Treating Mania in Older Patients with Bipolar Disorder

Little effort is made toward treating bipolar disorder in seniors.  Geriatric psychiatry is not a sexy specialty for doctors in training, and research on treatment for older patients is scant.

Doctors often don’t even notice mental illness in patients over 60. So I was excited to find a study that specifically looked at treating mania in geriatric patients with bipolar disorder 1.

Medication can be difficult in patients over 60.  The elderly usually tolerate only lower doses of psych meds than younger people with mood disorders.  Drug interactions must be approached with care, as senior citizens with bipolar disorder are often being treated for physical conditions as well.

Cognitive decline also becomes a challenge as patients age.

The study I cite investigated the use of lithium and divalproex (Depakote) in treating mania in a geriatric sample.  The researchers hypothesized that divalproex would yield better results and fewer side effects.

Surprisingly, they found that the drugs had near equal effectiveness, and both were well-tolerated.  The only downside to lithium was that it produced more tremors in the people who took it.

The study subjects were experiencing manic episodes during the trial.  They were followed for a 9-week period.  At the end of the study 79% of the patients on lithium and 73% of the patients on divalproex achieved remission.

Treatment effectiveness rates for younger patients in similar circumstances treated with slightly higher doses of meds hover around 85%.

During the study, subjects who showed no improvement in their manic symptoms after 3 weeks were administered the anti-psychotic risperidone.  Only 17% of those on lithium and 14% of those on divalproex required anti-psychotics.

The results are interesting because in younger patients there has been a significant shift away from lithium and toward anti-psychotics as a first-line treatment for mania.

The study did not follow-up on recurrence of mania in the sample group.

It’s an encouraging study that illustrates that the prognosis for geriatric patients with bipolar 1 is good.  So little effort is made in developing treatment protocols for older people with mental illness.  This study proves a significant step toward understanding mania in seniors and offering workable treatment options for the psychiatrists who care for them.

Source:  https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2017.15050657