Dr Daisy Stevens addresses the insidious nature of depression and its implications for diving.
In the United Kingdom, one in four adults is diagnosed with a mental health problem each year. Depression, anxiety and post-traumatic stress disorder are common among all groups in society, but despite increasing public awareness, suicide remains the main cause of death of men aged 15-49 (NHS England). This article will focus on depression, but often low mood and anxiety occur together.
Many curveballs in life can make us low in mood, whether it is a bereavement, financial strain, relationship difficulties, giving birth or work stress. These low periods often resolve after a few days to weeks, allowing us to return to our normal activities.
Depression can have many physical and emotional symptoms:
- Persistent sadness for weeks to months
- Loss of enjoyment of activities previously pleasurable
- Loss of hope
- Reduction of appetite
- Poor sleep
- Difficulty concentrating and making decisions
- Lack of sex drive
- Thoughts of self-harm or suicide
If you think you are depressed, the first thing to do is to contact your GP. They will be able to direct you to specialist support teams and start treatment if needed. This may include lifestyle changes, talking therapies and medications. If you are currently having suicidal thoughts then it is important that you seek help urgently, call 111, the Samaritans or go to the nearest emergency department.
What about divers with depression?
Active depression can affect a diver’s ability to function underwater. If they lack awareness, are struggling with concentration or suffering from anxiety, this can compromise decision-making and lead to safety measures being forgotten. If a diver has lost all hope, feels worthless and is actively suicidal, it is clearly not sensible for them to be diving. For these reasons, someone with active depression is not safe to go diving.
I take an antidepressant tablet every day and I no longer feel depressed, can I get back in the water?
Once the depression has lifted, whether this is because of talking therapies or medications, a diver may be fit to go back in the water. Many people find diving very therapeutic, saying it improves their mood significantly. To ensure a diver is ready to get back in the water they will need to see a diving doctor first.
During the appointment, you will discuss your mental health, any treatment received, and if there are any lasting effects on your day-to-day life. You may be required to get supporting evidence from your GP about how your mood has stabilised.
Just because you are on medications does not necessarily mean you cannot go diving. There are some medications which are considered safer than others.
The difficulty with medications, regardless of their indication, is the effect of pressure on their function. Some have been shown to have a greater effect at depth, others have additional side effects or no change at all.
Certain medications can increase your risk of nitrogen narcosis, or oxygen toxicity, while others could increase your risk of bleeding (which worsens barotrauma and decompression illness).
The important thing is to be stable on whatever treatment you have agreed with your GP for at least three months, and then your diving doctor will help explain the individual risks of each medication, and if necessary apply limits to your diving profile to ensure you are as safe as possible.
I have just stopped my antidepressant medication, can I go diving now?
It’s great news that you feel better, but it’s important not to suddenly stop your medication and without guidance from your GP. It might be safer to dive while taking an antidepressant if it controls your symptoms compared with stopping your medications allowing symptoms to recur just because you want to go diving.
All being well and after at least six weeks following stopping the antidepressant, it might be safe to get back in the water – speak to your diving doctor!
Interested in diving health and medicine?
This column is produced with DDRC Healthcare, specialists in diving and hyperbaric medicine. You can find out more on their website.
This Anatomy of a diver column was originally published in SCUBA magazine, Issue 103 June 2020. For more membership benefits, visit bsac.com/benefits.
Images in this online version may have been substituted from the original images in SCUBA magazine due to usage rights.