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Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment

Helios Klinik Berlin-Buch, 13125 Berlin, Germany
Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, 6020 Innsbruck, Austria
Psychiatrisches Zentrum Nordbaden, 69168 Wiesloch, Germany
Private Practice, Wilhelm-Greil-Straße 5, 6020 Innsbruck, Austria
Author to whom correspondence should be addressed.
Academic Editors: Martin Schäfer and Heinz Grunze
Medicina 2021, 57(6), 587;
Received: 22 April 2021 / Revised: 27 May 2021 / Accepted: 4 June 2021 / Published: 8 June 2021
(This article belongs to the Special Issue Management of Bipolar Disorder)
Data regarding older age bipolar disorder (OABD) are sparse. Two major groups are classified as patients with first occurrence of mania in old age, the so called “late onset” patients (LOBD), and the elder patients with a long-standing clinical history, the so called “early onset” patients (EOBD). The aim of the present literature review is to provide more information on specific issues concerning OABD, such as epidemiology, aetiology and treatments outcomes. We conducted a Medline literature search from 1970–2021 using the MeSH terms “bipolar disorder” and “aged” or “geriatric” or “elderly”. The additional literature was retrieved by examining cross references and by a hand search in textbooks. With sparse data on the treatment of OABD, current guidelines concluded that first-line treatment of OABD should be similar to that for working-age bipolar disorder, with specific attention to side effects, somatic comorbidities and specific risks of OABD. With constant monitoring and awareness of the possible toxic drug interactions, lithium is a safe drug for OABD patients, both in mania and maintenance. Lamotrigine and lurasidone could be considered in bipolar depression. Mood stabilizers, rather than second generation antipsychotics, are the treatment of choice for maintenance. If medication fails, electroconvulsive therapy is recommended for mania, mixed states and depression, and can also be offered for continuation and maintenance treatment. Preliminary results also support a role of psychotherapy and psychosocial interventions in old age BD. The recommended treatments for OABD include lithium and antiepileptics such as valproic acid and lamotrigine, and lurasidone for bipolar depression, although the evidence is still weak. Combined psychosocial and pharmacological treatments also appear to be a treatment of choice for OABD. More research is needed on the optimal pharmacological and psychosocial approaches to OABD, as well as their combination and ranking in an evidence-based therapy algorithm. View Full-Text
Keywords: old age; bipolar disorder; aetiology; mania; bipolar depression; mixed state old age; bipolar disorder; aetiology; mania; bipolar depression; mixed state
MDPI and ACS Style

Arnold, I.; Dehning, J.; Grunze, A.; Hausmann, A. Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment. Medicina 2021, 57, 587.

AMA Style

Arnold I, Dehning J, Grunze A, Hausmann A. Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment. Medicina. 2021; 57(6):587.

Chicago/Turabian Style

Arnold, Ivan, Julia Dehning, Anna Grunze, and Armand Hausmann. 2021. "Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment" Medicina 57, no. 6: 587.

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