Bipolar disorder is a mental health condition characterized by extreme mood episodes, including emotional ‘highs’ or irritability (mania or hypomania) and lows (depression). While it is often diagnosed in younger adults, it can also emerge later in life. In addition to this 3-minute video overview about bipolar I disorder with psychiatrist Dr. Fabiano Gomes, this post aims to shed light on late-life bipolar disorder, its unique challenges, and treatment options.
Download a transcript of this video.
What is late-life bipolar disorder?
Late-life bipolar disorder refers to bipolar disorder diagnosed in individuals aged 50 or older. It includes those who have had the condition for many years and those who experience their first episode later in life. Approximately 10% of bipolar disorder cases are diagnosed after the age of 50.
Symptoms and diagnosis
The symptoms of late-life bipolar disorder are similar to those seen in younger individuals but can be complicated by other health issues common in older adults. Key symptoms include:
- Mania: Elevated mood or irritability, increased activity, reduced need for sleep, grandiosity, and sometimes psychosis.
- Depression: Persistent sadness, loss of interest in activities, fatigue, feelings of worthlessness, and suicidal thoughts.
Diagnosing bipolar disorder in older adults can be challenging due to overlapping symptoms with other conditions like dementia or depression. A thorough medical and psychiatric evaluation is essential.
Causes and risk factors
The exact cause of bipolar disorder is unknown, but it is believed to involve a combination of genetic, environmental, and neurological (brain) factors. In older adults, secondary causes such as stroke, thyroid disorders, or medication side effects can trigger manic or depressive episodes.
Treatment options
Treatment for late-life bipolar disorder often involves a combination of medication and psychotherapy. Common medications include mood stabilizers like lithium or valproic acid (Epival®), antipsychotics (such as quetiapine), and antidepressants. However, older adults may require lower doses and careful monitoring due to potential side effects and interactions with other medications.
- Lithium: Effective for mood stabilization but requires regular blood tests to monitor levels and kidney function.
- Divalproex (Epival®): Effective for mood stabilization, occasional blood tests are used to monitor levels and liver function.
- Antipsychotics: Used to manage mania and psychosis. For example, quetiapine (Seroquel®) has evidence for the treatment of acute mania, depression, and maintenance phases.
- Antidepressants: Prescribed for depressive episodes but must be used cautiously to avoid triggering mania.
Psychotherapy, including cognitive-behavioral therapy (CBT), can help individuals manage their symptoms, develop coping strategies, and improve their quality of life.
Challenges and considerations
Managing late-life bipolar disorder presents unique challenges:
- Medical Comorbidities: Older adults often have other health conditions that can complicate treatment.
- Cognitive Impairment: Bipolar disorder in older adults is associated with an increased risk of cognitive decline and dementia.
- Medication Management: Polypharmacy (taking multiple medications) is common in older adults, increasing the risk of drug interactions and side effects.
Conclusion
Late-life bipolar disorder is a complex condition that requires careful diagnosis and management. With appropriate treatment and support, individuals can lead fulfilling lives. If you or a loved one is experiencing symptoms of bipolar disorder, seek professional help to ensure proper care and treatment.
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