Bipolar disorder, formerly known as manic depression, is a mental health condition characterized by extreme mood swings. People with bipolar disorder experience episodes of mania (elevated moods and energy) and depression (feelings of sadness and hopelessness). Bipolar disorder often begins in adolescence or early adulthood, with the average age of onset being 25 years old. As people with bipolar age, many wonder if their symptoms will calm down over time. Here is an in-depth look at how bipolar disorder progresses with age.
Do manic and depressive episodes decrease with age?
For many people, the frequency and severity of manic and depressive episodes do tend to decrease with age. There are several reasons why this happens:
- The brain matures – Brain development continues into the 20s. As the prefrontal cortex matures, some people gain better control over emotions and impulses.
- Lifetime of treatment – Years of medication, therapy, and lifestyle changes help manage symptoms.
- Less stress – Work and family demands tend to lessen in later life stages, reducing stress.
- Increased stability – Jobs and relationships become more stable, providing structure.
However, not everyone experiences this pattern. Around 30-50% of people with bipolar disorder continue to have episodes into their 50s, 60s, and beyond. Personality, genetics, early onset, and other factors affect the course of the illness.
Why do some people continue to have symptoms?
There are several reasons why bipolar disorder may persist and remain symptomatic later in life:
- Genetics – More affected biological relatives correlates with worse long-term outcomes.
- Personality – Some personality traits make episodes more likely.
- Early onset – Developing bipolar disorder early in life is linked to worse long-term prognosis.
- Lack of treatment – Stopping treatment increases risk of recurrence.
- Substance abuse – Drugs and alcohol make mood episodes more frequent.
- Medical conditions – Other illnesses and medications can trigger swings.
- Major life events – Loss, grief, and stress can lead to relapse of symptoms.
Additionally, the cumulative damage from years of bipolar episodes may make recovery and stability harder to achieve later in life.
How does bipolar progress with age?
If bipolar disorder persists into older age, the presentation of symptoms often changes:
- Depression increases – Depressive episodes tend to increase, while manic episodes decrease.
- Rapid cycling – Some people develop “rapid cycling” with 4 or more episodes per year.
- Mixed episodes – Symptoms of mania and depression occur simultaneously.
- Psychosis – Manic episodes are more likely to involve psychosis.
- Cognitive impairment – Memory and executive functioning may decline.
These changing patterns may be related to age-related brain changes combined with the cumulative impact of years of bipolar disorder. The episodes associated with bipolar can damage brain regions involved in mood regulation and cognition over time.
What are the risks of late-life bipolar disorder?
Older adults with ongoing bipolar disorder are at increased risk for:
- Suicide
- Medical illness
- Cognitive decline and dementia
- Social isolation
- Disability
- Poorer quality of life
Studies show a strong correlation between bipolar disorder and cognitive impairment in later life. However, some medications used to treat bipolar may also contribute to cognitive problems.
Can late-onset bipolar disorder occur?
In rare cases, bipolar disorder can first appear in a person’s 40s, 50s or even later in life. When onset occurs after age 50, it is considered “late-onset.” This type of bipolar disorder may have a different underlying biology and respond differently to treatments. Causes may include:
- Medical illness
- Medication side effects
- Hormonal changes
- Major life stressors
- Substance abuse
- Vascular disease in the brain
The symptoms of late-onset bipolar disorder may be less severe. Mania often manifests as irritability and agitation rather than euphoria. Late-onset bipolar carries an increased risk of dementia.
Treatments for older adults with bipolar disorder
Treatment guidelines recommend the following for stabilizing mood in older bipolar adults:
- Mood stabilizer medication, often lithium or anticonvulsants
- Atypical antipsychotic medication
- Antidepressant medication alongside mood stabilizers
- Electroconvulsive therapy for severe depression or rapid cycling
- Psychotherapy for coping strategies
- Consistency in daily routines
Doctors aim to use the minimal effective dose of medication due to increased sensitivity in older bodies. Lower doses help avoid complications such as excessive sedation, movement disorders, and cognitive impairment.
What are the best lifestyle habits for older adults with bipolar disorder?
Alongside medication and therapy, healthy lifestyle habits are strongly recommended:
- Regular exercise and activity
- Stress management and relaxation techniques
- Regular sleep schedule & 7-9 hours per night
- Healthy diet with brain-boosting foods
- Cognitive stimulation through learning and games
- Avoiding smoking, alcohol and substance abuse
- Engaging in work, volunteering, or hobbies
- Staying socially active and connected
These healthy habits help regulate moods, relieve stress, boost cognition, and improve overall mental and physical wellbeing.
What is the life expectancy with bipolar disorder?
People with bipolar disorder have a 10-25 year reduction in expected lifespan compared to the general population. The main causes of premature death include:
- Suicide
- Accidents
- Substance abuse
- Medical conditions exacerbated by lifestyle factors
However, many studies show that proper treatment and self-care can significantly improve life expectancy for bipolar patients. Prioritizing treatment, avoiding substance abuse, and managing health conditions can help increase life expectancy.
| Age Group | Expected Changes |
|---|---|
| 20s-40s |
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| 50s-60s |
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| 70s-80s |
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This table summarizes the expected course of bipolar disorder as patients age through different life stages.
What is the outlook for older adults with bipolar disorder?
With proper treatment and healthy self-care, many people with bipolar lead productive and fulfilling lives well into old age. While bipolar disorder can be challenging at any age, there are always new treatment options emerging. Even later in life, people with bipolar can achieve mood stability by actively managing their mental health.
Conclusion
In conclusion, bipolar disorder may improve with age for some people as the brain matures, but persists as an ongoing condition for others. Controlling symptoms throughout life with comprehensive treatment and healthy habits offers the best chance for stability. With proactive management, older adults with bipolar can maintain positive mental health, cognitive function, and quality of life.