Medication, Mental Health and High Altitude

Does anyone have experience managing mental health/medications at high altitude? Up until now, I really only rock climb, never above 4,000ft above sea level. However, I want to plan a trip to Nepal to trek to base camp, as well as do some things at higher altitudes within the US.

My psychiatrist doesn't seem to know much about this, he says he doesn't think people with my condition and medication go into high altitudes for climbing trips. My guess is that if I ask a psychiatrist from a state that might encounter this question more often, I'll find a more supportive answer?

I have bipolar 2 and take Lithium. The concern is dropping my lithium dose to avoid toxicity in high altitude and then not sleeping enough from just being uncomfortable. Lack of sleep is an issue for bipolar. I see his point but maybe there is a way to balance this with some sort of medication to help me sleep as well?

I refuse to believe that this can't be done but I am not a doctor. I am just curious if anyone has been through this/has any references.

Thanks!!
Jess

Jess ClimbsRocks wrote: Does anyone have experience managing mental health/medications at high altitude? Up until now, I really only rock climb, never above 4,000ft above sea level. However, I want to plan a trip to Nepal to trek to base camp, as well as do some things at higher altitudes within the US.

My psychiatrist doesn't seem to know much about this, he says he doesn't think people with my condition and medication go into high altitudes for climbing trips. My guess is that if I ask a psychiatrist from a state that might encounter this question more often, I'll find a more supportive answer?

I have bipolar 2 and take Lithium. The concern is dropping my lithium dose to avoid toxicity in high altitude and then not sleeping enough from just being uncomfortable. Lack of sleep is an issue for bipolar. I see his point but maybe there is a way to balance this with some sort of medication to help me sleep as well?

I refuse to believe that this can't be done but I am not a doctor. I am just curious if anyone has been through this/has any references.

Thanks!!
Jess

It certainly doesn't hurt to get a 2nd opinion and talk to another doctor but I would proceed with caution. I've been on lithium and, in my experience as well as observations from other people on lithium, it seems to weaken one's cognition, as does altitude  and I would not want to be in that environment on lithium.

I don't doubt that your experiences are different and that you can handle yourself much better on lithium as somebody who takes it regularly, but do know that it does really screw with some of your body's abilities to self-regulate. A lot of the psychiatric drugs do. For example, I take clomipramine (a tricyclic antidepressant) which messes with my liver and seriously impacts my body's ability to use water efficiently and this makes me far more prone to dehydration, which limits my ability to cope with altitude.

But I say this not to discourage you but to offer hope. I live at around 7000 ft and can manage backpacking up to around 11,000 to 12,0000ish feet, although around 12,000 I really have to be on top of self-care. I suspect you would be able to adapt to the low end of high altitude, especially with time and a healthy amount of regular exercise. Perhaps Nepal might be pushing it, but I think that certainly some of the high mountainous terrain in the lower 48 could be accessible to you. However, it is prudent to be cautious and seek advice from medical professionals.

Bipolar people definitely go on high altitude climbing trips.

I'm also bipolar, but I don't medicate so I can't help you with that question. Good luck on your adventure!

cognitive effects at altitude, concern about renal function with addition of diamox and nsaid'ing at altitude.

What about discussion of depakote as the stabilizer?

Also, regarding sleep, there are many solutions if you're worried about getting enough sleep. I also have bipolar and struggle with sleep. In addition to a drowsiness side effect from the clomipramine I also take melatonin at least 2 hours before I sleep which helps me wind down.

Things like being outside or dimming/turning off lights, or playing some soft quite music and avoiding caffeine can also help your body and mind wind down to sleep. Especially the light, which tells your body that it's time for sleep. Melatonin also helps with that. If those type of things aren't enough and you need something more powerful, you might ask your doctor if it would be possible and/or appropriate to change your medication to something that has a drowsiness side effect.

Many classes of psychiatric drugs have some that include such side effects. Off the top of my head, seroquel (anti-psychotic and mood stabilizer) has this side effect, as do several antidepressants. Additionally, there are several different OTC sleep aid options available if that is a better option than changing your medications.

The point is that there's a lot you can do to help your body manage activities at high altitude, but you (and preferably also your doctor/doctors) need to develop an informed plan and proceed cautiously. I think there's a good chance that it's possible for you, but it may require you to adapt your lifestyle, diet, exercise regimen and/or even medication regimen. But certainly do get out there and ask those questions, seek advice from medical professionals, and research into it for yourself. 

Buff Johnson wrote: cognitive effects at altitude, concern about renal function with addition of diamox and nsaid'ing at altitude.

What about discussion of depakote as the stabilizer?

He is hesitant to take me off lithium/change it as my stabilizer because it is supposed to be ideal for one of my main issues. This seems to be true because that issue has almost completely disappeared since being on lithium.

Here's a case report that's worth a read

http://www.clinicalschizophrenia.net/pdfs/FeaturedPaper-Brahm.pdf

There does appear to be a fairly good correlation in lithium pharmacokinetics (essentially, drug uptake) and altitude change, probable secondary to erythrocyte changes.  Dehydration does not seem to play a role, but kidney function is an important consideration. Kind of surprising to me, I can't find much detriment in using diamox with lithium to adjust your pH and pee out some bicarb.

What would be difficult is assessing whether you've got a slight mental status shift because of drug uptake or experiencing an altitude illness leading into HACE. Like others offered, there are surely people with abnormal psych out in the mountains and base camps doing just fine once they figure out what works for them.  One topic all over the search result is completed suicide risk and bipolar with high altitude, although I work at lower altitudes with higher completed rates in wilderness areas, so I suspect geographic/social isolation plays a much larger role.

Interesting topic, certainly could use some WMS research input on managing psychoses with high altitude.

Additional search, small lit review primarily discussing acute issues --
https://www.wemjournal.org/article/S1080-6032(08)70190-X/fulltext

I couldn't find anything on pubmed, but I'm not very bright to begin with.

Poor sleep is what I always expect at high altitude.  
I would try something closer to home before making my way to Nepal.  
The elevations aren't close, but when I'm sleeping above 12,000 ft in Colorado, my body knows it.

Buff Johnson wrote:Additional search, small lit review primarily discussing acute issues --
https://www.wemjournal.org/article/S1080-6032(08)70190-X/fulltext

The hyperlink didn't work on my computer. If anybody else is having trouble with that link, here's the DOI:
http://www.bioone.org/doi/abs/10.1580/07-WEME-LE-070.1

I’m not personally familiar with your medications, and I am especially not qualified to give medical options!

On that note! Anybody who is concerned about sleep at high altitude should consider a Benadryl+melatonin combo. Neither of these slow the heart rate while sleeping unlike sleeping medications which can actually hurt more than help in low oxygen environments. I discovered this cocktail after a stint of not sleeping for 4 days straight. With it, I sleep like a baby during rapid ascent schedules (ie. I sleep for a couple hours, wake up, sleep a couple hours, wake up, sleep...etc). It’s actually very manageable for me at this point and I can figure out exactly how much to take of each based on the activity the following day.

Chris C. wrote: I’m not personally familiar with your medications, and I am especially not qualified to give medical options!

On that note! Anybody who is concerned about sleep at high altitude should consider a Benadryl+melatonin combo. Neither of these slow the heart rate while sleeping unlike sleeping medications which can actually hurt more than help in low oxygen environments. I discovered this cocktail after a stint of not sleeping for 4 days straight. With it, I sleep like a baby during rapid ascent schedules (ie. I sleep for a couple hours, wake up, sleep a couple hours, wake up, sleep...etc). It’s actually very manageable for me at this point and I can figure out exactly how much to take of each based on the activity the following day.

Quick aside note to this:

In rare cases, diphenhydramine (Benadryl) can have a paradoxical effect of inducing hyperactivity and hypomania. I have one friend with bipolar for whom diphenhydramine would induce an manic episode. Probably not the case for you, but something to keep in mind. Also, liquid diphenhydramine like Zquil or other OTC products may work faster than pills, which may be something to consider.

And also I would talk to your doctor before considering taking more than 5mg of melatonin per night as there is some evidence that long term use of higher doses can disrupt your body's natural system of regulation. 

As a side note: my understanding from friends who climb mountains is altitude can affect the same person quite differently on different trips/expeditions. One friend had no issues one trip and then had hellish altitude issues on a trip to Ama Dablam where he never left basecamp and had tapering-off symptoms which lasted for like six months or so after he got back.

Thank you all for the information! Keep posting, of course but it already helps to know that there ARE indeed people who do this. Seems like I have a lot of research/talking with my doctor to do. At least I can test smaller altitude levels here in the US.

If anybody has a doctor they like that they work with who understands altitude/bipolar, I'd love to know who they are. I'm going to see what my psychiatrist comes up with but I think I'd like to cross it with a 2nd opinion of someone who actually knows a bit more about it.

Just wanted to write an update incase someone comes along with the same question. Basically, in NYC, I spend most of my time at -15ft below sea level with the subway lol. The day before I leave for Denver, I will need to reduce my lithium dose - even thought it's just at 4,000 ft. If I go closer to 10,000 - I will need to reduce again. And if I do ever get to Nepal, I will most likely need to completely come off of it.

I am nervous about reducing my dose, the last time I did this it wasn't so easy. But I am still looking for information about this, trying to get in touch with people in Denver who specialize in altitude and different conditions. http://www.ucdenver.edu/academics/colleges/medicalschool/departments/EmergencyMedicine/Clinical/Specialties/team/Pages/default.aspx (ignore the "strange and bizarre" lol)

Yer gonnnna die

Anothering you might try to talk with doctor about would be if switching temporarily from lithium to lamictal for high altitude excursions. In my experience, lamictal has a similar effect to lithium (albeit much weaker), so it might be better than dropping off the lithium.  

master gumby wrote: Yer gonnnna die

At some point!

Nate Tastic wrote: Forgot, here is the video I mentioned before:

And their site:

https://alpenglowexpeditions.com

Thank you for this!

eli poss wrote: Anothering you might try to talk with doctor about would be if switching temporarily from lithium to lamictal for high altitude excursions. In my experience, lamictal has a similar effect to lithium (albeit much weaker), so it might be better than dropping off the lithium.  

Good to know! Yeah I definitely notice it when I drop doses. Good to think about.