Does Bipolar Get Worse With Age? A Look at the Latest Research
Globally, more than 40 million people live with bipolar disorder. Currently, about 25 percent of patients with bipolar disorder are 60 or older. This number is expected to jump to 50 percent by the year 2030 because of the aging population. Does bipolar disorder get worse with age? The answer is yes, generally. However, there are some things that you can do to live well with bipolar disorder well into the Golden Years.
Does Bipolar Disorder Get Worse With Age?
Bipolar disorder is a neuropsychiatric condition that is characterized by manic or hypomanic episodes alternating with depressive episodes. During hypo- and manic episodes, a person may have erratic behaviors, racing thoughts and speech, and be unable to sleep. During depressive episodes, they may be sad or irritable, sleep excessively, have difficulty concentrating, and have feelings of hopelessness. If these episodes are severe, a person may experience suicidal thoughts and behaviors. Sometimes, psychotic symptoms are present.
Research has found that bipolar disorder tends to worsen over age — especially if a person is not being treated. Medical experts consider it to be a progressive disease. However, the rate at which it progresses varies depending on a variety of factors.
How Does Bipolar Change With Age?
There are several ways in which bipolar disorder changes with age. As they age, people with bipolar tend to have:
More frequent and severe mood episodes
Fewer manic episodes and more depressive episodes
More treatment resistance (meaning medications no longer work as well)
Onset of new cognitive issues
Some research has found that older adults with bipolar disorder have a lower risk of suicide. But this may be due to survivorship bias. Bipolar disorder has the highest risk of death by suicide of any other mental illness. People over the age of 75 have the highest rates of suicide in general. So, it stands to reason that people with bipolar disorder over the age of 75 would have a very high risk of suicide.
Why Does Bipolar Disorder Change With Age?
There are several reasons why bipolar disorder might get worse with age. Researchers believe that bipolar disorder changes the brain’s function and structure. Mania, in particular, is associated with damage to the brain. Studies have found that bipolar disorder is associated with changes in the frontal lobe in older adults with the disorder. The frontal lobe is involved in memory and decision-making.
Bipolar disorder causes progressive damage to telomeres. Telomeres are protective caps on DNA strands. They impact memory and mood regulation. They are involved in bipolar memory loss. Researchers have found that telomeres get progressively shorter in the brains of people who have bipolar disorder. It is thought that the destruction (shortening) of telomeres is related, in part, to the worsening of bipolar disorder as a person ages.
Additionally, the levels of an amino acid called N-acetylaspartate may decrease with age in people with bipolar disorder. This amino acid is involved in the regulation of memory and emotion.
Lifestyle factors may play a role, as well. Substance abuse has been found to significantly speed up the progression of bipolar disorder.
Can The Brain Recover?
Studies have shown that the brain can recover slightly during euthymic periods in people with bipolar disorder. So, during periods when your mood is stable or euthymic, your brain may slowly repair itself.
What Can Help?
Each manic episode progressively damages the brain. Even though the damage is very small, it adds up over a lifetime. Treatment is essential to minimize the risk of mood episodes.
Related: Can you manage bipolar without medications?
Medication: Mood stabilizers and antipsychotics are key medications for bipolar disorder. Lithium, a main mood stabilizer for bipolar, has been found to have neuroprotective properties that may protect the brain from aging-related damage.
Therapy: Therapy can help you cope with life changes as you age. Group therapy and support groups can help reduce loneliness and isolation. Therapy can also help you cope with things that are common with age, such as loss and grief.
Lifestyle changes: Comorbid physical health conditions like heart disease and high cholesterol can contribute to a worse outcome for those with bipolar disorder. Unfortunately, medications that are used to treat bipolar disorder can cause some of these issues. Talk to your doctor about how you can manage comorbid conditions. Also, make sure you have a relatively healthy lifestyle. Focus on things like healthy eating and exercise.
The bottom line is that older adults with bipolar disorder can live fulfilling lives and function well if they find the right treatment. Treatment can diminish or eliminate symptoms, which can help the brain stay healthy.
