Depression is a common affliction, a disorder that is present in 1 out of every 20 Americans and is also widespread throughout the world. This is a mental disorder which has a wide range of symptoms, including the feeling of sadness, hopeless, and of being down. People who suffer from depression often have lost interest in life and in the activities they once enjoyed. Other symptoms of depression include fatigue, inability to sleep, lack of energy, low level of concentration, restlessness, irritability, and a reduced capacity to concentrate and make decisions. Sometimes, people experience a manic side to the disorder, in which they often switch from depression to the opposite end of the spectrum which can include an increased sense of happiness and hope, racing thoughts, reckless behavior, and the capacity to be easily distracted.
Since the disorder of depression is so common in the general public and equally so among the diving population, it is crucial that this issue be addressed. After all, it is important to consider how the potential symptoms will affect a diver and what effect the treatments may have. Let's consider the symptoms first. The most concerning symptom of depression for the diver is the inability to concentrate and make decisions. When diving, there are times when emergencies come up and a diver has to stay calm, keep a clear mind, and make decisions quickly. Even when there is no emergency, a diver must still be able to monitor their gauges and equipment, the environment, and their buddy as they are diving and this certainly does require concentration and close attention. Any diver who experiences depression and subsequently loses their ability to concentrate and make decisions places their own life at risk as well as the lives of other divers they are diving with.
There are a number of other concerns for divers that suffer from depression. One of these is irritability. If even the slightest thing goes wrong, such as the dive boat leaving late, a missed photo opportunity, or a stinging brush with some coral, then the depressed diver may lose control and become angry and this can cause additional problems on a dive. Lack of energy and fatigue can slow a diver down and make it difficult to perform when high energy is required. Any physical symptoms, such as headaches and joint pain, while rare, can happen and can cause a diver to confuse these symptoms with those of decompression sickness. Finally, depression in some people can be severe enough to lead to suicide and in areas in which there is easy access to water, 9% of suicides are due to drowning. While there are no solid statistics, it is known that a number of scuba diving deaths have been the result of suicide.
The primary treatments for depression are psychotherapy and medication. When it comes to taking medication, divers must be aware of the potential side effects of their medications because these side effects might have a bearing on whether or not scuba diving is safe. There are three families of depression medications, including selective serotonin reuptake inhibitors (SSRIs), tricyclics/tetracyclics/heterocyclics (TCAs/HCAs), and monoamine oxidase inhibitors (MAOIs). The most commonly used are the SSRIs. The most concerning potential side effect of SSRIs is the possibility of seizures. While rare, they are almost certainly lethal when diving and must be taken into consideration for those on high doses of SSRI medications. With any depression medication, there can be drowsiness and a reduced level of alertness, which can negatively impact a diver's performance. Also possible are dizziness and the inability to concentrate, think clearly, and make decisions. Rarely as well, SSRIs can result in increased bleeding, which can cause problems for the diver.
What does this tell us? Fortunately, most people who take antidepressant medication do so with few problems and this means that, unless any of the above symptoms occur, it is generally safe for these individuals to dive. If there are side effects that may interfere with diving, a diver may be able to alter the dose or the time in which the doses are taken which often reduces the side effects that can affect diving. Many side effects of depression medications disappear after the person has been taking it for a few weeks.
All in all, being able to dive while taking depression medications it is good news for the diver. However, diving is not recommended for those with moderate to severe depression or depression that remains untreated as depression ranges from very mild to requiring hospitalization, so it is wise to consult with a physician if there are any concerns. Once a diver’s depression is treated and is under control and they have few or no side effects, then they can resume diving knowing that they will have a safe and enjoyable experience.