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any restriction on tasks requiring individual or cooperative
judgment. He must be cognitively intact. He must have
maintained remission for a significant period of time. As for
what constitutes a “significant period of time,” it may differ
from diver to diver depending upon the particular diagnosis
or patient circumstances. For that reason, consultation with
the treating medical provider may be appropriate. Should
the evaluator be familiar with the diagnosis and treatment of
such conditions (e.g., if the evaluator is a psychiatrist), then
consultation may not be necessary. For evaluators not highly
skilled in such determinations, Divers Alert Network
®
(DAN
®
)
has medical resources and staff available for consultation and
should be contacted.
Psychiatric illnesses in remission are not, in and of
themselves, contraindications to diving. It is the risk of
inappropriate judgment or action that is of concern to the
evaluator. It is therefore most important to understand the
protracted remission of illness means the prospective diver
has maintained an asymptomatic state and has typically been
driving, working and participating in various recreational
activities that require appropriate cognition, cooperation and
judgment. It means there is a clinician who has participated
in the assessment and treatment of the prospective diver who
should be available for consultation. Demographic data suggest
that perhaps as high as 50 percent of the American population
experiences an episode of psychiatric illness. Many of these
individuals may dive safely if their illness is successfully treated.
The second consideration is the assessment of medication
prescribed for psychiatric disease. There are few medications
inherently problematic in divers using air at standard
recreational depths. While there is little actual data on
psychiatric medication at depth, there is no data demonstrating
the hazard of selective serotonin reuptake inhibitors, serotonin
and norepinephrine reuptake inhibitors, nor is there data
regarding the hazards of the group of agents usually referred to
as atypical antipsychotics, often prescribed for antidepression
augmentation, bipolar disorder and schizophrenia. Stimulant
medications used to treat attention deficit hyperactivity
disorder (ADHD) show no clear risk; the greater risk is the
loss of medication benefit if it is not taken in a timely fashion.
Antiseizure medications must be assessed on a case-by-case
basis. Diving while taking lithium carbonate is relatively
contraindicated because of the severe hazards associated with
potential lithium toxicity if the diver becomes sodium depleted
or dehydrated. Benzodiazepines and benzodiazepine-like
compounds are contraindications to diving because of their
sedating and cognitive- and judgment-impairing qualities.
There is no evidence to suggest that recreational scuba
diving poses a special risk to psychiatric patients in remission
receiving appropriate medication without side effects.
Prospective divers in remission, under appropriate care
and who function without limitation may be considered
reasonable candidates for diving. Use of nitrox or other
exotic gas mixtures, diving below standard recreational
depths, decompression diving or other special circumstances,
however, all require individualized assessment.
AD
MEDICATIONS AND DIVING
Medications have become a part of an increasing number
of divers’ lives. Do you want to know more about safely
incorporating those medications into your diving? Watch the
online lecture “Medications and Diving” at www.DAN.org.
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