Bipolar Support Groups.com blog

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This disorder affects all age groups — and the number of seniors with bipolar disorder is expected to increase as the population ages. Here’s what you need to know.

Bipolar disorder can affect people of all ages, including older adults. According to one study, 10 percent of new cases occur after the age of 50. In the past, it was believed that bipolar symptoms “burn out” and slowly disappear with age. However, newer research has shown that this is not so, and other research suggests that untreated bipolar disorder actually worsens over time. Individuals who are first diagnosed with bipolar disorder late in life may well have had undiagnosed bipolar disorder for decades, with symptoms that simply became more noticeable and problematic with age. And as the American population grows older, the number of bipolar cases in seniors is expected to increase. Caring for seniors with the illness often falls on the shoulders of family members, such as spouses and adult children. Here’s what family members need to know about bipolar disorder in older adults.

Bipolar Disorder in Seniors: Symptoms

Just as depression is not a normal or natural part of aging, neither are the manic episodes associated with bipolar disorder. However, seniors may not exhibit the classic signs of mania, such as elation and feeling on top of the world. “Another version often seen in older folks is agitation and irritability,” says Michael First, M.D., a professor of clinical psychiatry at Columbia University and editor of the American Psychiatric Association’s latest diagnostic guidelines. Other common symptoms in 60-plus adults include distractibility, confusion, hyperactivity, and psychosis. “When bipolar shows up for the first time after age 60, it can be quite severe,” says Carrie Bearden, Ph.D., associate professor of psychology and behavioral sciences at UCLA and an expert in the disorder. Often, it’s the rapid-cycling form of the disorder, characterized by frequent episodes of depression and mania or having symptoms of both at the same time. As a result, bipolar seniors may appear to be in a state of irritable depression. Additionally, seniors with bipolar disorder show significant changes in cognitive functioning, including difficulties with memory, perception, judgment, perception, and problem-solving.

Bipolar Disorder in Seniors: Diagnosis

The first step in getting help for an older family member is to schedule a complete medical examination to rule out other medical problems. Alzheimer’s disease, dementia, and even a brain tumor can mimic some aspects of bipolar disorder. Some medications can produce bipolar symptoms too. Antidepressants and corticosteroids, for instance, can cause mania. “Anyone over age 60 with suspected bipolar disorder needs a full medical workup, including a discussion of past health complaints, family history, and an evaluation of all over-the-counter and prescription medications,” advises Dr. First. If warranted, a referral to a mental health professional is the next step. For help in locating a psychiatrist with special training in bipolar disorder in older adults, log onto the Web site of the American Association of Geriatric Psychiatry.

Bipolar Disorder in Seniors: Treatment

There are special considerations when treating seniors for bipolar disorder. Older patients may tolerate or metabolize medications at different speeds than younger adults, so they may need different dosages. And older people are likely to have other medical conditions and to be taking other medications. “Treatment is much more complicated for this age group because doctors need to take into account drug interactions, as well as the fact that medications may be tolerated differently,” says First. However, older adults with bipolar disorder should be treated for their mania and depression; a number of medications can be helpful. Ongoing research is comparing lithium to antiseizure medications in older bipolar patients in order to determine which type of drug has the greatest benefit with the least risk of side effects. Talk therapy can also be a valuable addition to bipolar treatment for older adults. Some therapy programs are specifically geared to older bipolar patients.

Help for Caregivers

Support groups can be an important resource for family members caring for an older adult with bipolar disorder. Many psychiatrists specializing in bipolar disorder can put caregivers in touch with family support groups. Additionally, the Depression and Bipolar Alliance and the National Alliance for Mental Illness have links to caregiver education programs and support groups for families dealing with bipolar disorder. Family caregivers can also find a wealth of information, as well as message boards and online support groups, through the National Family Caregivers Association.

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Having bipolar disorder could mean legal troubles. Here’s what could occur and how to handle these issues.

If you have bipolar disorder, there are certain legal issues that may arise related to your condition, including job discrimination, consent to treatment issues, and troubles with the law.

Bipolar Disorder and Legal Issues: In the Workplace

Angela Vickers, JD, who was diagnosed with bipolar disorder in 1988, knows firsthand about problems at work related to this condition. A Jacksonville, Fla., attorney and civil rights worker for those with mental illnesses, Vickers has been well and on daily medication since an episode of mania led to her diagnosis of bipolar disorder. She is now a full-time mental health advocate and national speaker.

“Because of the level of ignorance [about bipolar disorder], there’s blatant discrimination in the workplace,” says Vickers. “If you tell the truth on an application, you’re often faced with persecution.” Vickers found herself in this situation when she wrote down “lithium” — one of the oldest drugs used to treat bipolar disorder — on her health insurance form when starting a new job. “The company started to work real hard to make my life miserable and run me out,” she says. The reason her employer and others react in this way, according to Vickers, is out of fear that their insurance companies will charge them more for having someone who is mentally ill on the payroll.

If you are facing problems at work, it’s important to familiarize yourself with the Americans With Disabilities Act (ADA), which protects people with medical or other conditions (including bipolar disorder) from discrimination in the workplace. However, the ADA only covers companies with 15 or more employees, and there are other restrictions that may apply in specific circumstances.

Bipolar Disorder and Legal Issues: Treatment Preferences

Another aspect of bipolar disorder and the law concerns your preferences for treatment if you’re unable to give consent — for example, in the event that you’re experiencing an episode of severe psychiatric illness. Advance directives, which have been primarily used to make end-of-life decisions (a “living will” is an example of an advance directive), are now being used to document a competent person’s specific instructions or preferences regarding future mental health treatment. These are known as psychiatric advance directives, or PADs. Almost all states permit some form of legal advance directive for health care, which can be used to direct at least some forms of psychiatric treatment, and 25 states have adopted specific PAD statutes to date. Vickers says, “[An advanced directive is] basically a contract where you get to choose (and control) what happens to you if things get bad and you’re not thinking clearly. Instead of having some stranger make the decisions or have your family guess at your needs, you’ll get to list your preferences.” For more information, visit the Web site of the National Resource Center on Psychiatric Advance Directives.

Bipolar Disorder and Legal Issues: Trouble With the Law

Ankur Saraiya, MD, assistant clinical professor of psychiatry at Columbia University in New York, says people with bipolar disorder may run into problems with the law if they are in severe manic or mixed episodes. Often people will get arrested during episodes or take on financial burdens that later get them in trouble. “The courts don’t have a great way to deal with this,” says Dr. Saraiya, “so for minor crimes it’s often simplest to just pay the fine and serve the sentence.”

The good news is that most people with bipolar disorder can avoid these situations: “The symptoms are almost always manageable if the individual stays in treatment,” says Saraiya. “It’s a very treatable disease, but not getting the proper help can affect your money, your life, and your safety, and cause a host of other problems.”

Vickers adds that the legal community often doesn’t have accurate information about bipolar disorder and isn’t trained to handle these types of situations. “We do not have advocates to fight for us properly,” says Vickers. She’s stepping into this role by fighting the stigma and spreading the word: “We are very capable of holding jobs, being articulate and punctual, and not being volatile or unsafe.”