Does Bipolar Get Worse With Age? A Look at the Latest Research
Globally, more than 40 million people live with bipolar disorder. Currently, about 25 percent of patients with bipolar disorder are 60 or older. This number is expected to jump to 50 percent by the year 2030 because of the aging population. Does bipolar disorder get worse with age?
The short answer: bipolar disorder does change with age, but with the right treatment and lifestyle support, many people with bipolar disorder continue to live fulfilling, meaningful lives well into the Golden Years.
Does Bipolar Disorder Get Worse With Age?
Bipolar disorder is a neuropsychiatric condition that is characterized by manic or hypomanic episodes alternating with depressive episodes. During hypo- and manic episodes, a person may have erratic behaviors, racing thoughts and speech, and be unable to sleep. During depressive episodes, they may be sad or irritable, sleep excessively, have difficulty concentrating, and have feelings of hopelessness. If these episodes are severe, a person may experience suicidal thoughts and behaviors. Sometimes, psychotic symptoms are present.
Research has found that bipolar disorder tends to worsen over age — especially if a person is not being treated. Medical experts consider it to be a progressive disease. However, the rate at which it progresses varies depending on a variety of factors.
How Does Bipolar Change With Age?
There are several ways in which bipolar disorder changes with age. As they age, people with bipolar tend to have:
More frequent and severe mood episodes (for some people)
Fewer manic episodes and more depressive episodes
More treatment resistance (meaning medications no longer work as well)
Onset of new cognitive issues
Importantly, these changes are not inevitable; many protective factors can slow or prevent decline.
Some research has found that older adults with bipolar disorder have a lower risk of suicide, but this is complicated. Survivorship bias is one explanation: those who live into older age with bipolar may be the individuals who had fewer severe episodes or better treatment access earlier in life.
Why Does Bipolar Disorder Change With Age?
There are several reasons why bipolar disorder might get worse with age. Researchers believe that bipolar disorder changes the brain’s function and structure. Mania, in particular, is associated with damage to the brain. Studies have found that bipolar disorder is associated with changes in the frontal lobe in older adults with the disorder. The frontal lobe is involved in memory and decision-making.
Bipolar disorder may cause progressive damage to telomeres. Telomeres are protective caps on DNA strands. They impact memory and mood regulation. They are involved in bipolar memory loss. Researchers have found that telomeres get progressively shorter in the brains of people who have bipolar disorder. It is thought that the destruction (shortening) of telomeres is related, in part, to the worsening of bipolar disorder as a person ages.
Additionally, the levels of an amino acid called N-acetylaspartate may decrease with age in people with bipolar disorder. This amino acid is involved in the regulation of memory and emotion.
Lifestyle factors may play a role, as well. Substance abuse has been found to significantly speed up the progression of bipolar disorder.
Can The Brain Recover?
The encouraging news: yes.
Studies have shown that the brain can recover slightly during euthymic periods in people with bipolar disorder. So, during periods when your mood is stable or euthymic, your brain may slowly repair itself.
What Can Help?
Manic episodes can progressively damage the brain over time. The damage is very tiny each time. However, it can add up over a lifetime. What can help? Consistent treatment to help prevent manic episodes. Here are some other things that can help.
Related: Can you manage bipolar without medications?
Medication: Mood stabilizers and antipsychotics are key medications for bipolar disorder. Lithium, a main mood stabilizer for bipolar, has been found to have neuroprotective properties (when at a therapeutic dose) that may protect the brain from aging-related damage. Lithium increases the levels of proteins that support brain cell growth. It also stimulates neurogenesis (the production of new neurons). Second-generation antipsychotics (SGAs) like quetiapine and olanzapine have also been found to be neuroprotective in animal studies.
Therapy: Therapy can help you cope with life changes as you age. Group therapy and support groups can help reduce loneliness and isolation. Therapy can also help you cope with things that are common with age, such as loss and grief.
Lifestyle changes: Comorbid physical health conditions like heart disease and high cholesterol can contribute to a worse outcome for those with bipolar disorder. Unfortunately, medications that are used to treat bipolar disorder can cause some of these issues. Talk to your doctor about how you can manage comorbid conditions. Also, make sure you have a relatively healthy lifestyle. Focus on things like healthy eating and exercise.
The Bottom Line
Bipolar disorder may bring new challenges with age, but it is not a guaranteed decline. With ongoing treatment, strong support, and healthy lifestyle choices, older adults with bipolar disorder can stay well, preserve brain health, and continue building meaningful, connected lives.
