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Hello Ed:
As you might expect, there is little in the literature about diving and psychoactive medications of any kind. What we have to do is to extrapolate known dangers to divers in general with the effects and possible side effects of these drugs.
Drowsiness and dizziness is also a problem with some people and there is the warning that people taking this medication should not operate dangerous machinery or participate in activities requiring attention to multiple tasks. It is not known what effect the addition of nitrogen at depth will have on the diver taking this medication.
See references below.
Seizure activity is a major risk for divers as it invariably leads to drowning. This known due to diving accidents that have occurred with the seizures of oxygen toxicity. Therefore, any seizure activity is a contraindication to diving and medications that have a risk of causing seizures are also dangerous in this regard. This includes a low but constant 0.1-4% risk for all anti-depressives (including fluoxetine).
http://scuba-doc.com/epildv.htm
The incidence of seizures during fluoxetine therapy appears to be similar to that observed during therapy with most other currently available antidepressants. Seizures or events that were described as possible seizures have been reported in approximately 0.1-4% of patients receiving fluoxetine therapy to date. See references below.
In addition, we have to also be aware of the possible additive effect of nitrogen at depth or 'nitrogen narcosis', a real threat for divers who go below about 90 feet sea water. We have no literature on this subject. Only just recently do we have a RCT (controlled study) of the drug 'Dramamine' that indicates a significant decrement in cognition in divers (dry dives in a chamber). It is probable that if good studies were done with all medications, that we would find many that alter the ability to function underwater. Diving is a multi-task sport, requiring constant concentration and attention to minutae. Any alteration in sensorium is dangerous to the diver and to his 'buddy', to the divemaster and to all other divers on the dive excursion.
http://www.scuba-doc.com/gasesprbs.html#Nitrogen_Narcosis .
There have been several reports of abnormal bleeding (mostly ecchymosis and purpura) associated with paroxetine (a similar drug) treatment, including reports of impaired platelet aggregation. As a result of this, minor trauma can cause excessive bleeding with hematomas and tissue damage. Barotrauma occurs regularly in most divers. Air-filled spaces such as the middle ears, sinuses and lungs are the sites most frequently involved. Any
alteration in clotting ability can lead to damage in one or more of these sites that ordinarily would not be seriously affected. Visit our web page about anticoagulants and diving at
http://scuba-doc.com/antcoag.htm .
Also, generally, one needs to consider the following guidelines to use in considering the relationships between drugs and diving:
Consider the condition/illness/disease for which the medication is being given.
Are there any effects of the drug that alter consciousness or cause alteration in decision making ability. Are combinations of drugs additive in their effects, particularly when taken at depth with the added effects of nitrogen?
Consider complex relationships between drugs, the individual, other medications, diet and the conditions for which the drugs are taken.
These guidelines are particularly important in deciding if a person can be certified to dive while taking several medications - the usual situation with psychiatric patients.
Finally, the serotonin syndrome may occur in patients who receive selective serotonin-reuptake inhibitors such as fluoxetine concurrently or in close succession with other serotonergic drugs. Although the syndrome appears to be relatively uncommon and usually mild in severity, serious complications, including seizures, disseminated intravascular coagulation, respiratory failure, severe hyperthermia, and death occasionally have been reported.
It has been reported that there is a marked increase in serotonin during dives to 1.1 MPA Heliox. The observed highly significant increase in serotonin was thought to be due to pressure and not to emotional stressors. The significance of this combination of elevated serotonin from fluoxetine and high pressure is not known or unreported.
In summary:
1. You should not dive if there is any possibility of seizures.
http://scuba-doc.com/epildv.htm
2. You should not dive if you exhibit difficulty in concentrating or following instructions.
http://scuba-doc.com/teens.htm
3. You should not dive if you are suicidal or have psychiatric problems that would deter you from interacting with your buddy, instructors or other divers.
http://scuba-doc.com/psych.htm
4. You should not dive if your medications cause any change in sensorium that might be worsened at depth.
I hope that this is helpful!
Best regards for safe diving!
Ern Campbell, MD
Diving Medicine Online
http://www.scuba-doc.com/
