How Does Bipolar Disorder Change as You Get Older?

In people living with bipolar disorder, age can affect:

• how symptoms appear
• how severe symptoms are
• how the disorder affects the brain

Although many people with bipolar disorder are diagnosed at an early age, around 5 to 10 percent are ages 50 or older when diagnosed. Only about 0.5 to 1.0 percent of older adults are affected by bipolar I and bipolar II disorders, but the condition accounts for roughly 6 to 10 percent of psychiatric visits in senior communities.

So, how does bipolar disorder appear in older adults versus younger people, and how do the symptoms change as someone ages?

Mood shifts in bipolar disorder lead to distinct episodes that are referred to as:

• Mania: a drastically elevated or “high“ mood
• Hypomania: an elevated state that’s not as extreme as mania
• Depression: a “low“ mood

Changes in the frequency and severity of episodes are among the most evident changes in bipolar disorder at an older age. Research suggests that older adults with bipolar disorder often experience:

• more frequent episodes
• more depressive episodes and less time spent in manic or hypomanic states
• less severe manic symptoms and fewer psychotic features with mania
• new symptoms, such as irritability and poor cognition
• lower risk of suicide, although this may be due to survivorship bias
• resistance to treatment options, such as certain medications

Since research on bipolar disorder in older adults is still lacking, it’s difficult to determine exactly how these changes can affect the different types of bipolar disorder.

According to experts, bipolar disorder may speed up aging and contribute to cognitive decline. Older studies have found a link between bipolar disorder and cognitive decline, as well as an increased risk of dementia with each bipolar disorder episode.

While bipolar disorder seems to have a negative effect on executive function and verbal memory in all age groups, older adults are also more likely to be slower at processing information. Because of this, older adults with bipolar disorder may experience lowered neurocognitive ability, which can lead to a much lower quality of life.

Some of these changes may be due to how bipolar disorder affects the tissues within the brain. Many of these neurological changes can also be heightened by a variety of factors, including:

• natural changes of aging
• other medical conditions
• repeated mood episodes
• substance use or misuse

End stage bipolar disorder

Although there is no official classification for end stage bipolar disorder, mild structural changes in the brain that lead to cognitive dysfunction can severely reduce someone’s quality of life, especially toward the end of life.

Research from 2014 shows that older adults with bipolar disorder seem to have much less gray matter in the frontal area of the brain. This area directly contributes to emotional behaviors and emotional regulation. Other studies have also suggested that bipolar disorder may impact other areas of the brain linked to cognition, memory, and more.

So, while many older individuals already experience changes in mood, cognition, and memory as a part of the natural aging process, people with bipolar disorder may experience more intense changes.

Without the right treatment, day-to-day living can be harder, and the overall quality of life may be lower toward the end of life.

If you’ve been diagnosed with bipolar disorder, it’s important to seek treatment for the condition, as it can become progressively worse if left untreated.

Although treatment varies from person to person, doctors usually treat bipolar disorder with both medication and psychotherapy.

• Medications are often the first-line treatment option for people with bipolar disorder. Medications help reduce the chronic (long-term) symptoms of the disorder. Common medication options for bipolar disorder include:
  • mood stabilizers
  • second-generation antipsychotics
  • antidepressants
• Psychotherapy is often used along with medication to help reduce the behavioral symptoms of bipolar disorder. Helpful approaches include:
  • psychoeducation
  • cognitive behavioral therapy (CBT)
  • family-focused therapy

As we age, it becomes much more difficult for our bodies to metabolize certain medications. In older adults with bipolar disorder, this can change how traditional mood-stabilizing drugs work.

For example, one study from 2007 found that older participants who were taking lithium or antipsychotic drugs had significantly reduced cognitive functioning. This suggests that older people may be more susceptible to the negative side effects of these medications. With this in mind, it’s important for older adults with bipolar disorder to fully consider the treatment options available to them.

If medication does not help, doctors may suggest electroconvulsive therapy (ECT). During ECT, electrical currents are sent to your brain briefly to stimulate it. It’s usually a last resort to help treat depressive symptoms, but studies have found it effective.

Research from 2015 suggests that older adults with bipolar disorder tend to die 10 years earlier than the general population. This could be because bipolar disorder is often accompanied by other health conditions, such as:

• metabolic syndrome
• hypertension (high blood pressure)
• diabetes
• cardiovascular disease

With the right combination of medication, therapy, and lifestyle changes, people with bipolar disorder might be able to lessen these changes and greatly improve their overall quality of life.

If you’ve been diagnosed with bipolar disorder, it’s important to reach out to a doctor to discuss a treatment plan and find the options that work for you.