A report on older‐age bipolar disorder from the International Society for Bipolar Disorders Task Force

Abstract

Objectives In the coming generation, older adults with bipolar disorder (BD) will increase in absolute numbers as well as proportion of the general population. This is the first report of the International Society for Bipolar Disorder (ISBD) Task Force on Older-Age Bipolar Disorder (OABD). Methods This task force report addresses the unique aspects of OABD including epidemiology and clinical features, neuropathology and biomarkers, physical health, cognition, and care approaches. Results The report describes an expert consensus summary on OABD that is intended to advance the care of patients, and shed light on issues of relevance to BD research across the lifespan. Although there is still a dearth of research and health efforts focused on older adults with BD, emerging data has brought some answers, innovative questions, and novel perspectives related to the notion of late onset, medical comorbidity, and the vexing issue of cognitive impairment and decline. Conclusions Improving our understanding of the biological, clinical, and social underpinnings relevant to OABD is an indispensable step in building a complete map of BD across the lifespan.

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

“…In general, starting at a lower dose (eg, 150 mg nightly for lithium) is recommended, with gradual adjustments to reach the lowest end of the therapeutic range for adults, with subsequent titration based on tolerability and effectiveness; keeping in mind that some older patients will require similar blood levels as the general adult population in order to achieve remission. Further discussion, including clinical guidance and more detailed treatment recommendations, can be found in the ISBD Task Force report 654. In light of very limited international guidelines for maintenance treatment of older adults with BD, an ISBD Task Force is currently undertaking a Delphi survey of international experts, and clinicians are advised to consult this as results become available in the future (Shulman K, personal communication).…”

“…Quetiapine (level 2)655 can be considered as second‐line. Asenapine (level 4),656, 657 aripiprazole (level 4),658 risperidone (level 4),659 or carbamazepine (level 4)654 may be applied as third‐line treatments. For treatment‐resistant episodes, clozapine (level 4)660 and ECT (level 4)654 should also be considered.…”

“…Divalproex (level 4), aripiprazole (level 4),658 and carbamazepine (level 4)665 are third‐line options. ECT (level 4)654 is an important option that should be considered in treatment‐resistant cases, for suicidal patients, or for patients with inadequate food or fluid intake.…”

Mood disorders in the elderly: prevalence, functional impact, and management challenges

“…In addition, there seems to be an association between increased age at onset and duration of the affective episodes 21. In BD, the risk of suicide is lowest for patients aged 35 years or older,22 but the rate of suicide among older patients has not been specifically investigated 1…”

“…Mood disorders are frequent in old age and their prevalence is increasing with population aging 1. Because of its severe consequences, late-life mood disorders may be regarded as an important public health problem.…”