Bipolar Disorder and the Elderly

According to the National Institute of Mental Health, bipolar disorder affects more than 5.7 million adults in the United States each year—that’s about 3 percent of the population. The typical age of onset is the late teens or early twenties, and a history of depression is common in people diagnosed with bipolar. 

The early onset means that a lot of research is focused on young people. In about 10 percent of patients with bipolar disorder, however, the illness develops after the age of 50, and 5 percent of admissions to geropsychiatric inpatient units are for bipolar disorder.

As George Hofmann explained in an article on psychcentral.com, there is very little research on how to treat bipolar disorder in the elderly. Hofmann, who is in his mid-fifties, has bipolar disorder himself. According to his website, he has “successfully managed mixed-episode, rapid-cycling bipolar disorder 1 for more than a decade.”  Hofmann says he added a meditation practice, physical activity, and a commitment to work to the medication and therapy regimen prescribed by his doctor, and has been well since. 


Symptoms of Bipolar Disorder

According to mayoclinic.org, there are several types of bipolar and related disorders. “They may include mania or hypomania and depression. Symptoms can cause unpredictable changes in mood and behavior, resulting in significant distress and difficulty in life.”

  • Bipolar I disorder: Patients had at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. In some cases, mania may trigger a break from reality (psychosis).
  • Bipolar II disorder: Patients had at least one major depressive episode and at least one hypomanic episode, but you've never had a manic episode.
  • Cyclothymic disorder: Patients had at least two years—or one year in children and teenagers—of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression).
  • Other types: These include, for example, bipolar and related disorders induced by certain drugs or alcohol or due to a medical condition, such as Cushing's disease, multiple sclerosis or stroke.

Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.


The lack of research is matched by the invisibility of elderly people with bipolar disorder in popular media: “Popular portrayals of older people with bipolar disorder seem to be as rare as the scientific studies,” Hofmann writes. “There are gripping books and movies about the experience of violently swinging moods. They just all seem to be about young people.”

More Research Required

When doctors look for guidance on what drugs to prescribe to eldery patients with bipolar disorder, “they hit a wall,” writes Hofmann. “There are no double-blind placebo-controlled studies of geriatric bipolar disorder. All of the research concerns younger or mixed-age populations.”

Existing treatments may be as effective in the elderly as they are in younger populations,” says Hofmann. “Or maybe not. In geriatric bipolar disorder episodes of mania or depression recur in 85-100 percent of the patients.”

“It has been usual practice in the pharmacotherapy of bipolar elders to be guided by evidence derived from data on younger patients,” wrote Laszlo Gyulaia and Robert C. Young in a 2008 study.  “However, this extrapolation may not be valid because of age-related pharmacodynamic and pharmacokinetic factors, and psychosocial constraints that may affect management in the elderly. Late-onset bipolar disorder in elders is often associated with medical and neurological conditions, and these may diminish tolerability and efficacy.”

Treatment for bipolar disorder in the elderly should not be based exclusively on what works for younger patients. Aging can be accompanied by many challenges, including decreased physical and mental capabilities, the loss of loved ones, and end-of-life issues. Often, our seniors do not seek or get the care they need. At The Pavilion at Williamsburg Place, we work to overcome these barriers.

A sudden or prolonged change in behavior or mood may indicate the presence or the precursor stage of mental illness. Often, highly specialized care designed specifically to address geriatric psychological issues may be required. The Pavilion is ideally suited to provide this type and level of older adult psychiatric care.