Bipolar disorder in the elderly; different effects of age and of age of onset

Journal of Affective Disorders, 06/25/2009

Oostervink F et al. - Elderly bipolar manic patients differ from younger bipolar manic patients regarding treatment but not treatment outcome. LOB elderly patients demonstrated a more favourable outcome. The use of medication and the occurrence of rapid cycling in EOB elderly patients warrant further study.


  • The European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) study was a 2-year prospective, observational study in 3459 bipolar patients on the treatment and outcome of patients with an acute manic or mixed episode.
  • Within this study, elderly patients (> 60 years of age; n = 475) were compared with younger patients (< 50 years of age; n = 2286), and within the elderly group, Late Onset Bipolar (LOB) patients (onset ≥ 50 years; n = 141) were compared with Early Onset Bipolar (EOB) patients (< 50 years; n = 323).


  • In the year prior to enrolment, elderly patients, especially those with EOB, more frequently reported a rapid cycling course of illness, but fewer suicide attempts.
  • At baseline, elderly patients more often used one psychotropic medication and demonstrated less severe manic and psychotic symptoms, but no difference in depressive symptomatology.
  • However, prior to enrolment and during the acute phase of treatment, elderly patients more frequently received antidepressants.
  • Atypical antipsychotics were given less frequently.
  • Regarding 12-week outcomes, there was no difference between elderly and younger patients, although LOB elderly recovered faster, and were discharged sooner than EOB elderly patients.

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