Depression

Depression in the UK is very common.  Most cases are managed in primary care with only the most severe requiring specialist assessment & treatment.  Secondary care doctors will come across patients who are taking antidepressants on a regular basis.

The aim of this guideline is to provide a basis for the assessment of divers who wish to dive whilst taking antidepressants.

Depression is a condition where the patient experiences a disorder of mood. They complain of “being down”, unhappy, sad, tearful, poor sleep, feelings of hopelessness & worthlessness, poor concentration & decision making,  occasionally thoughts of self harm & suicide. These symptoms are also observed by close friends & relatives.

The cardinal diagnostic features are
·               Poor sleep
·               A black cloud hanging over the day when they waken
·               An inability to get pleasure from things such as hobbies that formerly provided pleasure

The full diagnostic features are listed in ICD10

http://www3.who.int/icd/vol1htm2003/fr-icd.htm

The concerns are that a diver who is suffering from depression may not be able to function in the water due to anxiety, poor concentration & decision making, or the irrational decision to use diving as form of suicide. This would put the sufferer & his buddy at risk.

There are also concerns about theoretical risks of diving whilst taking antidepressants.

However a patient who’s depression has “lifted “ & is now clinically cured but requires antidepressants to maintain that state of well being can probably dive safely.

Divers who are taking antidepressants must satisfy the following criteria:

There is a small but significant inhibition in coagulation in some patients taking SSRIs.  This would exacerbate the bleeding phase of DCI.  It may also make the bleeding associated with barotrauma worse.  It is therefore recommended that the maximum depth should be an E.A.D of 30 meters to minimise the risk of DCI & the slight theoretic risk that they might increase narcosis.

Referee Actions 

We would expect the referee having contacted the diver & taken an appropriate history. To write to the patients GP requesting that the questionnaire is filled out.  On this basis the referee may be able to sign the form without seeing the patient if there is any doubt the referee will have to see the patient.

THE PATIENT QUESTIONNAIRE CAN BE DOWNLOADED HERE

References

Arch Fam Med 1998 7 78-84

J.Clin Psychiatry 2004 65 1642-53