Elderly bipolar disorder

Treatment of elderly patients with bipolar disorder requires special care because of increased risks associated with concurrent non-psychiatric medical conditions and drug-drug interactions. General medical conditions including endocrine,... 

In addition to treating insomnia, gabapentin has been used to treat epilepsy, anxiety disorders, and bipolar disorder. It is generally well tolerated with sedation and headaches being the only prominent side effects. Because gabapentin is excreted unchanged in urine, it does not require metabolism by the liver. It is therefore easily eliminated by elderly patients and those with liver disease, although it should be used with caution in those with poor renal (kidney) function. 

Sajatovic M, Madhusoodanan S, Coconcea N. Managing bipolar disorder in the elderly. Defining the role of newer agents. Drugs Aging 2005 22 39-54. 

Older persons account for one-third of all suicides in the United States even though this group represents only 12% of the population ( 36). Suicide is even more often related to major depression in the elderly than in younger individuals in whom other causes such as substance abuse, bipolar disorder, schizophrenia, and personality disorders often play a major role. In fact, suicide rates are highest in older white men relative to any other segment of the population. For example, white men older than 85 years age commit suicide 30 times as frequently as black women. 

In terms of approved medical use, the neuroleptics are often prescribed for children with autism, attention-deficit hyperactivity disorder (ADHD), and Tourette s syndrome. In addition, the popularity of the newer atypical neuroleptics for childhood bipolar disorder is growing rapidly, and sometimes these drugs are the only treatment offered. The neuroleptics are also commonly prescribed for the elderly in nursing homes or other insti-... 

Nunes PV, Forlenza OV, Gattaz WF. Lithium and risk for Alzheimer s disease in elderly patients with bipolar disorder. Br J Psychiatry 2007 190 359-60. 

Parkinsonism has been studied in special groups, such as elderly patients (196), patients with bipolar disorders... 

Relative history of seizure disorder, bipolar disorder (may induce mania), urinary retention, narrow-angle glaucoma, delirium, hyperthyroidism, bradycardia (or drugs that cause bradycardia), or electrolyte disturbance (esp. K+ or Mg ). Use caution in conjunction with other antidepressants (including MAOIs and SSRIs), other anticholinergic medications, drugs that increase plasma levels (phenothiazines, haloperidol, cimetidine), or drugs that lower seizure threshold (esp. tramadol). Use caution in elderly, children/adolescents. 

Lithium is commonly used for bipolar affective disorders. Lithium however has a narrow therapeutic index and high risk for toxicity (Groleau 1994). The use of loop diuretics or ACE-inhibitors significantly increases the risk of hospitalisation for lithium toxicity in the elderly (Juurlink et al. 2004). Treatment of elderly patients with lithium should be thoroughly monitored. 

Clozapine also has been shown to benefit schizoaffective and bipolar patients with treatment-refractory mania ( 54) patients with Parkinson s disease and those with other neurological disorders with psychoses, such as Huntington s disease. Although clozapine has been shown to be an effective agent in the elderly, its usefulness in this population is limited because of its anticholinergic, sedative, cardiovascular, and potentially toxic effects on the bone marrow ( 55). In a study of 12 elderly female psychotic patients on clozapine (maximal daily dose, 300 mg), for example, five were taken off clozapine because of postural hypotension, one had a nonfatal episode of agranulocytosis, and one had leukopenia ( 56). 

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