pass out underwater, but your buddy would have more time to notice you and haul you up, as opposed to you spitting out your regulator, inhaling water and drowning very fast. In theory.

Safety is somewhat relative.

Richard.

 

[MGF1892]

Decker Many thanks, I haven't checked with DAN about Citalopram yet but I will be doing so

drrich2 - The medical advise I received, I believe to be first class. From a personel level I'll never dive again whilst on these meds, its not worth the risk for me. Plus I should be off them by early next year.
The info below you might find helpful as to the experience of Dr Adel Taher.

"The Hyperbaric Medical Center, Egypt started operating in March 1993 in Sharm El Sheikh, South Sinai and comprises a multi-place multi-lock recompression chamber which was built in the USA with the funding of USAID. It belongs to the Ministry of Tourism. To date, (October 2001), it has successfully treated over 550 severe cases of DCI. The staff comprises two full time specialists. Dr Adel Taher, Consultant in diving medicine, led the implementation and development of the chamber. He is the Director of both the chamber and DAN-Egypt and a member of UHMS and EUBS"

 

[flw]

Since the elimination half life of citalopram is around 1.5 days, missing a dose on the morning of a dive is unlikely to make much difference either way - however it will reduce overall compliance/concordance.
High pO2 such as those in diving, particularly rich nitrox gases also lower the seizure threshold in an individual - and the potential is for the two effects to become additive. Everyone has the potential to siezure if provoked enough, where the threshold lies in any individual on any given day is the unknown