Johns Hopkins Health Alerts | Depression and Anxiety | Bipolar Disorder and Older Adults

Just as depression is not a normal and natural side of aging, neither are extreme irritability, angry outbursts, paranoia, or irrationally hyper behavior.

One of the myths associated with bipolar disorder is that it follows a predictable pattern, with cycles of mania and depression following one another as neatly and symmetrically as day follows night. Not true. Bipolar disorder is an unpredictable disease. And while bipolar disorder usually makes its first appearance during adolescence or young adulthood, another, often unexpected, feature is that bipolar disorder can show up for the first time in late adulthood.

While the scientific literature on bipolar disorder in older adults is fairly limited, recent studies have begun to take a closer look at the condition. Some points to consider:

• Bipolar disorder: Percent affected. In a large study of people treated at Veterans Administration hospitals, 25% of the more than 65,000 people with bipolar disorder treated during one year were age 60 years or older. And in this over-60 age group, approximately 6% had new-onset bipolar disorder. And in a second study, 9.8% of 1,157 people between the ages of 18 and 70 years treated in an urban primary care clinic screened positive for bipolar disorder. Of those, 41% reported first being affected at age 40 years or older. The most commonly reported manic symptoms were being very irritable or “hyper.” Other frequently reported symptoms of bipolar disorder included being easily distractible, having racing thoughts, and being more talkative.
• Bipolar disorder: Men vs. women. Overall, men are more likely than women to have bipolar disorder, but women may be more likely to experience the late-onset form of bipolar disorder. In a study of 48 older adults with bipolar disorder, women were 2.8 times more likely to be in the late onset group.
• Bipolar disorder: Symptoms. Some research suggests that late-onset bipolar disorder may have a less-severe course of symptoms than early onset disease. As a result, many people may be under- or misdiagnosed. One review of mood disorders in late adulthood suggests that agitated depression in older people may be a form of bipolar disorder, but notes that this should be studied further.
• Other conditions that mimic bipolar disorder. It is important to note that late-life mania, like late-life depression, can be a symptom of another illness, such as dementia or another neurological condition, or a side effect of a medication taken for another illness, such as corticosteroids.

Johns Hopkins Health Alerts | Depression and Anxiety | Bipolar Disorder and Older Adults