Pharmacological maintenance treatment in older age bipolar disorder

The current review discusses the most recent developments in pharmacological maintenance treatment of older age bipolar disorder.

Older age bipolar disorder (OABD) applies to patients with bipolar disorder aged 50 years and over, a threshold reflecting the association between bipolar disorder and premature aging. Although medication effective in younger age bipolar disorder (YABD) are generally assumed to remain effective in older adults, the disease course becomes more complex in time and age-related changes in pharmacokinetics and pharmacodynamics require careful consideration. Despite the growing aging population, research targeting OABD remains limited. Therefore, the Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) was initiated by the ISBD (International Society for Bipolar Disorder) OABD taskforce in 2016. Several recent studies on pharmacological maintenance therapy originated from this initiative and are discussed in this narrative review alongside other recent findings. However, no intervention studies have been published in the last 18 months, and the current evidence base largely consists of prospective cohort studies and cross-sectional data.

When looking at maintenance therapy in OABD, lithium remains first line of treatment but with an adjusted lower therapeutic range. Lithium therapy should not be withheld due to concerns of future kidney function decline.