What Is Late Onset Bipolar Disorder? Diagnoses & Symptoms

What Is Bipolar Disorder?

Similar to late-onset bipolar disorder, bipolar disorder involves episodes of depression and episodes of mania that can each last for days, weeks, or longer. Many people with bipolar disorder have a stable mood in between these episodes. The duration and severity of these episodes can vary widely between individuals and over time. Bipolar disorder can be classified into several types, including bipolar I disorder, bipolar II disorder, and cyclothymic disorder.

Approximately 2.8 percent of adults in the United States have bipolar disorder, which is equally common among men and women. The typical age of onset is 25, but it can begin at any age. It takes an average of six years of experiencing bipolar signs and symptoms before someone receives appropriate treatment, and 69 percent of people may have been misdiagnosed initially with anxiety or depression.¹

Types of bipolar disorders include:²

• Bipolar 1: involves at least one manic episode, which lasts at least one week or requires hospitalization. Individuals with bipolar I disorder may also experience depressive episodes lasting at least two weeks. Understanding the difference between Bipolar I vs. Bipolar II disorder comes down to understanding the difference between mania and hypomania.
• Bipolar 2: involves at least one hypomanic episode (less severe than a full manic episode) and at least one depressive episode. Hypomanic episodes last for at least four consecutive days.
• Hypomania: a milder form of mania, is characterized by a persistent and elevated or irritable mood, increased energy, and activity levels that are not severe enough to cause significant impairment in daily functioning or require hospitalization. Hypomanic episodes typically last for at least four days.
• Cyclothymia: is a milder form of bipolar disorder, characterized by numerous periods of hypomanic and depressive symptoms that do not meet the diagnostic criteria for a full episode. Symptoms must last for at least two years in adults.
• Rapid-cycling bipolar disorder: A bipolar disorder characterized by having four or more mood episodes within 12 months. Mood episodes refer to periods of mania, hypomania, or depression. In contrast, those with non-rapid cycling bipolar disorder experience fewer mood episodes per year.
• Other specified bipolar and related disorders: This category includes bipolar disorder symptoms that do not fit the specific diagnostic criteria for bipolar I, bipolar II, or cyclothymic disorder. Examples include brief episodes of hypomania or depression, or bipolar disorder symptoms due to substance abuse or a medical condition.
• Unspecified bipolar and related disorders: The unspecified bipolar disorder category includes bipolar disorder symptoms that do not meet the specific diagnostic criteria for any of the other types of bipolar disorder.

Symptoms of mania in bipolar disorder include:

• Restlessness
• High energy
• Racing thoughts
• Grandiose ideas
• Euphoria
• Aggressiveness
• Needing little sleep
• Hypersexuality
• Elevated mood
• Increased goal-directed activity
• Impulsivity
• Irritability

Depressive symptoms of bipolar disorder include:

• Sadness
• Insomnia
• Loss of interest or pleasure in previously desired activities
• Fatigue and low energy levels
• Changes in appetite
• Feelings of worthlessness or guilt
• Difficulty concentrating
• Thoughts of suicide or death
• Hypersomnia
• Indecisiveness

What Is Late-Onset Bipolar Disorder?

Late-onset bipolar disorder is a term used to describe the onset of bipolar disorder symptoms that occur later in life, typically after age 50. While bipolar disorder typically begins in adolescence or early adulthood, research suggests that 10% of cases are diagnosed after age 50, and 5% are diagnosed after age 60.³

Late-onset bipolar disorder can be challenging to diagnose, as symptoms may be attributed to other medical or psychiatric conditions commonly found in older adults, such as dementia or depression. Additionally, older adults may be less likely to report symptoms of mania or hypomania or are more likely to experience mixed episodes with symptoms of both mania and depression.

Some factors that may increase the risk of late-onset bipolar disorder include a family history of bipolar disorder, traumatic life events, and certain medical conditions or medications. Treatment for late-onset bipolar disorder typically involves a combination of medication and psychotherapy, although the specific approach may vary depending on the individual’s symptoms and medical history.

Those with late-onset bipolar disorder may have unique features and symptoms, such as:

• Greater chance of comorbid medical disorders: A higher chance of neurological disorders, cerebrovascular diseases, stroke, and aneurysms may be related to underlying neurological changes that increase the risk of mood changes and neurological disorders.
• Less hereditary than other forms of bipolar disorder: Late-onset bipolar disorder is generally considered less hereditary than early-onset bipolar disorder. Studies have suggested that individuals with late-onset bipolar disorder are less likely to have a family history of mood disorders than those with early-onset bipolar disorder.
• Increased medical comorbidities: People with late-onset bipolar disorder may have higher rates of medical comorbidities, such as cardiovascular disease, diabetes, and thyroid dysfunction. Patients may need to take medication for other medical conditions, which can interfere with the symptoms of bipolar disorder or may interact with the medications used to treat bipolar disorder.
• More frequent depressive episodes: People with late-onset bipolar disorder may experience more depressive episodes than manic or hypomanic episodes.
• Less severe manic symptoms: Manic symptoms in late-onset bipolar disorder may be less severe than in early-onset bipolar disorder.

How Is Late Onset Bipolar Diagnosed?

A misdiagnosis of bipolar disorder is a common problem, especially with a late onset. This can be due to various factors, including the overlap of symptoms with other psychiatric and medical conditions, the presentation of atypical symptoms, and the reluctance of older adults to report symptoms of mood instability or changes in behavior.

Older adults may experience less pronounced mood swings or may experience more subtle changes in behavior or cognition. They may also be more likely to experience symptoms of depression rather than mania or hypomania, which can make it more difficult to diagnose bipolar disorder.

There are several comorbid and similar disorders that a doctor may need to rule out before diagnosing bipolar disorder. These include major depressive disorder, anxiety disorders, substance use disorders, and medical conditions such as thyroid disorders or neurodegenerative diseases. Early warning signs of late-onset bipolar disorder may include changes in mood or behavior, including increased irritability or agitation, changes in sleep patterns, changes in energy levels or motivation, and changes in cognitive function. However, these symptoms can be difficult to distinguish from normal aging or other medical conditions, so it is essential to seek a professional evaluation if you are concerned about changes in your mood or behavior.

To diagnose late-onset bipolar disorder, the diagnostic protocol will include:

• Check medical history
• Check family history
• Conduct psychological tests
• Physical exam
• Blood and urine tests
• Treat underlying conditions
• Comprehensive psychiatric evaluation

In the future, we may see the use of bipolar brain scans to help diagnose the different types of bipolar disorder and to help develop treatment plans.

Treatment Options for Late-Onset Bipolar Disorder

Treatment for late-onset bipolar disorder can be challenging, as there may be additional complications from prolonged lack of treatment. For instance, older adults may have other medical conditions or may be taking medications that can interact with bipolar medications. Moreover, older adults may have more difficulty with cognitive and physical functions, making it harder to comply with treatment plans or manage side effects. This can lead to decreased treatment adherence and increased risk of relapse.

Despite these challenges, effective treatment for bipolar disorder, regardless of age, is possible. Treatment should always be individualized and tailored to the unique needs and circumstances of the individual. This may include a combination of medication, psychotherapy, and lifestyle changes.  Finding and choosing the right online therapist is essential for the successful treatment of bipolar disorder. One way to do this is by accessing an online therapist directory. This allows individuals to browse and compare therapists specializing in treating bipolar disorder and choose one who fits their needs and preferences.

Psychotherapy

Psychotherapy can be an essential component of treatment for late-onset bipolar disorder, as it can help individuals manage their symptoms, improve their quality of life, and prevent relapse. However, the psychotherapy experience may differ in late-onset, as older adults may have unique needs and challenges. For example, older adults may have different life experiences and perspectives than younger adults, which can affect how they engage in therapy. Additionally, older adults may be dealing with other age-related challenges, such as physical health problems or changes in social support networks, which can impact their mental health.

Regarding specific types of psychotherapy for bipolar disorder, some research suggests that cognitive-behavioral therapy CBT for bipolar may be particularly effective for older adults with bipolar disorder. CBT focuses on identifying and changing negative patterns of thinking and behavior, which can help individuals with bipolar disorder better manage their symptoms and prevent relapse.

Another type of therapy that may be effective for bipolar disorder is dialectical behavior therapy (DBT). DBT teaches individuals skills to manage their emotions and improve their relationships. It can benefit individuals with bipolar disorder who may struggle with impulsivity and mood instability.

Medications

As individuals age, the ability to take medications for bipolar disorder and their effectiveness in treating symptoms may differ. This can be due to a variety of factors, including changes in the body’s ability to metabolize medications, changes in the way medications are absorbed, and interactions with other medications. One factor that can impact the effectiveness of medications for some older adults is liver and kidney function changes, which are responsible for metabolizing medications.

If individuals develop certain diseases, these organs may not function as well as they did previously, leading to slower metabolism of medications and a buildup of medication in the body. This can increase the risk of side effects and toxicity.

Additionally, older adults may be taking multiple medications for other health conditions, which can increase the risk of interactions between medications. These interactions can reduce the effectiveness of bipolar medications or increase the risk of side effects. Moreover, some older adults may also experience changes in gastrointestinal function, which can affect how medications are absorbed into the bloodstream. For example, the stomach may produce less acid, which can affect the absorption of certain medications. This can impact the effectiveness of bipolar medications and increase the risk of side effects.

Some medications prescribed to treat late-onset bipolar include:

• Mood stabilizers: Lithium is the most common mood stabilizer, but sometimes others are used. Mood stabilizers are a class of medications that are commonly used to treat bipolar disorder, including late-onset bipolar disorder. These medications reduce the severity and frequency of mood episodes, including both manic and depressive episodes.
• Anticonvulsant medications, such as valproic acid, carbamazepine, and lamotrigine, can also help stabilize mood and prevent relapse in people with bipolar disorder.
• Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), may be combined with mood stabilizers to treat depressive symptoms of bipolar disorder.
• Atypical antipsychotic medications, such as olanzapine, quetiapine, and risperidone, can help manage symptoms of mania and depression and improve overall functioning.

Alternative Treatments

When medication is hard to take or ineffective in treating late-onset bipolar disorder, several alternative therapies may be considered. Two of the most commonly used alternative therapies for bipolar disorder are electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS). In addition to ECT and TMS, alternative therapies may be considered for late-onset bipolar disorder, including light therapy, omega-3 fatty acids, and herbal supplements.

It’s important to note that alternative therapies are not a substitute for medication or psychotherapy and should only be considered in consultation with a healthcare provider.

Final Thoughts

Early diagnosis and treatment of bipolar disorder can significantly improve outcomes, especially in older adults with late-onset bipolar disorder. While medication and psychotherapy are the primary treatment options, alternative therapies such as ECT and TMS may be considered when medication is not effective or is hard to take. However, it’s essential to work closely with a healthcare provider to determine the best treatment course and monitor for potential risks and side effects.

It’s also important to recognize that misdiagnosis of bipolar disorder is not uncommon, which highlights the importance of seeking a second opinion and being diligent in following through with treatment once diagnosed. Ultimately, getting treatment for bipolar disorder is crucial for managing symptoms and improving quality of life.