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What links Winston Churchill, Lady Di and Stephen Fry? Yes, the Big Black Dog of depression. The College of Psychiatrists tells us that 1 in 10 of us gets it enough to warrant treatment. But sadly only 1 in 10 of those cases is ever really treated properly, leaving a lot of loose cannons out there. Poor lambs.

However treatment is a whole lot better than the old days St John's Wort in the medieval times and then the development of the antidepressant medications last century. Initially these were wrought with side effects and mostly incompatible with diving. Dry mouth, a racing heart, anxiety, twitchiness and insomnia would add up to a package that should not really strap on a BCD and fins. Also, they were not 100% effective. So the morbid dark thinking soul could potentially be a risk to themselves as well as their buddy. So that was a 'NO' on the Fit to Dive form.

Then the world was given the SSRI's (Selective Serotonin Reuptake Inhibitors). They do what they say on the box, leaving a lot more serotonin not re-uptaken in the brain synapses. Ergo total happiness and a world filled with sunshine and skipping lambs with pink ribbons passing love to you and me.
Ralf Tech
That's the theory, but all is not as it seems: SSRI's are a far safer drug to dive with. Less side effects and I pass a lot more people who take these than the old days of "tricyclics". But there are warnings. The diver on them should be stable. Side-effect free and in a good place mentally. This takes a while to get there.

If you have just been started on these meds, it takes 2 weeks to kick in and have an effect. So, I am only really happy to say 'yes' if the diver has been on them a month, at least. This WILL involve a face to face medical as well, to check the mental state of the diver and also includes heart tests for side effects from the medication.
Coming off them can be an issue as I have seen some problems when this occurs. Remember the Seroxat Scare a while ago? So, a frightened, panicking, all-over-the place diver is a risk too. Best wait a couple of weeks from the last tablet to the next dive.

There is another angle that does affect a doc's critical judgement too. And that is, that diving is a great form of therapy as well. Or the reverse too, e.g. the diver with a reactive depression, because his mum's died, has been put on Prozac, could mentally worsen if their passion or even employment (if they were an Instructor) is taken away. So this is taken into account and exceptions made where necessary.

Remember, a good dive doc should always do everything to make sure the diver can dive if possible. We are here to facilitate rather than restrict.
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