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Bipolar Disorder in Geriatric Medicine

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3 min read


The article seeks to enhance comprehension of bipolar disorder (mental health conditions) characterized by mood fluctuations in geriatric medicine.

Medically reviewed by

Dr. Abhishek Juneja

Published At December 12, 2023
Reviewed AtJanuary 17, 2024


Bipolar disorder, once known as manic-depressive illness, affects older people. It involves significant mood swings, energy changes, and activity variations. While commonly associated with younger individuals, bipolar disorder can persist into late adulthood. Diagnosing and treating bipolar disorder in older patients is tricky because their bodies change as they age, they may have other health issues, and their medications can interact in complicated ways.

What Is Bipolar Disorder?

Bipolar disorder is a health issue that causes changes in mood. These changes can be sudden and dramatic, affecting a person's life. Bipolar disorder is categorized into several subtypes, with bipolar I and bipolar II being the most recognized. Bipolar I is a condition of mania, which means that it makes changes in mood, energy, and activity. People with mania may feel euphoric, irritable, or restless. They may also have racing thoughts, decreased need for sleep, and increased impulsivity. Bipolar II is characterized by hypomanic episodes (less severe manic episodes), and depression is a period of low mood, energy, and interest in activities. People with depression may feel sad, hopeless, or worthless.

What Are the Causes of Bipolar Disorder?

The exact cause of bipolar disorder remains unidentified, but it is understood that bipolar disorder will be the result of various factors like genetic, environmental, and neurobiological factors. Bipolar disorder is a complex disease, and its development likely involves a combination of these factors rather than a single cause. If someone is struggling with bipolar disorder, seeking professional help is crucial.

The history of past generations who have bipolar disorder increases the disease development in the people. Imbalances in neurotransmitters like serotonin and dopamine play a role in bipolar disorder. In bipolar disorder, Changes in the areas regulating emotions and mood. Stressful life events, trauma, and major life changes can trigger or exacerbate bipolar symptoms. Hormonal imbalances and disruptions in the body's internal clock (circadian rhythms) might contribute. Drug or alcohol misuse can worsen symptoms and trigger episodes.

Brain development during childhood and adolescence may influence the risk of bipolar disorder. Mood disorder is indirectly linked with chronic inflammation, which causes bipolar disorder. Sleep Disruptions like irregular sleep patterns and insomnia can impact mood stability. Personality traits and cognitive styles might make certain individuals more susceptible.

What Are Symptoms of Bipolar Disorder?

Diagnosing bipolar disorder in the elderly can be challenging due to overlapping symptoms with other medical conditions and age-related changes. Manic symptoms may be mistaken for agitated states, while depressive symptoms may be attributed to other health issues. Common signs include changes in sleep patterns, energy levels, loss of interest in activities,

concentration, feelings of sadness, hopelessness, or worthlessness, cognitive functions, and mood fluctuations.

1. Mood Swings:

Bipolar disorder in older adults often involves abrupt shifts between depressive episodes (persistent sadness, low energy, and loss of interest) and manic or hypomanic episodes (marked by elevated mood, increased energy, and impulsive behavior).

2. Physical Complaints and Psychosis:

Some older adults with bipolar disorder may manifest physical symptoms, such as unexplained aches and pains, during depression. Geriatric patients with bipolar disorder may experience psychosis, including delusions (false beliefs) or hallucinations (false sensory perceptions).

3. Cognitive Impairment:

Cognitive difficulties, including trouble concentrating, decision-making, and memory problems, can occur during mood episodes in older adults with bipolar disorder. These impairments can affect daily functioning and independence.

4. Sleep Disturbances:

Sleep disturbances are common in geriatric bipolar patients, with insomnia during depressive phases and a reduced need for sleep during manic phases. These disruptions can negatively impact overall well-being.

5. Irritability:

Older adults with bipolar disorder may exhibit chronic irritability, which can be more pronounced than euphoria during manic states. This irritability can strain relationships and daily functioning.

What Is the Treatment and Therapeutic Management of Bipolar Disorder?

Treatment involves controlling the symptoms and preventing future episodes. Medication and psychotherapy are frequently used in conjunction with treatment. To treat bipolar disorder, a variety of drugs are available. The most common medications are mood stabilizers, such as lithium, valproic acid, and Lamotrigine.

Antidepressants (used to treat depression) should not be used alone, as they can trigger mania. Psychotherapy is learned to manage their symptoms and cope with stress. The main talk therapy used for bipolar disorder is called cognitive-behavioral therapy (CBT). CBT helps individuals recognize and alter harmful thought patterns that play a role in their mood swings.

What Are Drugs Used for Bipolar Disorder?

Asenapine is used to treat bipolar disorder, and its adverse effects are milder. Lithium is a mood stabilizer often considered the first-line treatment for bipolar disorder. It prevents both mania and depression, and it is more effective. Antipsychotics like Olanzapine and Risperidone can help manage manic and depressive symptoms of bipolar disorder. Anticonvulsants such as Valproate and Carbamazepine may be used as mood stabilizers. Benzodiazepines may be used short-term to manage acute agitation or insomnia, but their long-term use is generally avoided due to the risk of dependency and cognitive impairment.

Valproic acid is another mood stabilizer that is effective in treating mania and depression. It is also used to treat other conditions, such as epilepsy and migraine headaches. Lamotrigine is a newer mood stabilizer that prevents mania and depression. It also treats other conditions, such as seizures and restless legs syndrome. Antidepressants and selective serotonin reuptake inhibitors (SSRIs) like Sertraline or Citalopram can treat depression in people with bipolar disorder. Still, they should not be used alone, as they can trigger mania.

It is essential to note that medication choices and dosages should be carefully tailored to each geriatric patient's specific needs and closely monitored to avoid adverse effects and drug interactions, especially considering the elderly population's higher likelihood of taking multiple medications for other medical conditions.


Bipolar disorder remains a significant mental health concern among geriatric patients. As the population ages, healthcare professionals must be equipped with knowledge about the unique challenges associated with diagnosing and managing bipolar disorder in the elderly. A multidisciplinary approach considering medical, psychological, and pharmacological interventions is crucial for improving the quality of life for older adults with bipolar disorder. Ongoing research and clinical advancements will further enhance management and treatment in geriatric medicine.

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Dr. Abhishek Juneja
Dr. Abhishek Juneja



bipolar disordergeriatric care
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