Bipolar Disorder & Diving

A discussion about diving with bipolar disorder.
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A key element of the DAN Mission is educating the diving public and the medical profession on the appropriate care for divers injured in dive accidents. This education takes on many forms, disseminating information on topics related to dive safety through articles, reports, seminars, lectures and training programs.

[@kambizjamousi2056]

Regarding this instructor's illness, it should be noted that in both manic and depressive states, if the condition is not controlled, diving is not permitted. This is especially true during manic episodes, which may be accompanied by risky and dangerous behaviors, making it completely inappropriate for an instructor to dive with their students.secondly due to his/her medication he or she is very porn to drowning and diving in risky conditions contraindications for this guy

[@DrFJCronje]

Thank you for pointing out these crucial considerations, Kambiz. It's indeed vital to recognize that diving while experiencing uncontrolled manic or depressive states is highly unsafe, particularly during manic episodes, due to the potential for risky behaviors. Additionally, the effects of certain medications can increase the risk of drowning and make diving in hazardous conditions even more dangerous. Ensuring that any diver is both mentally stable and not adversely affected by medication is essential. I also agree that it would be highly exceptional for an Instructor to be approved to provide instruction with a confirmed diagnosis of Bipolar Disorder treated with medication -- for the safety of both the instructor and their students. Your insights highlight important safety protocols that must be adhered to in diving instruction. Thank you so much, Dr Frans Cronje

[@DrFJCronje]

Thank you Kambiz. Yes, my personal advice would be conservative, as you suggested. If the individual is stabilized on medication with a better safety profile than bupropion, I will reconsider. This is the type of situation I would not make an individual decision on fitness. I would solicit the opinions of diving medical colleagues to have a consensus verdict. Thank you again.

[@Gabi-sm7du]

Any medical condition can be more or less severe. So if the instructor did not show any unapproperiate behaviour, why should he have to stop diving or instructing? However, if he chooses to start with those medication, he has to make sure, that he is not negative affected by it. Maybe a 3 to 6 month period to survey how it works? of course no teaching during that period. For the first couple of courses, he could have a DM to join. If there is no prove that the med increases chances of seizures, why overdue it? Diving has some risks anyway, you cannot completly exclude all.

[@DrFJCronje]

Hi Gabi, thanks for engaging. You raise several valid points. A major element of this discussion revolves around the risk of seizures associated with bupropion and the risk of an instructor with bipolar disorder possibly putting his students at risk. First, a quick note on Bupropion: Bupropion has been linked to an increased risk of seizures (from 1/1000 on lower doses to 4/1000 on 450 mg). Certain people are more susceptible, such as those with a history of seizures, eating disorders, or those withdrawing from alcohol or sedatives. Numerous case reports and ongoing surveillance have documented seizures in patients taking bupropion, often associated with dose increases or existing risk factors. While the exact cause is unclear, it’s believed that bupropion's impact on brain chemicals may trigger seizures. Despite its benefits, it's important to be aware of this risk and use the medication cautiously. Given that seizures have a high risk of drowning underwater, this is not an insignificant risk. The additional confounding factor is being an instructor. In DAN Southern Africa, we consider Bupropion use a contra-indication to diving. It has also been ruled as unsuitable for Commercial Divers and Pilots. Thank you for your suggestions for mitigating the risk of using a divemaster. Kind regards, Frans

[@TanjaHase_Fronczek]

Based on the information given 1. I would be against this person working as an instructor if the person is prone to risk taking, reckless behavior… or at least during this period of his condition this person should not be instructing / responsible for the safety of students… 2. If ppl want this person as an instructor it should be their decision after they are being educated about the persons condition. 3. If the person wants to dive it should be the persons own decision if he wants to take the risk or not as long as no one else is being endangered….. It is hard to form an educated opinion as I do not have enough in depth knowledge about being bipolar or the risk factor of seizures while taking the medication….

[@DrFJCronje]

Thank you for sharing your thoughtful perspective, Tanja. It's understandable to have concerns about the safety of both the instructor and the students in such situations. Your points about the importance of ensuring an instructor is not prone to risky or reckless behavior during a period of instability are well-taken. Educating potential students about the instructor's condition is a considerate approach, allowing them to make informed decisions. Additionally, respecting the personal autonomy of the instructor to dive, as long as it doesn't endanger others, is a balanced view. Whether it is possible to allow Instructors to dive with any potentially unstable mental health problem poses various challenges, including liability for the dive operator or resort. It's clear that your reflections come from a place of care and a desire to prioritize safety, which is essential in this context. Please read my response to Kambiz's comment below for additional information. Kind regards, Dr Frans Cronje

[@DrFJCronje]

Hi Tanja, I like your succinct summary. A good track record of medication stability and safety, disclosure of the condition, and avoiding endangering others would be three important governing principles. The challenge would be the practical implementation. Thank you for your valuable perspectives!