I’d like to present the research about how to treat bipolar disorder in the elderly. Unfortunately, there isn’t any.
In 10% of patients with bipolar disorder, the illness develops after age 50, and 5% of all admissions to geropsychiatric inpatient units are for bipolar disorder.
But when doctors seek guidance on how to treat geriatric patients with BP, whether the patients have had the disorder for years or are newly diagnosed, they find that no treatment algorithms specific to the elderly have been devised.
And when the same doctors reach out for guidance on the best drugs to prescribe to these patients, they hit a wall. There are no double-blind placebo-controlled studies of geriatric bipolar disorder. All of the research concerns younger or mixed-age populations.
These treatments may be as effective in the elderly as they are in younger populations. Or maybe not. In geriatric bipolar disorder episodes of mania or depression recur in 85-100% of the patients.
Most disturbing about the lack of research on older patients with BP is that the suicide rate is highest for people aged 45-65.
Now I turn 56 this year and I do have bipolar disorder, but I sure don’t feel elderly. And I’m sure not geriatric (that’s people over 60, so I’m getting close). But I do feel under-represented in the data.
And the data, like me, is getting long in the tooth.
The last NIH report about the elderly and bipolar disorder, a review of the literature that concludes simply that more research needs to be done, is from 2006. In the last 13 years the only follow-up study concludes that there are some similarities, and some differences, between BP and dementia, and that this, too, should be researched further.
Popular portrayals of older people with bipolar disorder seem to be as rare as the scientific studies. There are gripping books and movies about the experience of violently swinging moods. They just all seem to be about young people.
So while 10-25% of all geriatric patients with mood disorders are diagnosed with BP, the experience can feel a little lonely.
I’m not one to clamor for special attention, but this challenge of being old and having a mental illness is different. We suffered through years of episodes and had to try and keep it all hidden away, because the stigma against those with mental illness was so severe then. Treatments that did exist were not as advanced as the ones available today. Even family histories were difficult because our older relatives may have faced mood disorders before the modern diagnostic guidelines were even developed.
If when you were first diagnosed they called it manic depression, you know what I’m talking about.
And now it turns out that the elderly who are newly diagnosed may be even more marginalized than those of us who have suffered for years.
The body and its systems change as we age. Years of decline bring about all sorts of new medical conditions and change chronic conditions dealt with over a lifetime. It would be nice to know that in bipolar disorder these changes are carefully measured, noted, and researched. It would be nice to know that the treatment given is cutting edge and most appropriate for a brain undergoing the changes age brings. It would be nice to know that some serious thought, and science, went into this.
Or maybe not.