Is there special travel preparation for bipolar vacationers that is appropriate?
One of my patients asked me this question as he prepared for a summer trip to Europe.
It’s a good question and I think the answer is “yes.”
Background
There are at least two studies (see references below) that examined the relationship between the direction of travel and presentation of patients with psychiatric emergencies in airports. One in London and the other in Honolulu.
The study conducted at Heathrow airport suggested that eastbound travel was associated with hypomania or mania and westbound with depression. In this study the association of westbound travel with depression appeared to be stronger. However the study did not consider how these presentations compared with presentations of other patients having psychiatric emergencies. In other words it didn’t evaluate whether patients having psychiatric emergencies were more likely in general to have depressive or hypomanic or manic presentations.
The study in Hawaii found that the association between travel direction and mood was strongest for hypomania and mania symptoms in eastbound travelers. Westbound travelers might have had slightly more depressive symptoms, but when you compared westbound travelers to the control group, which was a group of patients who hadn’t traveled, you can see that the association between westbound travel and depression wasn’t significant. On the other hand, eastbound travel was very strongly associated with hypomania or mania.
In addition, since seasons, particularly Spring and Fall, are often associated with mood changes in people who have a mood disorder, traveling from one hemisphere to the other, which naturally involves moving from one season to another, can lead to mood changes. If you’re in the midst of a fall or winter seasonal depression and you go to the southern hemisphere you may switch from depression into a normal mood or even into hypomania or mania.
And this is likely to be a particularly marked effect if you’re going from an area that has naturally cloudy weather to a sunny location.
The Plan
The most important thing to do is to make sure that you start out the trip in a relatively normal mood. Traveling when you are finding yourself becoming increasingly energized is extremely risky.
Just to be sure, talk to your doctor about medications to take “just in case” you find that you are not able to sleep during or after the trip.
To deal with sleep disruption from travel…
- Go to the jet lag calculator on the British airways website to find out how to make appropriate adjustments in light and darkness exposure during and after their travel in order to most quickly adapt to the new time zone. This is particularly important if you are traveling east because eastbound travel seems to be associated with more severe jet lag generally.
- Buy blue blocking glasses to help you with the “avoid light” part of the suggestion for adjusting to the new time zone. This is often the hardest part of the plan to follow.
This should be adequate to help prevent depression, but for those who are traveling east and who have some risk of hypomania or mania it may be a good idea to carry along a medication to ensure that you get plenty of sleep in your first few nights, since adequate sleep is one of the best preventatives for hypomania. In addition, sleeping later than you usually do is also a good way of preventing hypomania.
Finally, if you find yourself more energized than you would like to be, put those blue blocking glasses on between 6 PM and 8 AM and that should definitely help bring you down a notch.
References
Jauhar P, Weller MP. Psychiatric morbidity and time zone changes: a study of patients from Heathrow airport. Br J Psychiatry. 1982 Mar; 140:231-5.
Young DM. Psychiatric morbidity in travelers to Honolulu, Hawaii. Compr Psychiatry. 1995 May-Jun;36(3):224-8.