Depression is a serious and common mental illness. It affects more than 17 million Americans each year and it affects millions more worldwide. However, depression is not simply a disease of the mind; it can also physically affect an individual. Any person with depression should be treated. Fortunately, 80% of people who are treated for depression improve and are able to function normally. However, recognizing depression is important and can be difficult because there is a wide variety of symptoms and not everyone experiences all of them nor do they experience them to the same degree.
The symptoms of depression are many and include sadness, lethargy, a lack of interest in life, fatigue, irritability, mood swings, anger, agitation, worry, anxiety, the inability to make decisions, the inability to concentrate, episodes of crying, changes in sleeping and eating patterns, changes in appetite, aches and pains, and in extreme cases suicidal thoughts and hallucinations. Many symptoms of depression can be troubling for divers. People who are severely depressed and have suicidal thoughts and hallucinations should not dive. Those who have difficulty concentrating and anyone whose cognitive ability is affected should not dive until they have been treated. It is also important to note that some symptoms, particularly aches and pains and an inability to concentrate can be confused with decompression illness, which can make a diagnosis difficult if issues are encountered while diving.
Treatment for depression can include psychotherapy and generally involve taking prescription medications. There are many anti-depressant medications on the market today which target the central nervous system (CNS) and all have similar side effects that vary in intensity from medication to medication and person to person. As with all medications, some people will experience side effects while others will not and it is important to determine what side effects will be experienced while on a medication before diving.
There are three families of anti-depressants. These are selective serotonin reuptake inhibitors (SSRI’s), monoamine oxidase inhibitors (MAOI’s), and tricyclics/tetracyclics/heterocyclics (TCA’s/HCA’s). SSRI’s tend to be more expensive, but are also relatively safe for those who dive. These medications can cause drowsiness, which can be a problem for divers, and can also increase the risk of bruising and bleeding, which in turn increases the risk for barotrauma of the lungs, ears, and sinuses. This risk is increased if the diver is also taking a blood thinner. In high doses, there is a possibility of seizures, which could be fatal during a dive.
MAOI’s can cause dizziness and drowsiness. There are certain foods that must be avoided when taking MAOI’s, particularly aged and fermented foods, and if taken in conjunction with certain medications, high blood pressure can result. TCA’s/HCA’s can also cause dizziness and drowsiness and can cause blurred vision. MAOI’s and TCA’s/HCA’s are more likely to have these side effects than are SSRI’s and if these side effects do occur and affect a diver's ability to concentrate, see clearly, or make decisions, then that diver should avoid diving as the risk of having an accident or injury are much higher than normal.
There are also other popular anti-depressants, including bupropian (Wellbutrin and Zyban), trazodone (Desyrel), and venlafaxine (Effexor). These all increase the chances of a person having seizures by lowering the body's seizure threshold. In addition, venlafaxine has potential rare side effects that include difficulty breathing, excitability, and fainting. Bupropian can also have other side effects including dry mouth, CNS stimulation, agitation, nausea, vomiting, rash, tinnitus, headaches and migraine, and psychosis.
Overall, a diver who suffers from mild depression may be able to dive without treatment. If a diver has moderate depression and there are no side effects that could cause problems while underwater, then diving may also be permitted. Severe depression would probably contraindicate diving in any situation. Once a diver has been treated for the depression, diving may be resumed or may begin, but only if there are no side effects from the prescribed medications that could cause issues during a dive. When in doubt, the best thing to do is to consult with your regular physician or a dive doctor to ensure that diving will be safe for you and your condition. If you suffer from depression and take medication for it, your doctor might be able to switch you to a different prescription if the one you are taking has side effects that affect your ability to dive. No matter what, you must be safe when you dive, so it is crucial to get the depression and medication under control first so that you can dive without concern and can simply have fun in the big blue sea.