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IntroductionA paucity of evidence describes the presentation of depression across age groups among patients with bipolar disorder.ObjectivesWe explored the symptoms and the severity of acute bipolar depression in a multicenter, naturalistic follow-up study for treating bipolar disorder.AimsTo investigate whether specific depression symptoms are more frequent and/or severe in the elderly with bipolar disorder compared to a younger cohort.MethodsThe Systematic Treatment Enhancement Program for Bipolar Disorder is a National Institute of Mental Health-funded project to evaluate the longitudinal outcome of patients with bipolar disorder. Patients were categorized with “depression” if they experienced at least two consecutive weeks of five clinically significant depression symptoms (change in sleep or appetite; decreased energy; low mood, guilt or low self-esteem; anhedonia; decreased concentration or increased distractibility; psychomotor agitation or retardation; and presence of suicidal thoughts, intent or plans). Patients were stratified by age, (20-59 and >60), and data of all diagnosed with depression were analyzed.ResultsOf 3,615 participants with bipolar subtype-I or II, 1,564 were diagnosed with depression. Ninety-eight (6.3%) were at least 60 years of age. The most common symptoms in both groups were anhedonia and decreased energy. Younger adults were more likely to have low self-esteem, distractibility, and psychomotor agitation. Except for decreased sleep in the younger cohort, the severity of symptoms was comparable between groups. The two cohorts had a Clinical Global Impression score of 3.99 (p = .887).[Step BD- Depression Rating Guidelines][STEP-BD Bipolar Depression Symptoms by Age][STEP BD Bipolar Depression Symptom Severity]ConclusionsPresenting symptoms and severity of depression in patients with bipolar disorder are comparable across age groups.