International Travel & Bipolar Disorder
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Q:  International Travel & Bipolar Disorder

Dear Dr. Phelps,
Are there any good rules of thumb for preventing problems with BP during international travel?

I'm going to be traveling overseas for the first time since my diagnosis (BP II) a few years ago.  I used to travel all over the world  and would simply jump into the day in whatever new time zone I found myself in -- I'd go to bed and eat the appropriate meals at the locals'  usual time -- on the theory that I should shock my body into adjusting to the new time zone as quickly as possible. My jet lag would fade fairly quickly that way but I'd be especially tired and disoriented for the first day or two.  I'm wondering if that method would be wise with BPII.  I've read(on your web site among other places) that east west travel can lead to manic or depressive episodes, and as this is a working trip and a tryout for my ability to do a job that involves international travel I'd especially like to avoid those.  I was worrying about insomnia and concentration problems more than anything else, until I read an article indexed on PubMed about people taken directly from Heathrow Airpo  rt to the hospital(!).  Half were schizophrenic rather than bipolar, etc., but the possiblity of severe and fast reactions hadn't occurred to me.

What causes problems with long-distance travel and bipolar disorder specifically?  Is it stress, changes in light, disruption of circadian rythms?  Are there ways to use light, sleep schedules, etc., to prevent or alleviate any problems with bipolar disorder especially?  Would travel from the  U.S. eastward (to, say, Russia) be more likely to cause manic or depressive problems?  Or is personal inclination rather than direction of travel more relevant? 

Also:  what to do about medications?  I'm traveling to a time zone that is 10 hours ahead of my home.  If I jump into the new time zone I'd be taking my bedtime meds nearly a half day early by my body clock.  I take lithium and Lamictal, and Seroquel for sleep -- Is the shortened period from the previous night's dose OK?  I'd be taking that previous dose on the overnight trip over the Atlantic, I guess, which is another worry.  I'm pretty groggy and dizzy if I have to get up after taking my meds, so I'm hoping there's no sudden emergency return to the U.S. and disembarking at a place like JFK at an inopportune time!  Ive heard about melatonin, but does it mix well with phychiatric medications?  Could I (and would I want to) increase the Seroquel instead to knock myself out and ensure the right amount of sleep?  Lack of sleep is guaranteed to cause me problems so I'm especially concerned about that.


Dear Cara -- 
These are very good questions, very wise of you to be thinking through this, given your plans. 

1. What causes problems with long-distance travel and bipolar disorder specifically?  Is it stress, changes in light, disruption of circadian rhythms? 
You know the joke about multiple answers: "yes". In this case the circadian rhythms are likely the key component, modulated by light, and subject to even more disruption by stress (e.g. lying awake thinking about a highly exciting or highly disappointing day).  At present, from what I read, the key is to re-regulate your internal biological clock, and that's not easy to do quickly. Remember none of this is anything we were ever prepared for evolutionarily. 

2. Are there ways to use light, sleep schedules, etc., to prevent or alleviate any problems with bipolar disorder especially?  
You've probably read about using melatonin to "prevent" jet lag (more like adjust yourself more quickly and minimize it). That makes sense in this context but of course is completely untested in terms of preventing bipolar mood shifts so is just trying to use what we know to perhaps minimize the potential for trouble, with an unknown degree of risk from using melatonin (although people have done this rather a lot; and now there's a melatonin-shifter medication (Rozerem; ramelteon), but no data yet -- just did a quick check; could have missed something, nothing big probably though -- on the effects of this medication in bipolar disorder. To my knowledge no one has formally adapted the usual recommendations for jet lag management to use in someone with bipolar disorder. You and your doctor might be able to use this article by a
well-known sleep researcher

3. what to do about medications?
I'm not a specialist in this area; there's probably somebody out there who's studied this, but I haven't seen any literature on it myself. You might even try writing Dr. Avery, who is an extremely nice fellow and a thoughtful question like yours might just get a reply (send me a copy if you get one). His email address is on the abstract linked above).  I just generally try to bump the medication schedule around the clock face during travel so as to be roughly halfway to the timetable you'll be on when you get there -- pretty seat-of-the-pants approach. 

You've probably also thought through the bigger question of whether taking a job with known potential for sleep disruption (through time-zone-crossing travel) is a good idea. That's one to discuss with your doc', as you may already have done. 

Good luck with all that -- 
Dr. Phelps

Published October, 2006


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