Hi SD fans, and welcome back. We have been working with the team at Divers Alert Network
for several years now, and over the coming months, I aim to share some of their knowledge
and expertise when it comes to medical ailments and conditions and scuba diving, starting
with depression, medications for depression, and fitness to dive.
For those here for the first time, my name is Mark, I am the editor-in-chief of the Scuba
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Now, let’s dive into the video!
Who gets depressed? It's not as uncommon as you may think, especially given the current
state of the world with the COVID-19 pandemic. Even divers get depressed. Some of the more-frequently
asked questions on the DAN Medical Information Line concern medications divers take for depression,
and how these drugs can affect their fitness to dive.
According to the National Institute of Mental Health, each year more than 17 million Americans
experience a period of clinical depression. Fortunately, with appropriate treatment, nearly
80 percent of those diagnosed with depression experience significant improvement. Depression
isn't simply in your head - it affects both body and mind. Symptoms of depression vary
from person to person, as does their severity. Obviously, those individuals who are out of
touch with reality, are suicidal or have hallucinations should not dive. Also, any condition that
could affect one's physical or rational decision-making ability would not be safe for the diver or
a dive buddy. However, many people dive successfully while they take medication and receive treatment
for everyday depression.
Symptoms of depression According to the National Depression and Manic
Depression Association, some symptoms of depression include:
• prolonged sadness or unexplained crying spells;
• significant changes in appetite and sleep patterns;
• irritability, anger, worry, agitation, anxiety;
• inability to concentrate, indecisiveness; • unexplained aches and pains;
• recurring thoughts of death and suicide. For divers, here's an extra consideration
- some of the symptoms associated with depression could also mimic those of decompression illness.
Unexplained aches and pains or an inability to concentrate could make a differential diagnosis
very difficult. Diving at depth is not a place to lose focus on the immediate dive tasks
- following the dive plan, monitoring one's air supply or just being an observant dive
buddy. Should divers with depression be cleared to dive? Yes and no - each diver should be
considered on an individual, case-by-case basis. Factors should include each diver's
medical history, type and dosage of the medication, the individual's response to treatment and
motivation for diving. In-water safety for the diver and buddy is the primary consideration.
Treating depression Part of the treatment for depression can include
the use of central nervous system medications that have varying but similar side-effects.
Dozens of anti-depressant medications currently on the market effectively treat depression.
Each group has its own distinct properties that react chemically in the brain. Unfortunately
for divers, some medications have side-effects similar to the symptoms of decompression illness.
Side-effects such as visual disturbances, weakness, dizziness, lack of co-ordination,
numbness and tingling, when occurring after a dive, may require evaluation for possible
DCI. Sometimes finding the optimal medication involves trial and error. People should never
change dosage or discontinue medication without direction from their physicians. Individual
reactions and effective therapy may take several weeks, even months to achieve, so any diving
would have to be postponed until the patient has adjusted to the medication.
The following are the most-common medications used in treating depression:
SSRIs (selective serotonin reuptake inhibitors) Although SSRIs typically cost more than other
antidepressant medication, they tend to be relatively safe for divers. They do, however,
have a side effect of drowsiness; this can influence the safety of the dive.
TCAs and HCAs (tricyclics / tetracyclics / heterocyclics) Dizziness, drowsiness, and blurred vision
may be among side effects from TCAs and HCAs. Any medications that affect concentration,
decrease alertness or impair decision-making are not compatible with safe diving.
Other anti-depressants such as bupropian), trazodone and venlafaxine.
Fainting, excitability and difficulty breathing are among the rare side effects of venlafaxine.
Bupropian may have side effects of agitation, CNS stimulation, seizures, psychosis, dry
mouth, headache, migraine, nausea, vomiting, rash, tinnitus, muscle pain and dizziness.
Obviously, a diver with these symptoms could experience safety risks.
For divers, there is little available research about diving with depression or diving while
taking anti-depressants. When divers taking CNS medications report problems while diving,
most commonly come of nitrogen and the side effects of the drugs. The diver should discuss
the possibility of seizures with a doctor. Every case should be evaluated independently,
with honest communication from the diver or prospective diver, a physician and the training
organization. Divers who respond well to medication over a long period, have appropriate decision-making
abilities and are cognizant of potential side effects, may be considered for some types
of diving. This should be a joint decision reached by the diver and physician.
Got a medical query? Leave your question below – if we or the team at DAN can’t answer,
maybe someone in our community will be able to. Remember, if you enjoyed this video, be
sure to subscribe to our YouTube Channel, and check out our playlist for more inspirational
and educational content. As always, stay safe – and if you are going
diving soon, enjoy!