Visions & the Full Moon
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Q:  Visions & the Full Moon

Dr. Phelps:

My husband, 51 years, has been diagnosed by a Neuropsychologist with Bipolar I and Dementia (unknown origin).  He generally maintains successfully medicated with Wellbutrin and Gabapentin. However, he has noticed "hallucinations" of a sort upon attempting to go to sleep which involve gears turning and interacting (as in a clock) somehow connected, he says, to visions of planetary systems. These hallucinations became particularly powerful this year during the full harvest moon, 9-10-03, while we were building our cabin in the Alaskan bush. He is convinced there is a connection. He also reports a "physical sensation" that goes with the visions. Please advise as to whether you have heard of this particular set of symptoms and any research that may have been done or is ongoing.  Though he reports that his symptoms worsen monthly during the full moon I have only noticed a seasonal (fall) correlation during our 5 years of marriage. Thanks so much.


Dear Ms. F' -- 
Well, this is pretty complicated.  I'll just throw out some thoughts in somewhat random order: 

1. Wellbutrin and Gabapentin for bipolar disorder.  Well, this is not standard treatment, to put it mildly.  The reason I say that bluntly is that it seems to me that his "dementia" might at least be exacerbated by either of these medications, if not caused thereby (e.g. if the "dementia" clearly preceded each of them; if not, they are obvious candidates for examination as to the basis of the "dementia").  This line of thought is further warranted by the "hallucinations" story, regardless of its timing -- i.e. that this symptom as well warrants some examination as to whether these medications might be "causing" it somehow, or at least exacerbating it.  (Background, if needed:  Wellbutrin is an antidepressant, and all antidepressants can make bipolar disorder worse, with a few exceptions perhaps like exercise;  Wellbutrin works in part through a neurotransmitter called dopamine, which is associated with hallucinations in schizophrenia for example; Neurontin acts like an antidepressant in many cases and is not a mood stabilizer). 

2. On the timing question:  Well, first we note that you're in Alaska, or were this year when this was so notable.  And we also note that this occurred in September, which at Alaskan latitudes (even right here in mid-Oregon!) exposes a person to a pretty dramatic shift downward in the amount of light exposure one gets per day.  This shift, or something about September, is well known amongst my colleagues as a time when we'll see a lot of people with bipolar disorder get worse.  Then, on top of this we add substantial light exposure (the Moon, in this case, while out there in a setting with little other light at that time).  And, the light is at night.  We know that light exposure can clearly affect the circadian rhythms that clearly are associated with bipolar disorder (e.g. this essay on biological clocks and bipolar disorder).  

Adding all this up I'd say that perhaps there is indeed something about the moon in his case.  Since women's menstrual cycles, which clearly affect bipolar disorder, are often linked to the lunar cycle, there's a relationship in women along these lines but we can't invoke that one in his case, now, can we.  

Finally, I suppose we could wonder if there isn't something about this unknown "dementia" -- at 51? -- that is interacting with the moonlight; can't rule that out, since we don't know what we're dealing with!  I guess my point there is that there's something that strikes me as really fishy about the idea of "dementia" at 51, which is early even in familial early-onset Alzheimers, but in that case you'd have a family history of that to go on.  So I'd keep my attention on the possibility that somehow the "dementia" and the bipolar disorder are related (note the implication:  since he's not on standard treatment for bipolar disorder, is it possible the "dementia" could be addressed by such a standard approach?) (e.g. as outlined on my education website (where I don't make any money, so your visit there, if I prompt you to it, is of no advantage to me, just wondering out loud here; have a look at the section on treatment, which applies to BP I as well as to BPII....).  

I'd be interested in hearing from you if you ever learn anything more about any aspect of this, e.g write me in a year and tell me "remember the Alaska guy with the moon reaction; here's what's happened since...".  Good luck with that.   Don't let me get your hopes all up and ruin your current relationship with his doctor, now;  just think about this and perhaps cautiously introduce some of these ideas if you think that's warranted.

Dr. Phelps

Published December, 2003


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