May 18, 2010
“Dear Dr. Vikingo. I’m an already certified 600+ dive diver who after tours in Iraq and Afghanistan with the Military developed PTSD. For the last 2 years I have been in therapy and have done inpatient treatment. I’m now stable and have no side effects. I’d love to get back to diving but need to do it right I take depakote blood test are fine and citalopram. When would you suggest I talk to my Drs. about this? I have been through CBT therapy, Individual, and group therapies. Honestly the most peacefull times of my life have been while I was diving.”
Per the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, (DSM-IV-TR), 17 possible symptoms that can develop following the experience of a traumatic event are divided into three clusters.
-Frequently having upsetting thoughts or memories about a traumatic event.
-Having recurrent nightmares.
-Acting or feeling as though the traumatic event were happening again, sometimes called a “flashback.”
-Having strong feelings of distress when reminded of the traumatic event.
-Being physically responsive, such as experiencing a surge in your heart rate or sweating, to reminders of the traumatic event.
-Making an effort to avoid thoughts, feelings, or conversations about the traumatic event.
-Making an effort to avoid places or people that remind you of the traumatic event.
-Having a difficult time remembering important parts of the traumatic event.
-A loss of interest in important, once positive, activities.
-Feeling distant from others.
-Experiencing difficulties having positive feelings, such as happiness or love.
-Feeling as though your life may be cut short.
-Having a difficult time falling or staying asleep.
-Feeling more irritable or having outbursts of anger.
-Having difficulty concentrating.
-Feeling constantly “on guard” or like danger is lurking around every corner.
-Being “jumpy” or easily startled.
Clearly many of these could pose a significant danger to diving.
All divers must show attention, concentration, decision making capacity, impulse control and behavioral modulation that are fully adequate to meet the demands of scuba. These faculties may be compromised in persons diagnosed with PTSD and treated with mood stabilizers such as the SSRI citalopram (Celexa) and the anti-convulsant divalproex sodium (Depakote).
Before returning to SCUBA, it would be prudent that: (a) mental status examination demonstrates the condition to be well controlled; (b) the diver who is taking medications has been on them for an extended period and side effects dangerous to scuba are neither reported nor observed upon careful examination; (c) there are no other contraindications, mental or physical, in the clinical picture; (d) the diver feels he is up to it and fully comprehends any additional risks; (e) the diver has been cleared for diving by his physician and makes full disclosure to the dive op (which likely will want to see written clearance) and to his/her dive buddy.
Best of luck and thanks for serving your country.
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such. Consult with your physician before diving.”