Jet Lag May Exacerbate Mood Disorders

For leisure travelers, jet lag usually amounts to only a minor inconvenience. In people with mood disorders, however, circadian misalignment may trigger more acute sleep and mood disturbances, Robert Sack, M.D., a professor of psychiatry at Oregon Health and Science University, told Psychiatric News. People with mood disorders need to be aware of this possibility when traveling across multiple time zones.

Psychiatrists may want to encourage such patients to use light exposure and melatonin prior to departure to hasten their adaptation to the new local time, Sack said.

A hypnotic medication or melatonin may help improve sleep on the plane and when taken at bedtime the first few nights in the new time zone. A Northwestern University study found ramelteon, a melatonin receptor agonist, taken at bedtime, was more effective than a placebo in speeding sleep onset for the first four nights after arrival in 110 healthy adults who had flown five hours eastward.

Individuals who have not taken such medications previously should take a test dose at home before a trip, Sack said. Hypnotics' potential adverse effects include amnesia and confusion.

Caffeine can help counter daytime sleepiness. The potential usefulness of other alerting agents is being studied.

Researchers at the Atlanta Sleep Medicine Clinic found the wake-promoting medication armodafinil improved daytime alertness, assessed by both objective and subjective measures, in 427 people traveling from the eastern United States to France. The Food and Drug Administration has approved armodafinil for use in treating sleepiness in narcolepsy, shift-work sleep disorder, and obstructive sleep apnea. In March, however, the FDA declined to approve armodafinil's use for jet lag.

More information is in Sack's review, “Jet Lag,” in the February 4 New England Journal of Medicine posted at <www.nejm.org/doi/pdf/10.1056/NEJMcp0909838>.