Ultras and anti-psychotics

Triathlon Forum
1

Hello….I’m not a triathlete (my bf is), but I’m having some trouble finding out information, and thought maybe some of the posters here would have some experience as endurance athletes. Sorry if this is long.

I’m preparing for my first ultra, and am planning to run a few next year, including a 100 mile race.

I’m also bipolar and take Seroquel, which is an anti-psychotic. Due to injury, I haven’t been able to train for most of this year – my last race was 30k in the spring. The 30k race was the only ‘long’ race I’ve done since being on Seroquel – previously, I did race (including marathon) while on lithium (which I am no longer on). Lithium was fairly easy to handle – I just didn’t take any the night before the race (safe doses of lithium can cause lithium toxicity if you get too dehydrated) and hydrated well regularly, also ran with e-load and pedialyte. I am far more stable on Seroquel and don’t have any plans to go off of it.

But….I don’t know if there’s anything I need to prepare for/be aware of in terms of running really long distances, and the stress on the body, when on an anti-psychotic. (In terms of moving up the distances, I do have marathon experience, have run for years, and have done ultra-distance hikes, so I don’t think the increase in distance will be an issue in that sense) My family doctor and psychiatrist don’t really have a concept of ultras, so that hasn’t been helpful (in fact, when I was on lithium, I was told I would have to stop running, and had to find my own way to make sure toxicity wouldn’t be a problem while continuing to run as the doctors were not at all helpful).

I’m sure the races I’ll be doing (all trail….78k, 100 mile, and hopefully 135k) will be far more stressful on my body. I don’t have any concept of what the Seroquel might do under those stresses (and I’m still building back up after coming off of injury, so I haven’t been doing really long training runs yet).

I have 2 other questions, in addition to the general ‘what will Seroquel do under a lot of physical/mental stress’:

  1. for the longer races, I could be running for over 24 hrs (for my first 100 miler, I just want to finish, so I’m not going to push speed or anything). Since I take the Seroquel every night before bed, this would mean that I will be running through the time that I normally would take my meds.

….one thing about Seroquel….it also knocks you out. Sometimes it is prescribed for sleep disorders, actually. So I can’t take my full dosage, b/c I will fall asleep, whether or not I want to. But before I do, I will become very dizzy, start stumbling, slurring my words, and falling over, in general, acting EXTREMELY intoxicated, before I in essence pass out. Normally I take 600mg/night. I’m actually prescribed 800mg/night, but I find 600mg controls my symptoms, for the most part, although in times of stress I can have mild hallucinations in terms of hearing things, but I can go up to 800mg until those are resolved. I don’t take 800mg on a regularly basis b/c I find it very difficult to wake up in the morning, and in general, will be sub-functional for hours after getting up, which is not exactly career-positive.

So, during a race, when I hit the 24hr mark – do I take no meds? A small dosage that I should be able to stay awake and hopefully functional through? Will the stress of the race make my body more susceptible to a smaller dosage? One other point, is that if I don’t take my meds, I have a window of a few hours before I start to get withdrawal symptoms – dizziness, nauseous, feel like I have the flu, hot flashes. On the other hand, I cannot sleep without Seroquel now, so at least I wouldn’t have any issues staying awake through the night.

  1. I know it’s common (or not uncommon) for ultra runners doing longer races to hallucinate. I’m wondering if anyone who is bipolar (or schitzoaffective) has experience with ultra races at ‘hallucination’ distances, given that there is an existing predisposition to hallucinations. For the most part, my hallucinations (aural) are relatively mild, and I don’t lose grip with reality – basically, I know I’m hallucinating, and even though I’m terrified, and sometimes change my behaviour, I do know it isn’t real, though….it’s kind of hard to explain.

I’m thinking there are 2 possible scenarios here – 1)I hallucinate, but it’s not a big deal, b/c I already have to some extent learned how to handle hallucinations and know how to deal with them; or 2)the hallucinations are worse.

If anyone has any experience with doing endurance events (Ironman-distance races, for instance) while on anti-psychotics and/or being bipolar (or schitzoaffective), and could help me, I’d really appreciate it. If you don’t want to post, but could PM me, again, I’d really appreciate it.

Thanks!

2

I have done a couple shorter Ultras, 50k. However given the issue you are speaking of I would definitely seek a medical professional about this rather than a forum, even if something works for someone else it may not work for you, try to find a doctor with a background in endurance sports or some such.

3

Thanks.

I do definitely know it’s individual - nobody’s bipolar is exactly the same, and nobody responds to meds exactly the same, etc, etc.

That said, if anyone has experience - yes, I may not experience what they do - but it’s helpful in terms of what some of the possibilities are.

My problem really is, like I said, that my family doctor and psychiatrist don’t have any concept of what running an ultra is/could mean in terms of physical/mental stress. And I live in Ontario, and there is a shortage of family doctors, so basically, since I have one, no doctor I’ve contacted will take on a new patient who already has a doctor. My sports medicine doctor - I really like him, he’s excellent - but he has no background in anti-psychotics. I’ve tried to do research myself, but I can’t find any studies or abstracts related to this.

Besides, people who are in similar situations often have helpful advice. Like I said, I know we wouldn’t be exactly the same, but heck, I’ve yet to meet 2 individuals who have had the exact same race, but people can still offer advice about what to expect from a particular race. I’m not expecting this to supplant medical advice, I’m really just trying to gather as much information as possible.

:slight_smile:

4

I can’t answer the questions but thought I’d point out an additional resource: Kickrunners.com has a pretty healthy ultra forum with friendly folks. I enjoy reading their race reports (and have seen them mention hallucinations on more than one occasion).

Best of luck in finding the right balance!

5

Since you don’t need the seroquel to live, like say blood pressure medicine, why not just try skipping a dose 1 night and go running for a couple hours and see how you feel. Maybe your bf can bring it along in case you need it. My dad is a psychiatrist and I know many doc’s but none of them I know have a clue about ultra distance events. You be better off telling them that you are looking to pull 24 hour shifts at a coal mine or something rather than trying to explain to them ultra running.

6

thanks everyone.

mobius, kickrunners looks great.

alex, yup, that’s been my problem with the doctors.

i guess i’m also a bit worried about the longer training runs, especially if i’m by myself (well, one of the dogs will be with me) on trail. a few hours could be good…maybe i could get the bf to come on a training run like that with me (i bet he’s reading this going ‘damn!’ tee hee).

i’m assuming the races will be the most stressful, especially the 100 miler. i am actually going to try in a few weeks going for an 85k-ish hike overnight without sleeping, so i can test a bit the going all night, though hiking will not be as stressful as running. i’ll have my meds with me just in case (and a tent, just in case i have to sleep b/c i took my meds).

i’m just not sure if i can create stress levels in training that will accurately prepare me for races. it may be a matter of just seeing how things go as i keep on training, and then seeing how the races go. on the bright side, the 100 miler is done over a 20k loop (i’ll be so sick of that loop), so i think that maybe makes things a bit easier if something happens.

7

Above all, take care of your mental and physical health.

8

thanks :slight_smile:

definitely, being stable now is just wonderful for me, and i’ve been able to have other wonderful things in my life (like my bf)…i don’t want to lose that stability at all, so taking care of that is really important.

9

This sounds like a tough position to be in. Thanks for posting.

Have you experimented with lower dosages of Seroquel during training? Are the side effects less risky than passing out? Is there someone experienced with the symptoms you’re describing who could run with you, especially during the end of the race?

On a different tack, is there a different form of Seroquel with different absorption properties? Is the absorption rate affected by exercise? You might try contacting AstraZeneca and asking them about that. (I don’t know anyone there, sorry.)

Anyway, ultra racing is all about pushing our limits, so: best of luck to you!

10

I wish I had good information for you.

You are probably in uncharted territory. I doubt there has been a study of the affects of your drug on ultra racers!

I know that the Drs. want to keep you safe more than they want to see you fulfill your competitive desires. All I can suggest is to stick to your plan of trying to simulate race conditions with your new medicine. From what you say, for your race performance, you will need to take as little of your medication as possible during the race. If you start to go through your withdrawal symptoms it would ruin your race, if you take a full dose it would ruin your race.

I would suggest you have a very watchful support crew tracking you every step of the way. Preferrably someone that knows you and your condition well enough to know how to handle you when you might not yourself (say your boyfriend).
I would suggest this for both your races and your race simulations.

Approach this very cautiously. Consider a GPS-based tracking device that will let your support crew watch your progress in real-time on a map. If you stop moving, or leave the trail it would enable them to go straight to you to offer aid.

11

thanks.

rubberband, that’s a great idea to contact astra-zeneca. …i don’t know why i hadn’t thought of that!

b/c i was off for months this year due to a stress fracture (don’t even ask), i haven’t been able to experiment with seroquel and training. i will have to, probably also trying to figure out this for training as well. i know if i take 300mg, i still can’t sleep, but i get kind of…weird. like a sort of zombie-ish, but not quite. it’s enough to affect my function. anything less and i do get withdrawal symptoms - it’s like having the flu and what i imagine early-menopause to be like.

jyeager - you’re right, safety has been the primary concern of the doctors, which is why with the lithium they just told me to stop running (even 1/2 marathons they weren’t okay with). i actually ended up working with my best friend, who is a dietitian, on the best things to take in during runs to stop dehydration/lithium toxicity. i only had a problem once, on a short trail race, which i didn’t think was long enough to warrant not taking the lithium the night before - i went in well-hydrated, and took liquid (gatorade and water) at the aid stations, but for whatever weird reason, i went blind immediately after the race, which was frightening, to say the least. it passed though, but it really affected how i trained and raced.

i do have a 405 and another garmin that’s for trails…maybe those could be fed into a computer or something. my bf is good w/that kind of stuff, i’ll ask him. the first 2 races - 78k and 100 miles - will be on relatively short loops. the 135k race will be the one that is probably highest-risk, in terms of access to support, but i’m also hoping doing 2 other races and some equivalent kind of training run will help work out the possibilities.

my bf will be my support crew for the 135k race - i’ll probably ask him and my family for the other 2 races, which are closer to home. they’re all supportive, and i think would be able to pick out warning signs/issues - i guess my concern is too, i don’t want to be pulled b/c i’m bipolar and hallucinating, when a non-bipolar person might hallucinate too, but how do we distinguish where a safety line is crossed, i guess. i’ll have to do some thinking on that.

really appreciate everyone’s input :slight_smile:

12

Well, you’ve got more experience with hallucinations than the rest of the field, so it’s really up to your support crew to know if/when you’ve crossed the line. It would be the same for any other athlete. If you know you are hallucinating and staying on the trail you’re OK. If you have lost touch with reality and wander off the trail, it’s time to pull you.

13

i guess that’s where the gps tracker would be handy. :slight_smile: i’ll start on a list of questions to test how functional i am while hallucinating.

my all-night hike in a few weeks might not have the gps tracker…but i’ll set a time i’m expected out and that i will phone by, and my route, and go from there. i’ve soloed trails before (multi-day) and that’s always what i’ve done. plus i’ll have one of my dogs with me (he’s my running buddy and a great hiker) and he’ll help me as well, having the dogs does, b/c i have to stay with it for them.

14

i just wanted to update, since you all were so helpful.

this weekend i did my first all-night training, a 61.1k hike. it didn’t go quite as expected, but did go well, and i felt totally comfortable being out on the trail in the dark, i loved it actually. i was out solo (well, luc my dog was with me).

i was supposed to do an 86.8k loop (the entire trail), but the real point was too practice being on trail in the dark, and see how i functioned without my meds and with the sleep deprivation. i did bring a tent/sleeping bag/my meds just in case, but did not use them.

i kept things slow deliberately when i was hiking during the day - 4-4.5k/hr - so that i would be relaxed and just focused on being out there overnight. the biggest problem i had was that last sunday at the start of trail run i pulled a ligament in my ankle (i partially tore 2 ligaments in that ankle 15 months ago, and there was no popping/tearing noise this time, nor is the pain as bad, though i can feel how localized it is). the ankle was fine on the trail run and on all other runs last week, though it swelled up after yoga and was sore in general if placed at the wrong angle etc, but i figured since it caused no problems on my runs, it’d be fine for the hike.

however, the ankle hurt on and off, and was getting worse over the duration of the hike, though not bad enough to stop hiking or anything. i came to a point in the hike where i had the choice to continue with the big outer loop, or take a short cut down and across to the second loop and bypass a bunch of distance.

b/c i was basically just cutting out the sunday morning during the light portion of the hike, and would still be getting in my goal - hiking all night, in the dark on trail experience - and b/c i don’t want the ankle to develop into some sort of chronic problem - i took the short cut. this reduced the hike by about 25k, so i only ended up getting to do 61.1k. i think the trail conditions (it was extremely wet and slippery; it rained and snowed) made the ankle work a bit more than when i was doing any of my runs (dry trail, though uneven, and while i ran in the snow last week, it was on road). for the last 20k, the ankle was really bothering me at points, so i’m glad i made that decision. i also thought i’d be able to keep up the 4-4.5k/hr pace in the dark, since it’s relatively easy, but i slowed down, so my ‘night’ speed is something i need to work on, but i think that will come, and i have lots of time.

like i said, i didn’t take my meds, but had no problems with alertness - i felt perfectly awake and was fine in that sense. i did feel sick (expected withdrawal), but it came a bit later than expected, was relatively mild, and only lasted for about 3 hours and then went away entirely.

i had 2 hallucinations, the same thing, but so mild i almost hesitate to call them hallucinations. basically, twice i thought a leaf was running across the trail (not blowing - the little tips of the leaves were like little legs). however, i knew they weren’t (neither leaf actually moved) and it wasn’t scary, it was like watching a silly cartoon. no problems there.

one thing i did not do right was fueling. all i’d eaten all day pre-hike was a bagel with cream cheese and a coke (healthy!). on the hike, i drank lots of water, and in terms of calories, took in: 1.5 ounces of gel, 1.5 PB sandwiches, and 5/6 of a bottle of 591mL coke. not quite enough. however, i didn’t feel tired or low-energy at all.

there was one unexpected side effect, that i hadn’t even thought of. times where i’ve accidentally missed my meds, missing them one day has not been enough to start triggering me up (in terms of being bipolar), though like i said, i’m now physically dependent on the seroquel to sleep.

but, when i got out (7.15 am), i wasn’t just awake, i was HYPERAWAKE. way past any sort of normal wakefulness. when i called my bf to say i was out, i was speaking quickly (far more so than normal) - he commented on it, but it was enough that even i noticed. both those things are signs of triggering up into a hypomanic/manic (i’m more of a hypomanic bipolar as these things go) episode. so that’s something i’m going to have watch out for, and it really surprised me, but it may be that skipping meds + being physically active tip something that mildly triggers me. i didn’t sleep until 11 pm Sunday night, b/c while i tried to nap, i wasn’t tired. i wonder too if one reason why I didn’t fuel properly (I didn’t feel hungry or in need of energy) was b/c i was partially triggering, and i had that false bipolar energy. which was enough to carry me through a shorter hike, but i doubt it will be enough during races, so i need to not get off track in terms of taking in fuel.

other than that, i’m feeling good today. no stiffness or sore muscles!

so, so far, so good, just wanted to say thanks again for everyone’s help and suggestions!