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donutboy
18-01-2014, 03:30 PM
Hi all

Please see if you can help me either by your knowledge or someone you know who can help me.

I'm 35 and was diagnosed with Bipolar Disorder II a year ago (I am a mild case). I have been on Lamotrigine 150mg (Lamotrigine is to help with any possible depression) for 9 months with No side affects, no dizziness, drowsiness, nausea, loss of cognitive function, nothing! Normal anti depressants don't work on bipolar as it is a chemical imbalance (I don't actually get depressed as such) my own doctor says I'm mentally stable and I have had no bouts of 'depression' for over a year.

I have been told I cant dive because of my medication, Lamotrigine is an AED (Anti Epileptic Drug) mainly given to reduce convulsions in people who have fits (I dont and have never had seizures) but also is given to people with Bipolar. In patience who have seizures it can increase the frequency in rare cases (1 in 10,000 < 1 in 100,000) but nothing in people with Bipolar.

I have been told that my medication COULD increase the affects of Nitrogen Narcosis but In the research I have done looking at medical papers, I have found no proof of this and I even found a paper done that looks at patience given nitrogen oxide for pain relief "there was no noticeable increase in the affect of the gas, the speed in which it took affect or the patience recovery from the gas".

My dive buddy would be a chap I have know since childhood and who I would trust with my life, he has said he would dive with me any time. I am happy to restrict my diving to 30m and never dive alone. I refuse to believe I am the only person with Bipolar who wants to dive or am the only person on this medication.

If I had not been diagnosed with Bipolar or placed on this medication I know my mental state would not have been an issue in diving, I am not looking to dive as an extreme sport. I love the ocean and always have, I have recently tried diving and am hooked!
Please help me dive again!

Links for supported data
http://www.ncbi.nlm.nih.gov/pubmed/17508997 (talks mainly about epilepsy but does support some data on AED's and diving)
http://www.medicines.org.uk/emc/medicine/25909/SPC/Lamotrigine+100+mg+Tablets/ (Information on Lamotrigine)

Nigel

Tel
18-01-2014, 03:42 PM
I'd suggest you contact a medical referee attached to a dive chamber. You'd get a more
accurate idea then of what's possible and they can also if necessary refer you to a specialist.

Based on what you've said though, think the 30m limit is a bit extreme. Narcosis is known to
start around 25m, but can be felt at much less. Past 25m and you've also got increased
gas consumption and deco issues which both could in your condition be a contributory factor
to a possible incident. Throw in the severity in conditions of UK diving and that's a pretty
bad recipe.

So in your situation id first see a diving doc, but even if I get an ok would be looking at 20m
max, nice clear warm-water diving in places with good medical infrastructure and some
hefty insurance.

GLOC
18-01-2014, 03:46 PM
Mark Downs on here is a referrer for the UKSDMC, so worth dropping him a line. Very onside and very approachable. Ultimately the risk is yours. No-one can stop you diving, but bear in mind that if a doctor has advised against it as they consider the risk too great and you do die whilst diving, any life insurance etc you have will unlikely pay out.

Regards

Janos
18-01-2014, 03:53 PM
I think you have to talk it through with a UK Sports Diving Medical council (UKSDMC) referee.

There's a list here:
http://www.uksdmc.co.uk/index.php?option=com_content&view=article&id=33:medical-referees&catid=7:medical-referees&Itemid=3

Janos

PS - Nitrous oxide is nothing to do with nitrogen narcosis.

Iain Smith
18-01-2014, 03:55 PM
Nigel,

Nitrogen narcosis and pain relief from nitrous oxide (aka "laughing gas") are completely different things. You can't extrapolate from one to the other.

The problems with mental health conditions (in general) are firstly that the condition may affect someone's ability to function underwater. This might be particularly the case during the manic phase of bipolar disorder, in which (as I'm sure you know) poor judgement and excessive risk-taking may feature. Obviously neither of these are a good thing underwater. Secondly, there are potential side effects of medication. You can find some specific information about lamotrigine and diving at the second link below.

You can find some information about bipolar depression and diving here:
http://www.scubadiving.com/training/basic-skills/ask-dan-august-2008
http://www.diversalertnetwork.org/medical/articles/Psychological_Issues_in_Diving_

In short, no-one can advise you over the internet whether you might be able to be cleared to dive or whether you should be advised not to dive. You need to have a full and honest consultation with a doctor with expertise in diving medicine. (I am a doctor who dives, which is a very different thing!)

You can find a list of the UK Sport Diving Medical Referees with their contact details here (http://www.uksdmc.co.uk/index.php?option=com_content&view=category&id=7&Itemid=3).

Hope this is of some help to you.

Regards,

Iain

donutboy
18-01-2014, 04:39 PM
Nigel,

Nitrogen narcosis and pain relief from nitrous oxide (aka "laughing gas") are completely different things. You can't extrapolate from one to the other.

The problems with mental health conditions (in general) are firstly that the condition may affect someone's ability to function underwater. This might be particularly the case during the manic phase of bipolar disorder, in which (as I'm sure you know) poor judgement and excessive risk-taking may feature. Obviously neither of these are a good thing underwater. Secondly, there are potential side effects of medication. You can find some specific information about lamotrigine and diving at the second link below.

You can find some information about bipolar depression and diving here:
http://www.scubadiving.com/training/basic-skills/ask-dan-august-2008
http://www.diversalertnetwork.org/medical/articles/Psychological_Issues_in_Diving_

In short, no-one can advise you over the internet whether you might be able to be cleared to dive or whether you should be advised not to dive. You need to have a full and honest consultation with a doctor with expertise in diving medicine. (I am a doctor who dives, which is a very different thing!)

You can find a list of the UK Sport Diving Medical Referees with their contact details here (http://www.uksdmc.co.uk/index.php?option=com_content&view=category&id=7&Itemid=3).

Hope this is of some help to you.

Regards,

Iain

Hi Iain

Unfortunately I know there's a difference it was just the only comparison I could find - the increase in nitrogen in the blood (even though it gets there under different conditions) I appreciate the differences. I couldnt find any experiments as obviously the affects of Nitrogen Narcosis are too random (dive to dive). Even in a mania I wouldn't be daft enough to volunteer for that experiment.

Ive read the above links and they say maybe depending on your medical state more than the medication but Ive spoken to two medical referees over the phone and they just say no as soon as I get to the medication. No offer to see me, look in to it, restrict my depth, nothing. they just hear Lamotrigine then run a mile. The links talk about the primary reason for the medication but in reality that seems to be garbage. I would just like an honest conversation with a medical refferee.

I just cant accept no one out there is diving on this medication.

Hopefully the Referee suggested above will be more open to discussion than the others.

Thanks

GLOC
18-01-2014, 04:47 PM
I just cant accept no one out there is diving on this medication.


Mark - http://www.londondivingchamber.co.uk/index.php?id=team and his own website - http://www.scuba4fun.org.uk/about_Us.htm

Regarding divers using those drugs, they might be using them and they might be ok, but the doctor who signed them off (if they did sign them off) would be carrying the liability if something went wrong. As I said, you can do what you like, no-one is stopping you, but your insurance company might not pay up if it goes wrong.

Regards

donutboy
18-01-2014, 04:51 PM
Mark Downs on here is a referrer for the UKSDMC, so worth dropping him a line. Very onside and very approachable. Ultimately the risk is yours. No-one can stop you diving, but bear in mind that if a doctor has advised against it as they consider the risk too great and you do die whilst diving, any life insurance etc you have will unlikely pay out.

Regards

Thanks Gareth I'll give him a try.
I know I can dive anyway If I choose, I'm prepared to not be covered by insurance, if necessary, BUT the one thing that will have to stop me is training, I think no matter how good you are you need to keep on board with training (keep learning especially with people trained to teach) unfortunately without a 'fit to dive' my local clubs wont have me (I can understand why, the risk to other divers and the club isn't worth 1 member).
Plus if I have to lie on a dive about a potential medical problem, that could endanger other divers and that's not even worth thinking about.

Thanks again
Nigel

greatwhite
19-01-2014, 10:54 AM
I had an accident yrs ago and was on medication to "take the edge off" of feeling a little low and as a pain relief. To make sure I will be covered by Diving insurance and holiday insurance I have sent my medical records to a UKSDMC referee Dr and hopefully will see him to get a 'fit to dive certificate' which the insurance company has advised. Best to pay the professionals rather than go diving with it on the back of your mind thinking if you will be covered if an accident does occur.