Evidence-Based Pharmacological Treatment of Geriatric Bipolar Disorder

Young, Robert C.

doi:10.1016/j.psc.2005.09.011

Cited by 15 publications

(9 citation statements)

References 135 publications

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“…After recognition of BD and careful diagnostic assessment, pharmacotherapy represents the cornerstone of their management. Lithium remains the treatment of choice for bipolar mania in elderly patients 16. Although lithium has greater proven efficacy than other mood stabilizers with respect to treating and preventing manic episodes and reducing suicidal behavior17 there is a dearth of good studies of its use in the elderly population.…”

Section: Introductionmentioning

confidence: 99%

Lithium in late-life mania: a systematic review

Fazio¹,

Gaetano²,

Caroleo³

et al. 2017

NDT

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The prevalence of mania among >65-year-olds ranges from 0.1% to 0.4% and its treatment is a particular challenge for clinicians. Although lithium is the treatment of choice for bipolar disorder (BD), its use in elderly population was recently questioned. This study provides a comprehensive review of literature on the efficacy and tolerability of lithium as a pharmacologic treatment for mania in elderly BD patients. We conducted a systematic review, based on PRISMA guidelines, of articles published between 1970 and August 2016 and indexed in the following databases: EMBASE, MEDLINE, Cochrane Library Databases and PsycINFO. The key words “age”, “late-life”, “geriatric”, “elderly”, and “older” were combined with words indicating pharmacologic treatments, such as lithium and other mood stabilizers and with the diagnostic terms “bipolar disorder” and “mania”. Fifteen out of 196 retrieved studies met our inclusion criteria. Seven studies evaluated both the efficacy and tolerability of lithium treatment in elderly BD patients; a further three evaluated only the efficacy and five assessed tolerability. Only limited data on the treatment of elderly BD patients are available, but evidence suggests that lithium is effective and tolerated in this subgroup of patients and thus should remain a first-line drug. It seems to be more effective at lower doses and close monitoring of plasma concentrations is necessary.

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Section: Introductionmentioning

confidence: 99%

Lithium in late-life mania: a systematic review

Fazio¹,

Gaetano²,

Caroleo³

et al. 2017

NDT

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“…A long term study by Angst et al reported that only 16% of elderly patients with BD had fully recovered with usual treatment 4. There are no current evidence-based recommendations for managing affective episodes in elderly persons with BD and little is known about recommended medications or doses in older patients 5. Data from younger patients may not be applicable given metabolic changes that occur with age.…”

Section: Introductionmentioning

confidence: 99%

Prescription Patterns of Psychotropic Medications in Elderly Compared With Younger Participants Who Achieved a “Recovered” Status in the Systematic Treatment Enhancement Program for Bipolar Disorder

Jurdi

Marangell

Petersen

et al. 2008

The American Journal of Geriatric Psychiatry

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Objectives-This study aims at comparing prescription patterns between young adults and elderly with bipolar disorder who achieved a recovery status during the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).Design-STEP-BD is a multicenter National Institute of Mental Health (NIMH)-funded project designed to evaluate the longitudinal outcome of patients with bipolar disorder. The STEP-BD study involved extensive assessment across multiple domains including demographic data, diagnosis, Corresponding Author: Rayan K. Al Jurdi, MD, Michael Debakey VAMC, 2002 Holcombe Blvd. MHCL 116, Houston, TX, 77030, Tel: 713-794-8709, Fax: 713-794-8172, Email: rayana@bcm.tmc.edu, rayan.aljurdi@med.va Participants-we analyzed data of all subjects who achieved a recovered status at least once in their participation.Measurements-We compared treatment regimes and doses between young participants to middle age (n=3,364), 20 to 59 years old, and older participants 60 and above (n=246).Results-Of the 3,615 STEP-BD participants who had a lifetime diagnosis of bipolar subtypes I or II, 67.6% (n=2442) achieved a recovered status during their participation. 78.5% (n=193) of older patients recovered compared to 66.8% of the younger cohort. On average, participants who reached a recovered status took 2.05 medications with no difference between age groups. Lithium was prescribed to 37.8% of younger patients compared to only 29.5% of older participants. The mean dosages taken by younger and older patients differed significantly only for lithium, valproate and risperidone with elderly individuals prescribed lower daily dosages. Significant reduction in lithium dosing was observed among individuals age 50 and older and among individuals 60 and older for valproate. Although valproate was more often prescribed, 42.1% of recovered bipolar elder achieved recovery with lithium alone compared to only 21.3% of the younger cohort.Conclusion-This data shows recovery is achievable in the elderly though more than one medication is often needed regardless of age.

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“…15 Patients with bipolar disorder can present in a Symptoms of bipolar disorder are often distressing to patients, their loved ones, and caretakers, and effective psychopharmacological management is essential. When considering an agent for this illness in older adults, numerous factors such as tolerability, side-effect profile, and potential interactions need to be weighed in addition to efficacy.…”

Section: Bipolar Disordermentioning

confidence: 99%

Psychotropic Medication Use in Older Adults

Strauss

2014

International Anesthesiology Clinics

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Evidence-Based Pharmacological Treatment of Geriatric Bipolar Disorder

Cited by 15 publications

References 135 publications

Lithium in late-life mania: a systematic review

Lithium in late-life mania: a systematic review

Prescription Patterns of Psychotropic Medications in Elderly Compared With Younger Participants Who Achieved a “Recovered” Status in the Systematic Treatment Enhancement Program for Bipolar Disorder

Psychotropic Medication Use in Older Adults

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