Optimizing the Treatment of Bipolar Disorder in Older Adults

August 22, 2018
Martha Sajatovic, MD

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Despite the differences between older and younger people with BD, the US Food and Drug Administration (FDA) does not differentiate between the groups for pharmacological treatments.

In addition, very few published clinical trials have focused on older adults with bipolar disorder (OABD), Dr. Sajatovic said. She knows of only one such randomized, controlled clinical trial, and she will discuss it in her Psych Congress presentation. That research, funded by the US National Institute of Mental Health, compared lithium with divalproex in people aged 60 years and older who have type 1 bipolar mania.

Many clinicians believe lithium should not be used in older people—a concept which Dr. Sajatovic hopes to also address in her presentation, titled “Bipolar Disorder in Later Life.”

“I think our understanding in recent years is a bit more nuanced than that,” she said. “I think we just have to be careful how we use it, but it can actually be a highly effective medication for older age bipolar disorder.”

Data has suggested that lithium can preserve or protect cognitive functioning, and the US National Institutes of Health is funding more research on the topic, Dr. Sajatovic noted.

“I think that’s an area that everybody can get behind,” she said. “It potentially has properties that can really help brain health and, again, given the demographic changes that we’re seeing globally, I think that’s very exciting.”

Her talk will also cover medication safety and tolerability issues and interactions between psychiatric medications and other types of drugs in the OABD population.

Generally, “older people are much more likely to have side effects, and tend to tolerate the drug less well,” Dr. Sajatovic said. “A rule of thumb to treat older people is to start low and go slow with drugs. I would also throw in a third one—­don’t stop too soon.”

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As is the case with the general population of people with BD, there is little data on nonpharmacological interventions that may help OABD. Social support is one element that has been shown to be beneficial, Dr. Sajatovic said.

In her talk, she will present some data from a study that she was involved in, on a self-management program designed to help people with serious mental illness and comorbid health conditions manage their health. BD and other chronic serious mental illness generally shorten a person’s life span by 1 to 2 decades, Dr. Sajatovic said.


World Health Organization. Are you ready? What you need to know about ageing. World Health Day 2012. http://www.who.int/world-health-day/2012/toolkit/background/en/. Accessed July 17, 2018.

Young RC, Mulsant B, Sajatovic M, et al. GERI-BD: a randomized double-blind controlled trial of lithium and divalproex in the treatment of mania in older patients with bipolar disorder. The American Journal of Psychiatry. 2017;174(11):1086-1093.