How Does Bipolar Change With Age?

According to Steve Guglielmi, a licensed professional clinical counselor-supervisor at LifeStance Health, bipolar disorder can change with age.

Guglielmi explained that, similar to most mental and physical health-related concerns, bipolar symptoms can increase in severity and frequency if left untreated. Early treatment can prevent such progression to psychosis or self-harming/suicidal behaviors.

A2021 literature review added that any symptomatic and outcome differences might be less about how bipolar disorder functions across the lifespan.

Instead, it’s more about differences in educational achievements, stable social relationships, social adjustment and support, and resources to cope with the mental illness, which may all be impacted by a person’s age.

Typical signs and symptoms of bipolar disorder can be categorized as depressive, manic/hypomanic, or mixed (ie., both symptoms of depression and mania/hypomania).

Depressive episode symptoms include:

• sadness
• fatigue
• concentration issues
• sleep or appetite changes
• hopelessness
• guilt
• thoughts of death or suicide

Manic or hypomanic mood episode symptoms include:

• elevated or euphoric mood
• restlessness
• decreased need for sleep
• engaging in risky or impulsive decisions
• rapid speech
• racing thoughts
• grandiose ideas

Dr. Meghan Marcum, a chief psychologist with AMFM Healthcare, explains that while evidence on this topic is limited, we know that when the onset is earlier in life, the symptoms tend to be more severe overall.

The aforementioned literature review suggests the same, demonstrating that earlier onset bipolar disorder is associated with more severe symptoms including:

• more severe and atypical symptoms in first manic episode
• greater psychotic symptoms
• increased rapid mood cycling

Later onset bipolar disorder (ie., bipolar disorder presenting in people over 60) is associated with less severity of bipolar disorder symptoms, but additional symptoms including:

• greater cognitive challenges
• more frequently irritable behaviors
• more treatment resistance
• higher mortality rates

Guglielmi adds that later in life bipolar is associated with anhedonia (inability to feel pleasure) and impulsivity. Bipolar can also speed up the aging process in older adults and can result in such ailments as cognitive decline.

“This has been shown to be linked with early-onset for dementia in individuals experiencing several manic and depressive episodes,” he says.

Oxford University researchers estimate that individuals with bipolar disorder have a life expectancy that is between 1 or 2 decades lower than the average population.

Marcum explains that when bipolar disorder is not managed effectively, it can increase the risk for life threatening situations that can impact life expectancy. “For example, when someone is extremely depressed, they may feel they are in so much pain the only way out is to end their life,” she explains.

At the other end of the mood spectrum, Marcum says that when someone is experiencing mania, they may be more likely to engage in risky decisions like driving recklessly or putting themselves into harm’s way without recognizing the severity of the risk.

“A euphoric mood accompanied by grandiose thinking can create false feelings of invincibility,” she explains.

Guglielmi clarifies that there is no definitive causation between bipolar and lower life expectancy. Still, it can be linked to increased high risk behaviors, unhealthy lifestyles (including drug and alcohol addiction), and suicide.

Without treatment for bipolar disorder, symptoms usually get worse. However, treatment for bipolar in older adults may look different than in younger adults due to factors including changes in how the body metabolizes medication, cognitive decline, and physical ability changes.

Some examples of treatment, and how they may differ in older adults, include:

• Medications such as mood stabilizers or antipsychotic medications may need to be adjusted as a person ages to accommodate differences in how the body metabolizes medication later in life. This can often impact how mood stabilizers are prescribed, says Gugliemi.
• Psychotherapy (talk therapy), such as cognitive behavioral therapy (CBT), aims to help a person recognize changes and mitigate environmental factors that might elicit a change in mood. Gugliemi says developmental/life stages will directly impact the key focus areas of the psychotherapy process. This includes necessary relapse prevention and treatment plan development.
• Complementary care approaches are a helpful addition to traditional treatment. This may include exercise therapy, nutritional therapy, meditation, or prayer. All of these examples may need adjustments as the body and brain age.

Marcum says that no matter a person’s age, treatment for bipolar disorder is specific to the individual. And while it is recommended to utilize both medication and therapy to treat the symptoms and learn how to effectively manage changes in mood cycles, she also notes that the exact protocol depends on when the interventions occur.

“Depending on how early the interventions occur, there may be less need for intensive psychotherapy after the symptoms have been successfully managed and no longer cause significant disturbance in functioning,” she says.

“The family and loved ones of the individual diagnosed with bipolar disorder can also help reduce the need for intervention if they are educated about the symptoms and can provide support.”

Bipolar disorder symptoms can change with age, which means treatment may need adjustment as a person ages. Because of this, it’s likely best to stay in communication with your healthcare professional, who can help assist you with any changes and adjustments necessary throughout your life.

There is no one way bipolar symptoms evolve throughout a lifetime. Each person’s experience with bipolar disorder is slightly different. However, research has found that the earlier the onset of bipolar disorder, the more severe symptoms tend to be throughout a person’s life.

No matter the severity of your symptoms, help is available, and you’re not alone. Through a combination of medication, therapy, and healthy lifestyle adjustments, you can manage your bipolar symptoms and live a long and healthy life.