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Pharmacotherapy of Bipolar Disorder in Old Age

Review and Recommendations

Received September 26, 2002; revised August 26, September 18, 2003; accepted October 23, 2003. From the Dept. of Psychiatry of Weill Medical College of Cornell University; University of Pennsylvania (RCY); the Dept. of Psychiatry, Bipolar Disorders Program (LG); Western Psychiatric Institute and Clinic, Dept. of Psychiatry, Univ. of Pittsburgh School of Medicine and the Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System (BHM,CFR); the Dept. of Psychiatry, Faculty of Medicine, Univ. of Toronto (AF,KIS); the Dept. of Psychiatry, Duke Univ. Medical Center (JLB). Send correspondence to Robert C. Young, M.D., Payne-Whitney, Westchester, and the Institute for Geriatric Psychiatry, Department of Psychiatry, Weill Medical College of Cornell University, 21 Bloomingdale Road, White Plains, New York 10605. e-mail: ryoung{at}med.cornell.edu
© 2004 American Association for Geriatric Psychiatry

ABSTRACT

The authors reviewed the evidence-base for pharmacological treatment of mania and bipolar (BP) depression in late life. Treatment benefits and side effects may be modified by age-associated factors, such as neurocognitive impairments. Lithium and divalproex have most often been studied in elderly patients, and both may be efficacious in acute treatment of mania, but there are no controlled efficacy or effectiveness trials. The role of atypical antipsychotic agents remains to be clarified. Similarly, there are no systematic studies of the treatment of BP depression in elderly patients. The authors make suggestions for management and delineate priorities for research.

Key Words: Bipolar Disorder • Depression • Divalproex • Lithium

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