Bipolar Disorder Age of Onset & Why it Matters

What Is Bipolar Disorder?

Bipolar disorder is a mental health condition that causes a person’s mood to fluctuate between two extremes: depression and mania. It can also impact energy levels, communication, judgment, and behavior.

A diagnosis of bipolar disorder requires a person to experience periods of mania, causing extreme elation and high energy. These periods of mania can lead to impulsivity and risk-taking behaviors that are often dangerous or regrettable.

Bipolar disorder may be classified as Bipolar I or Bipolar II, distinguished by the severity and longevity of the manic episodes experienced.

Typical Bipolar Disorder Age of Onset

The average age someone will receive a bipolar diagnosis is 25. Symptoms of bipolar I typically first appear between the ages of 12 and 24. Bipolar II symptoms tend to appear later, between the ages of 18-29. People can go years without a bipolar diagnosis but still experience bipolar signs and symptoms. In these cases, bipolar symptoms may be mistaken for other conditions that present similarly.

The age distribution amongst bipolar diagnosis varies. Less than 15% of those with bipolar disorder are diagnosed before the age of 18. In contrast, 60% of those with bipolar disorder receive their diagnosis in their late teens and early 20s. Lastly, around 25% of those with bipolar disorder are diagnosed at age 45 or later.¹

Early-Onset Diagnosis of Bipolar Disorder

Early-onset bipolar disorder can begin to show signs in patients as young as six, who present with extreme mood phases, alternating between mania, depression, or mixed-symptom states. Patients who show symptoms of bipolar disorder at younger ages are likelier to have a family history of bipolar disorder or other mental health conditions.

There are unique challenges that occur for those with early-onset bipolar disorder, such as difficulty coming to the diagnosis itself. Since children experience and display emotions differently, diagnosing early-onset bipolar disorder can be challenging. Those who exhibit symptoms of bipolar disorder at an early age may receive an initial diagnosis of Disruptive Mood Dysregulation Disorder (DMDD), ADHD, depression, or anxiety.

Early-onset bipolar disorder may result in:

• More intense bipolar disorder cycles, 
• A higher likelihood of developing rapid-cycling bipolar disorder
• Higher likelihood of a family history of bipolar disorder and passing it on to children
• More acute manic episodes
• Increased social isolation²

Late-Onset Diagnosis of Bipolar Disorder

Late-onset diagnosis for bipolar disorder is more common than previously thought, as those 60 and older are a significant portion of those diagnosed with bipolar disorder. The challenges of late-onset bipolar disorder include various medical and psychological comorbid issues.

Many with LOBP are more likely to have neurological issues like strokes. They also have a higher likelihood of depression and depressive episodes, which can be exacerbated by medical comorbid issues. The symptoms of late-onset bipolar disorder aren’t necessarily better or worse than those diagnosed earlier. However, those who are diagnosed later may experience more depressive symptoms than manic symptoms.

Those with late-onset bipolar disorder may have different experiences, such as:

• Higher frequency of neurological disorders
• A higher frequency of cerebrovascular diseases, stroke, and aneurysms
• More comorbid medical conditions
• More depressive episodes than manic episodes
• Increase in vascular lesions and changes³

Prolonged Diagnoses for Bipolar Disorder

Given the often variable mental health and medical conditions, medications, and other factors older adults face, misdiagnosis is not uncommon. It can take longer to determine if someone has bipolar disorder if there are existing medication side effects or a history of seizures, epilepsy, post-traumatic stress disorder (PTSD), and neurodegenerative diseases. Many conditions have to be ruled out to ensure a proper diagnosis of bipolar disorder can be given.

What Causes the Difference in Bipolar Diagnosis Age?

There are many factors that can influence the diagnosis of bipolar disorder. Causes such as genetic predisposition, family history, trauma, medication side effects, and neurological diseases are all possible.

Those with late-onset bipolar disorder may have different experiences than early-onset diagnoses, including:

• Genetics: Those with a family history of mental health issues or bipolar disorder are more likely to have an early onset of bipolar disorder versus late onset.
• Stress: Changes in family or personal relationships can trigger depression or mania, impacting both early and late-onset bipolar disorder.
• Brain structure: Those with late-onset bipolar disorder are more likely to have vascular changes in their brain. Those with early onset may also have structural changes in the brain, but since children’s brains continue to develop, it is important to track other symptoms.
• Medical conditions: Different medical conditions that come with age can impact brain functioning, which can lead to further medical concerns.

Age Differences in Bipolar Diagnoses

The diagnosis process between early and late-onset bipolar disorder often differs. It is more common for late-onset bipolar disorder to be misdiagnosed due to other medical comorbid issues which may be at play, such as dementia. For those with early onset bipolar disorder, some may be misdiagnosed with ADHD or depression. Recognizing the swings between depressive episodes and manic episodes is a telltale sign, and it is important to consider these episodes.⁵

Treatment Differences Between Early & Late-Onset Bipolar Disorder

Bipolar disorder treatment methods may also differ depending on the age of onset. While treating bipolar disorder can be challenging, regardless of the age of diagnosis, the condition can be managed with medication, lifestyle changes, and therapy. All bipolar disorder treatment requires individualized care. The first step to creating a customized care plan is to find the right therapist. Accessing an online therapist directory can serve as a great resource to start your search.

Psychotherapy

Psychotherapy is an effective intervention to manage bipolar disorder. Patients with early-onset bipolar disorder may benefit from family therapy, group therapy, and play therapy with various cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) interventions in session.

For those with late-onset bipolar disorder, CBT and DBT can also be helpful in a more direct and organized way. Group therapy options for adults can also be beneficial and is recommended to learn the interpersonal skills that bipolar disorder can compromise.

Medications

Bipolar disorder medications and their effectiveness in treating symptoms may differ between early and late-onset. Certain medications may work better for some, but not for all patients. Working with your physician is important to ensure you are on the correct medication. Some medications may not be indicated for some who are contraindicated.⁶

Medications prescribed to treat early-onset bipolar include:

• Abilify
• Seroquel

Those with LOBD may be more likely to be prescribed medications including:

• Lexapro
• Wellbutrin

Alternative Treatments

Those with late-onset bipolar disorder can sometimes benefit from electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS) if medications and psychotherapy don’t work. Since some medications for late-onset bipolar disorder can interact with other medications, treatment may be more complex and include alternative treatments.⁷

Final Thoughts

What you are dealing with is unique to you, but you are not alone. Dealing with bipolar disorder is tough, but it doesn’t have to hold you back. Trying to find the correct diagnosis and learning about your symptoms can be challenging, but working with a therapist can make a big difference in how you feel. Together you and your therapist can help you craft a plan where you can manage your symptoms safely. There is always hope that things can feel better.