Treatment of Bipolar Disorder in Special Populations

Though often considered a young person's disease because its mean age of onset is in late adolescence, bipolar disorder (BD) frequently demonstrates recurrent episodes and morbidities that continue throughout the lifetime of the patient and into old age. In fact, presentation of mood episodes in older age is quite common and requires clinicians to understand the unique challenges that the interaction of aging and mental illness present. Further, it has been well established that the depressive polarity of episodes increases in frequency over the life span with a decline in manic and mixed episode presentations. Finally, while new onset of illness is relatively rare in later ages, it is not unknown, and the variability of age of onset may allow for a better understanding of the disease process. This chapter reviews our current understanding of BD in the elderly and highlights the implications of age in understanding the heuristic causes of the disease, challenges to treatment, and the limitations of our knowledge for clinical care.