Antidepressant

Question:
My specific query is that I have an student who dives with us, but is currently on prescription medicine of 'diazepam' @ 5mg/day and 'seroxat' @ 10mg /day. Her previous doctor told her she was able to dive to a
limit of 20m, but she has since advice that diving is completely contra-indicted. Could anyone at DAN offer advice?
Would nitrox worsen or improve her condition, or even make no difference at all?

Answer:
The issue is double:
A) Both drugs, but diazepam in particular, may have a synergic effect with nitrogen, oxygen and carbon dioxide effects at increased pressure, with a result in facilitating and potentiating nitrogen narcosis, even at
relatively shallow depths. Furthermore the drugs may ahve a significant effect on attention and general self-control or awareness, thus generating potential problems and risks while submersed.
Under this light, it would be correct to advise a drastic limitation in the maximum depth, and even 20 meters could be considered at relative risk. A safer limit could be 10 meters and always under strict control by an
experienced buddy or divemaster.
B) The condition that is generating the prescription of these two drugs should be examined and understood in more detail, as it is likely to involve self-control and awareness of the diver and her capacity to react and perform adequately under stressful situations, with particular regard to panic-proneness evaluation. This aspect should be evaluated by a diving medicine specialist during a specific fitness-to-dive physical.

Nitrox would imply a decreased nitrogen concentration in the breathing mixtures, which would decrease the likelihood and possible strength of any nitrogen-related (and drug-enhancing) narcotic effect.
The possible increase in carbon dioxide retention due to the increased oxygen concentration in the breathing mixture and the relative respiratory drive depression should not be considered a problem within the suggeste maximum depth.
The main problem is (as always in similar cases) with the reason why a sedative and antidepressant medication is used and its implications regarding the likelihood of loss of control, panic and other emotional
stress related emergencies while submerged".

Question:
I have been using Seroxat in a dosis of 2 x 10mg per day for 2 years now.
Since this medication didn't give a sufficient relief, My Doctor gave me the advise to switch to another medication.
Since 1 week I'm using Remerom (Mirtazapine) in a dosis of 1 x 30mg per day.
On the Dutch market this drug is relatively new, and not 31to 40 meters. Decompression dives are sometimes made, depending on the tide and the dive spot, but not standard.
Could you please tell me what the experience is with this medicine, and if I can continue diving like i'm used to do.
If possible I would like to participate in research at the effects of diving with this drug.

Answer:

 

Little research exists to characterize the relationship between mental conditions and scuba diving. Other than the obvious reasons people shouldn’t dive — i.e., they are out of touch with reality, severely depressed and suicidal or paranoid with delusions and hallucinations — many people with everyday anxieties, fears and neuroses can dive and do so safely. Some actual psychological disturbances are well known, but, as for the risks of scuba diving, documented and studied cases are few in number. These include the depressions, bipolar disorder, anxiety and phobias, panic disorders, narcolepsy and schizophrenia. In addition to the risks caused by the condition itself, we must add the possible hazards of the effects of medications taken singly or, even more dangerously, in combination. No scientific studies show data that can confirm the relative safety or danger of taking any given medication.

 

In terms of danger to divers, medications usually play a secondary role to the condition for which the medication is prescribed. Plainly a powerful drug, a mood-altering medication, should be used with care by divers. Drugs that carry warnings indicating they are dangerous for use while driving or when operating hazardous equipment should also be considered risky for divers; if they’re dangerous for drivers, they’re risky for divers. It is important to consider the possibility of additive effect of nitrogen narcosis on the actual effects of the medication.

 

Paroxetine / Seroxat is used to treat depression, anxiety and obsessive-compulsive disorder.

 

Possible side effects that may be adverse to diving include:

 

• Anxiety / restlessness: Usually disappears with continued use. If this causes difficulty, contact your psychiatrist.

 

• Drowsiness: If this occurs, take this medication one hour before bedtime. Disappears with continued use.

 

• Dry mouth: May disappear with continued use. Dry mouth may increase risk of dental disease. Chew sugarless gum and brush at least daily with fluoridated toothpaste.

 

• Blurred vision: Usually temporary, will diminish with continued use.

 

• Tremor: Tends to go away with continued use.

 

• Bruising / bleeding: Use of paroxetine can slightly increase risk of bruising and bleeding; can be significant when also taking aspirin or non-steroidal anti-inflammatory drugs (e.g naproxen, ibuprofen, ketoprofen, flurbiprofen, diclofenac, sulfasalazine, sulindac, oxaprozin, salsalate, piroxicam, indomethacin, etodolac). This might be a danger if there is excessive bleeding due to the barotrauma of diving (e.g., middle ears, sinuses, lungs or any air-filled structure.

 

Mirtazapine / Remeron

 

Mirtazapine is used to treat depressive and anxiety symptoms. Possible side effects that may be adverse to diving include:

 

• Drowsiness: Mirtazapine should be taken one hour before bedtime. Make sure you know how you react to this drug before driving or using dangerous machinery. Drowsiness often disappears with increased dose.

 

• Dizziness: Slowly rise from sitting or lying position.

 

• Dry mouth: Drink plenty of fluids. Chew sugarless gum or suck on sugarless candy to promote saliva production.

 

As a general rule, if these drugs are taken while on a diving holiday it may be advisable to take them before bedtime and after the diving day is over and not in the morning or during the day.