Optimizing the Treatment of Bipolar Disorder in Older Adults

August 22, 2018
Martha Sajatovic, MD

Demographic Shifts Creating Larger Geriatric Population

The world’s population of people aged 60 years and older has doubled since 1980, and, for the first time ever, the number of adults aged 65 years and older is expected to exceed the number of children under 5 by 2020.

Considering such demographic trends, Martha Sajatovic, MD, believes mental health clinicians need to be educated about mood disorders in older adults, even if they are not specifically practicing geriatric psychiatry.

“It’s my opinion, and I think a number of clinicians agree, that as a field we need to be more familiar with working with older people,” said Dr. Sajatovic, Professor of Psychiatry and Neurology and Willard Brown Chair in Neurological Outcomes, Case Western Reserve University School of Medicine, Cleveland, Ohio.

Sajatovic session box“People are living longer. Unfortunately, the downside of that is…we have more years that we’re dealing with different kinds of chronic health conditions.”

Dr. Sajatovic will speak at the annual Psych Congress conference about one such condition—bipolar disorder (BD), which often affects older adults and younger adults differently.

Although the research is somewhat limited, studies have suggested the manic symptoms of BD are often—but not always—attenuated or milder in older adults, compared with younger people with BD. Older people may also be more irritable and may experience physical complications related to BD more frequently. Conversely, depressive symptoms are generally the same in the two groups.

Older people with bipolar depression may think more slowly and may have difficulty concentrating or focusing on things, which sometimes leads to a misdiagnosis of dementia or Alzheimer’s disease, said Dr. Sajatovic, a practicing clinician who has performed research and clinical care in the field for more than 20 years.

“That’s another reason why it’s really important for clinicians to at least have some familiarity with what mood disorders look like in elderly people,” she added.

Also Coming up at Psych Congress 2018:

Clearing Up Confusion About Cannabis Therapeutics
Looking at Depression Through an Evolutionary Lens
A New Generation of Depression Treatment Approaches

Taking a thorough clinical history is critical in distinguishing between bipolar depression and dementia, she said. She suggests clinicians ask about patients’ previous mood-related symptoms, mania, and bouts of depression, including postpartum depression. Women with BD are particularly prone to postpartum mood disorders, and there used to be much less appreciation of those conditions, she said.

Some people have a misconception about BD—that it burns out or goes away as people age, Dr. Sajatovic said, adding that the data do not suggest that is true.

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