{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T23:04:38Z","timestamp":1793055878145,"version":"4.5.0"},"reference-count":115,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T00:00:00Z","timestamp":1623110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Data regarding older age bipolar disorder (OABD) are sparse. Two major groups are classified as patients with first occurrence of mania in old age, the so called \u201clate onset\u201d patients (LOBD), and the elder patients with a long-standing clinical history, the so called \u201cearly onset\u201d patients (EOBD). The aim of the present literature review is to provide more information on specific issues concerning OABD, such as epidemiology, aetiology and treatments outcomes. We conducted a Medline literature search from 1970\u20132021 using the MeSH terms \u201cbipolar disorder\u201d and \u201caged\u201d or \u201cgeriatric\u201d or \u201celderly\u201d. The additional literature was retrieved by examining cross references and by a hand search in textbooks. With sparse data on the treatment of OABD, current guidelines concluded that first-line treatment of OABD should be similar to that for working-age bipolar disorder, with specific attention to side effects, somatic comorbidities and specific risks of OABD. With constant monitoring and awareness of the possible toxic drug interactions, lithium is a safe drug for OABD patients, both in mania and maintenance. Lamotrigine and lurasidone could be considered in bipolar depression. Mood stabilizers, rather than second generation antipsychotics, are the treatment of choice for maintenance. If medication fails, electroconvulsive therapy is recommended for mania, mixed states and depression, and can also be offered for continuation and maintenance treatment. Preliminary results also support a role of psychotherapy and psychosocial interventions in old age BD. The recommended treatments for OABD include lithium and antiepileptics such as valproic acid and lamotrigine, and lurasidone for bipolar depression, although the evidence is still weak. Combined psychosocial and pharmacological treatments also appear to be a treatment of choice for OABD. More research is needed on the optimal pharmacological and psychosocial approaches to OABD, as well as their combination and ranking in an evidence-based therapy algorithm.<\/jats:p>","DOI":"10.3390\/medicina57060587","type":"journal-article","created":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T12:08:55Z","timestamp":1623154135000},"page":"587","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":61,"title":["Old Age Bipolar Disorder\u2014Epidemiology, Aetiology and Treatment"],"prefix":"10.3390","volume":"57","author":[{"given":"Ivan","family":"Arnold","sequence":"first","affiliation":[{"name":"Helios Klinik Berlin-Buch, 13125 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Dehning","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Grunze","sequence":"additional","affiliation":[{"name":"Psychiatrisches Zentrum Nordbaden, 69168 Wiesloch, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armand","family":"Hausmann","sequence":"additional","affiliation":[{"name":"Private Practice, Wilhelm-Greil-Stra\u00dfe 5, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1017\/S0033291797005333","article-title":"The epidemiology of DSM-III-R bipolar I disorder in a general population survey","volume":"27","author":"Kessler","year":"1997","journal-title":"Psychol. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1001\/archpsyc.1978.01770350071006","article-title":"Age at onset of bipolar affective illness","volume":"35","author":"Loranger","year":"1978","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1192\/bjp.120.558.523","article-title":"Manic-depressive illness: A comparative study of patients with and without a family history","volume":"120","author":"Mendlewicz","year":"1972","journal-title":"Br. J. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1001\/archpsyc.1973.04200040066011","article-title":"The phenomenology of mania: A new look at some old patients","volume":"29","author":"Taylor","year":"1973","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/S0165-0327(03)00195-2","article-title":"Diagnostic conversion from depression to bipolar disorders: Results of a long-term prospective study of hospital admissions","volume":"84","author":"Angst","year":"2005","journal-title":"J. Affect. Disord."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1097\/00019442-200504000-00004","article-title":"Differences in clinical features and mental health service use in bipolar disorder across the lifespan","volume":"13","author":"Depp","year":"2005","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"53","DOI":"10.4088\/JCP.v64n0111","article-title":"Screening for bipolar disorder in the community","volume":"64","author":"Hirschfeld","year":"2003","journal-title":"J. Clin. Psychiatry"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1001\/archpsyc.62.6.593","article-title":"Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication","volume":"62","author":"Kessler","year":"2005","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1007\/BF01066763","article-title":"Tailoring adult psychiatric practices to the field of geriatrics","volume":"63","author":"Greenwald","year":"1992","journal-title":"Psychiatr. Q."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1111\/j.1399-5618.2004.00139.x","article-title":"Bipolar disorder in older adults: A critical review","volume":"6","author":"Depp","year":"2004","journal-title":"Bipolar Disord."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1111\/bdi.12104","article-title":"The prevalence of late-life mania: A review","volume":"16","author":"Dols","year":"2014","journal-title":"Bipolar Disord."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1097\/00019442-200504000-00006","article-title":"Maintenance treatment outcomes in older patients with bipolar I disorder","volume":"13","author":"Sajatovic","year":"2005","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/S0193-953X(18)30520-3","article-title":"Late-onset bipolar disorder","volume":"11","author":"Yassa","year":"1988","journal-title":"Psychiatr. Clin. N. Am."},{"key":"ref_14","first-page":"34","article-title":"Late-onset bipolar disorder: A case for careful appraisal","volume":"7","author":"Prabhakar","year":"2010","journal-title":"Psychiatry"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1111\/j.1399-5618.2005.00181.x","article-title":"Age at onset in bipolar affective disorders: A review","volume":"7","author":"Leboyer","year":"2005","journal-title":"Bipolar Disord."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1176\/appi.ajp.160.5.999","article-title":"Age at onset in bipolar I affective disorder: Further evidence for three subgroups","volume":"160","author":"Bellivier","year":"2003","journal-title":"Am. J. Psychiatry"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1001\/archpsyc.58.5.510","article-title":"Admixture analysis of age at onset in bipolar I affective disorder","volume":"58","author":"Bellivier","year":"2001","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1016\/j.jad.2013.05.026","article-title":"Characteristics and profiles of bipolar I patients according to age-at-onset: Findings from an admixture analysis","volume":"150","author":"Azorin","year":"2013","journal-title":"J. Affect. Disord."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1111\/bdi.12331","article-title":"A report on older-age bipolar disorder from the International Society for Bipolar Disorders Task Force","volume":"17","author":"Sajatovic","year":"2015","journal-title":"Bipolar Disord."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/S0165-0327(01)00476-1","article-title":"Evidence for a late onset bipolar-I disorder sub-group from 50 years","volume":"73","author":"Moorhead","year":"2003","journal-title":"J. Affect. Disord."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1002\/gps.4465","article-title":"Depressive symptoms in early- and late-onset older bipolar patients compared with younger ones","volume":"32","author":"Ezquiaga","year":"2017","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/S0165-0327(99)00111-1","article-title":"Early and late onset bipolar disorders: Two different forms of manic-depressive illness?","volume":"58","author":"Bellivier","year":"2000","journal-title":"J. Affect. Disord."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1017\/S0033291701004718","article-title":"Vascular risk factors in late onset mania","volume":"32","author":"Cassidy","year":"2002","journal-title":"Psychol. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1161\/01.STR.26.6.946","article-title":"Silent cerebral infarctions in patients with late-onset mania","volume":"26","author":"Fujikawa","year":"1995","journal-title":"Stroke"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1002\/(SICI)1520-6394(1998)7:2<76::AID-DA5>3.0.CO;2-3","article-title":"Age of first onset of bipolar disorder: Demographic, family history, and psychosocial correlates","volume":"7","author":"Hays","year":"1998","journal-title":"Depress. Anxiety"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1002\/gps.3801","article-title":"Neurocognitive functioning in early-onset and late-onset older patients with euthymic bipolar disorder","volume":"28","author":"Martino","year":"2013","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1176\/ajp.151.1.130","article-title":"First-episode mania in late life","volume":"151","author":"Tohen","year":"1994","journal-title":"Am. J. Psychiatry"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1017\/S1041610202008517","article-title":"Bipolar disorder: Similarities and differences between patients with illness onset before and after 65 years of age","volume":"14","author":"Almeida","year":"2002","journal-title":"Int. Psychogeriatr."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, APA Press. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1007\/s11920-007-0024-8","article-title":"Mania in the medically ill","volume":"9","author":"Arora","year":"2007","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1001\/archpsyc.1978.01770350059005","article-title":"Secondary mania: Manic syndromes associated with antecedent physical illness or drugs","volume":"35","author":"Krauthammer","year":"1978","journal-title":"Arch. Gen. Psychiatry."},{"key":"ref_32","first-page":"31","article-title":"Secondary mania: Diagnosis and treatment","volume":"56","author":"Evans","year":"1995","journal-title":"J. Clin. Psychiatry"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2033","DOI":"10.1176\/appi.ajp.162.11.2033","article-title":"Secondary mania in older adults","volume":"162","author":"Brooks","year":"2005","journal-title":"Am. J. Psychiatry"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1192\/bjp.136.1.26","article-title":"Bipolar affective disorder in old age","volume":"136","author":"Shulman","year":"1980","journal-title":"Br. J. Psychiatry"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1176\/ajp.141.9.1084","article-title":"Secondary mania with focal cerebrovascular lesions","volume":"141","author":"Cummings","year":"1984","journal-title":"Am. J. Psychiatry"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1192\/bjp.155.2.220","article-title":"Mania in the elderly","volume":"155","author":"Stone","year":"1989","journal-title":"Br. J. Psychiatry"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1176\/ajp.149.3.341","article-title":"Mania compared with unipolar depression in old age","volume":"149","author":"Shulman","year":"1992","journal-title":"Am. J. Psychiatry"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/S0749-0690(18)30489-0","article-title":"Geriatric mania","volume":"8","author":"Young","year":"1992","journal-title":"Clin. Geriatr. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1002\/gps.1730","article-title":"The role of vascular risk factors in late onset bipolar disorder","volume":"22","author":"Subramaniam","year":"2007","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1212\/WNL.0b013e3181e62124","article-title":"Recurrent depressive symptoms and the incidence of dementia and mild cognitive impairment","volume":"75","author":"Dotson","year":"2010","journal-title":"Neurology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1001\/archpsyc.63.5.530","article-title":"Depression and risk for Alzheimer disease: Systematic review, meta-analysis, and metaregression analysis","volume":"63","author":"Ownby","year":"2006","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1136\/jnnp.2003.031773","article-title":"Does the risk of developing dementia increase with the number of episodes in patients with depressive disorder and in patients with bipolar disorder?","volume":"75","author":"Kessing","year":"2004","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1192\/bjp.bp.106.029868","article-title":"Lithium and risk for Alzheimer\u2019s disease in elderly patients with bipolar disorder","volume":"190","author":"Nunes","year":"2007","journal-title":"Br. J. Psychiatry"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1111\/bdi.12077","article-title":"A quantitative review of neurocognition in euthymic late-life bipolar disorder","volume":"15","author":"Martino","year":"2013","journal-title":"Bipolar Disord."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1017\/S0033291709005534","article-title":"Age transitions in the course of bipolar I disorder","volume":"39","author":"Coryell","year":"2009","journal-title":"Psychol. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1002\/gps.930050403","article-title":"Mania in old age: A First Prospective Study","volume":"5","author":"Broadhead","year":"1990","journal-title":"Int. J. Geriatric. Psychiatry"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1111\/j.1600-0447.1999.tb10862.x","article-title":"Recovery from episodes during the course of affective disorder: A case-register study","volume":"100","author":"Kessing","year":"1999","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1002\/gps.4128","article-title":"Two years\u2019 outcome of acute mania in bipolar disorder: Different effects of age and age of onset","volume":"30","author":"Oostervink","year":"2015","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_49","first-page":"17","article-title":"Outcome of a clinical cohort of unipolar, bipolar and schizoaffective patients. Results of a prospective study from 1959 to 1985","volume":"146","author":"Angst","year":"1995","journal-title":"Schweiz. Arch. Neurol. Psychiatr."},{"key":"ref_50","first-page":"5","article-title":"Course of a clinical cohort of unipolar, bipolar and schizoaffective patients. Results of a prospective study from 1959 to 1985","volume":"146","author":"Angst","year":"1995","journal-title":"Schweiz. Arch. Neurol. Psychiatr."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1192\/bjp.172.1.29","article-title":"Recurrence in affective disorders. II. Effect of age and gender","volume":"172","author":"Kessing","year":"1998","journal-title":"Br. J. Psychiatry"},{"key":"ref_52","first-page":"489","article-title":"The course of monopolar depression and bipolar psychoses","volume":"76","author":"Angst","year":"1973","journal-title":"Psychiatr. Neurol. Neurochir."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1055\/s-2007-1019628","article-title":"Course of the manic-depressive cycle and changes caused by treatment","volume":"13","author":"Kukopulos","year":"1980","journal-title":"Pharmakopsychiatr. Neuropsychopharmakol."},{"key":"ref_54","first-page":"1","article-title":"The longitudinal course of recurrent affective illness: Life chart data from research patients at the NIMH","volume":"317","author":"Post","year":"1985","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1002\/gps.5094","article-title":"Episodic density, subsyndromic symptoms, and mood instability in late-life bipolar disorders: A 5-year follow-up study","volume":"34","author":"Strejilevich","year":"2019","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1192\/bjp.185.5.372","article-title":"Course of illness in depressive and bipolar disorders. Naturalistic study, 1994\u20131999","volume":"185","author":"Kessing","year":"2004","journal-title":"Br. J. Psychiatry"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"469","DOI":"10.4088\/JCP.v63n0602","article-title":"Risk factors for completed suicide in bipolar disorder","volume":"63","author":"Tsai","year":"2002","journal-title":"J. Clin. Psychiatry"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1017\/S0033291704003307","article-title":"Incidence and distribution of first-episode mania by age: Results from a 35-year study","volume":"35","author":"Kennedy","year":"2005","journal-title":"Psychol. Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.psychres.2010.10.033","article-title":"An admixture analysis of the age at index episodes in bipolar disorder","volume":"188","author":"Ortiz","year":"2011","journal-title":"Psychiatry Res."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.jad.2008.11.012","article-title":"Bipolar disorder in the elderly; different effects of age and of age of onset","volume":"116","author":"Oostervink","year":"2009","journal-title":"J. Affect. Disord."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"S69","DOI":"10.1016\/S0165-0327(00)00180-4","article-title":"Current issues in the identification and management of bipolar spectrum disorders in \u2018special populations\u2019","volume":"59","author":"Cassano","year":"2000","journal-title":"J. Affect. Disord."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1177\/089198870201500303","article-title":"Aging-related issues in bipolar disorder: A health services perspective","volume":"15","author":"Sajatovic","year":"2002","journal-title":"J. Geriatr. Psychiatry Neurol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1176\/appi.ajp.2017.15050657","article-title":"GERI-BD: A Randomized Double-Blind Controlled Trial of Lithium and Divalproex in the Treatment of Mania in Older Patients With Bipolar Disorder","volume":"174","author":"Young","year":"2017","journal-title":"Am. J. Psychiatry"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"148","DOI":"10.4103\/abr.abr_110_18","article-title":"Evaluation of the Effect of Memantine Supplementation in the Treatment of Acute Phase of Mania in Bipolar Disorder of Elderly Patients: A Double-blind Randomized Controlled Trial","volume":"7","author":"Omranifard","year":"2018","journal-title":"Adv. Biomed. Res."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1111\/j.1399-5618.2008.00614.x","article-title":"Quetiapine for the treatment of bipolar mania in older adults","volume":"10","author":"Sajatovic","year":"2008","journal-title":"Bipolar Disord."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.4088\/JCP.15m10261","article-title":"Efficacy of Lurasidone in Adults Aged 55 Years and Older With Bipolar Depression: Post Hoc Analysis of 2 Double-Blind, Placebo-Controlled Studies","volume":"77","author":"Sajatovic","year":"2016","journal-title":"J. Clin. Psychiatry"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/S0193-953X(05)70100-3","article-title":"The nature and management of mania in old age","volume":"22","author":"Shulman","year":"1999","journal-title":"Psychiatr. Clin. N. Am."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1097\/00019442-200407000-00002","article-title":"Pharmacotherapy of bipolar disorder in old age: Review and recommendations","volume":"12","author":"Young","year":"2004","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.amjopharm.2006.12.007","article-title":"Treatments for late-life bipolar disorder","volume":"4","author":"Aziz","year":"2006","journal-title":"Am. J. Geriatr. Pharmacother."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11920-017-0804-8","article-title":"Update on the Epidemiology, Diagnosis, and Treatment of Mania in Older-Age Bipolar Disorder","volume":"19","author":"Chen","year":"2017","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.cger.2019.11.008","article-title":"Older Age Bipolar Disorder","volume":"36","author":"Dols","year":"2020","journal-title":"Clin. Geriatr. Med."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1176\/ps.49.9.1145","article-title":"Use of mood stabilizers by hospitalized geriatric patients with bipolar disorder","volume":"49","author":"Sanderson","year":"1998","journal-title":"Psychiatr. Serv."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"181","DOI":"10.4088\/JCP.v60n0306","article-title":"Efficacy of lithium vs. valproate in the treatment of mania in the elderly: A retrospective study","volume":"60","author":"Chen","year":"1999","journal-title":"J. Clin. Psychiatry"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1097\/JGP.0b013e318187135f","article-title":"Prescription patterns of psychotropic medications in elderly compared with younger participants who achieved a \u201crecovered\u201d status in the systematic treatment enhancement program for bipolar disorder","volume":"16","author":"Marangell","year":"2008","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_75","first-page":"479","article-title":"Valproate use in the older manic patient","volume":"51","author":"McFarland","year":"1990","journal-title":"J. Clin. Psychiatry"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1177\/070674379303800213","article-title":"Treatment of rapid cycling bipolar disorder with combination therapy of valproate and lithium","volume":"38","author":"Sharma","year":"1993","journal-title":"Can. J. Psychiatry"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"165","DOI":"10.3109\/10401239809147033","article-title":"Clinical correlates of response to valproate in geriatric inpatients","volume":"10","author":"Niedermier","year":"1998","journal-title":"Ann. Clin. Psychiatry"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"304","DOI":"10.4088\/JCP.v61n0410h","article-title":"Low-dose lithium augmentation of divalproex in geriatric mania","volume":"61","author":"Goldberg","year":"2000","journal-title":"J. Clin. Psychiatry"},{"key":"ref_79","first-page":"215","article-title":"Safety and efficacy of divalproex sodium in elderly bipolar patients","volume":"55","author":"Risinger","year":"1994","journal-title":"J. Clin. Psychiatry"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1177\/089198879500800407","article-title":"Tolerability of divalproex sodium in elderly psychiatric patients with mixed diagnoses","volume":"8","author":"Puryear","year":"1995","journal-title":"J. Geriatr. Psychiatry Neurol."},{"key":"ref_81","first-page":"238","article-title":"The use of valproate in an elderly population with affective symptoms","volume":"57","author":"Kando","year":"1996","journal-title":"J. Clin. Psychiatry"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1097\/00019442-199808000-00008","article-title":"Divalproex treatment of mania in elderly patients","volume":"6","author":"Noaghiul","year":"1998","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.jad.2012.05.027","article-title":"Asenapine for elderly bipolar manic patients","volume":"145","author":"Baruch","year":"2013","journal-title":"J. Affect. Disord."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1177\/0891988703016002010","article-title":"Gabapentin in geriatric mania","volume":"16","author":"Sethi","year":"2003","journal-title":"J. Geriatr. Psychiatry Neurol."},{"key":"ref_85","first-page":"113","article-title":"Treatment of elderly institutionalized bipolar patients with clozapine","volume":"33","author":"Shulman","year":"1997","journal-title":"Psychopharmacol. Bull."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1111\/j.1399-5618.2011.00923.x","article-title":"Multisite, open-label, prospective trial of lamotrigine for geriatric bipolar depression: A preliminary report","volume":"13","author":"Sajatovic","year":"2011","journal-title":"Bipolar Disord."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"398","DOI":"10.4088\/JCP.14m09410","article-title":"Lurasidone in the treatment of bipolar depression with mixed (subsyndromal hypomanic) features: Post hoc analysis of a randomized placebo-controlled trial","volume":"76","author":"McIntyre","year":"2015","journal-title":"J. Clin. Psychiatry."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1176\/appi.ajp.2013.13070985","article-title":"Lurasidone as adjunctive therapy with lithium or valproate for the treatment of bipolar I depression: A randomized, double-blind, placebo-controlled study","volume":"171","author":"Loebel","year":"2014","journal-title":"Am. J. Psychiatry"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1007\/s00392-020-01697-8","article-title":"The impact of SSRIs on mortality and cardiovascular events in patients with coronary artery disease and depression: Systematic review and meta-analysis","volume":"110","author":"Fernandes","year":"2021","journal-title":"Clin. Res. Cardiol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1016\/j.neubiorev.2010.10.001","article-title":"Pathways underlying neuroprogression in bipolar disorder: Focus on inflammation, oxidative stress and neurotrophic factors","volume":"35","author":"Berk","year":"2011","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1097\/JCP.0000000000000326","article-title":"Antidepressant effects of open label treatment with coenzyme Q10 in geriatric bipolar depression","volume":"35","author":"Forester","year":"2015","journal-title":"J. Clin. Psychopharmacol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1097\/YCT.0b013e3181e6332e","article-title":"Efficacy and safety of electroconvulsive therapy in the treatment of bipolar disorder: A systematic review","volume":"27","author":"Versiani","year":"2011","journal-title":"J. ECT"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1097\/YCT.0000000000000547","article-title":"Efficacy of Continuation\/Maintenance Electroconvulsive Therapy in the Treatment of Patients With Mood Disorders: A Retrospective Analysis","volume":"35","author":"Hausmann","year":"2019","journal-title":"J. ECT"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1002\/gps.1989","article-title":"The effects of ECT on cognitive functioning in the elderly: A review","volume":"23","author":"Tielkes","year":"2008","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1017\/S1041610213001932","article-title":"Short- and long-term neurocognitive functioning after electroconvulsive therapy in depressed elderly: A prospective naturalistic study","volume":"26","author":"Verwijk","year":"2014","journal-title":"Int. Psychogeriatr."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1111\/acps.12942","article-title":"Long-term neurocognitive functioning after electroconvulsive therapy in patients with late-life depression","volume":"138","author":"Obbels","year":"2018","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1097\/00019442-200504000-00002","article-title":"Electroconvulsive therapy: A selected review","volume":"13","author":"Greenberg","year":"2005","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.4088\/JCP.v64n0906","article-title":"A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently depressed patients with bipolar I disorder","volume":"64","author":"Calabrese","year":"2003","journal-title":"J. Clin. Psychiatry"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1001\/archpsyc.60.4.392","article-title":"A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder","volume":"60","author":"Bowden","year":"2003","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"377","DOI":"10.3389\/fpsyt.2020.00377","article-title":"Lithium Treatment Over the Lifespan in Bipolar Disorders","volume":"11","author":"Volkmann","year":"2020","journal-title":"Front. Psychiatry"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"39","DOI":"10.2165\/00002512-200522010-00003","article-title":"Managing bipolar disorder in the elderly: Defining the role of the newer agents","volume":"22","author":"Sajatovic","year":"2005","journal-title":"Drugs Aging"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/j.jad.2019.07.054","article-title":"Conventional mood stabilizers and\/or second-generation antipsychotic drugs in bipolar disorders: A population-based comparison of risk of treatment failure","volume":"257","author":"Tournier","year":"2019","journal-title":"J. Affect. Disord."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/acps.12117","article-title":"Physical health of patients with bipolar disorder","volume":"127","author":"Young","year":"2013","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1177\/0891988712436683","article-title":"Medical and psychiatric comorbidities among elderly individuals with bipolar disorder: A literature review","volume":"25","author":"Lala","year":"2012","journal-title":"J. Geriatr. Psychiatry Neurol."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1001\/jamapsychiatry.2015.1834","article-title":"Use of Lithium and Anticonvulsants and the Rate of Chronic Kidney Disease: A Nationwide Population-Based Study","volume":"72","author":"Kessing","year":"2015","journal-title":"JAMA Psychiatry"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1517\/14740338.2015.1053457","article-title":"Safety and tolerability of antipsychotic-mood stabilizer co-treatment in the management of acute bipolar disorder: Results from a systematic review and exploratory meta-analysis","volume":"14","author":"Galling","year":"2015","journal-title":"Expert Opin. Drug. Saf."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1097\/YIC.0b013e32836435e2","article-title":"The prevalence and management of side effects of lithium and anticonvulsants as mood stabilizers in bipolar disorder from a clinical perspective: A review","volume":"28","author":"Dols","year":"2013","journal-title":"Int. Clin. Psychopharmacol."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"769","DOI":"10.2174\/1871527318666191114095249","article-title":"A Review for Lithium: Pharmacokinetics, Drug Design, and Toxicity","volume":"18","author":"Wen","year":"2019","journal-title":"CNS Neurol. Disord. Drug. Targets"},{"key":"ref_109","first-page":"25","article-title":"Pharmacokinetics, drug interactions, and tolerability of valproate","volume":"37","author":"DeVane","year":"2003","journal-title":"Psychopharmacol. Bull."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1001\/jamapsychiatry.2020.2993","article-title":"Adjunctive Psychotherapy for Bipolar Disorder: A Systematic Review and Component Network Meta-analysis","volume":"78","author":"Miklowitz","year":"2021","journal-title":"JAMA Psychiatry"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1001\/archpsyc.62.9.996","article-title":"Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder","volume":"62","author":"Frank","year":"2005","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1037\/a0019629","article-title":"Randomized trial of social rehabilitation and integrated health care for older people with severe mental illness","volume":"78","author":"Mueser","year":"2010","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1590\/S0104-11692011000400013","article-title":"Medication therapy: Adherence, knowledge and difficulties of elderly people from bipolar disorder","volume":"19","author":"Cruz","year":"2011","journal-title":"Rev. Lat. Am. Enferm."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1111\/j.1399-5618.2007.00397.x","article-title":"Medication adherence skills training for middle-aged and elderly adults with bipolar disorder: Development and pilot study","volume":"9","author":"Depp","year":"2007","journal-title":"Bipolar Disord."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/j.jagp.2016.12.007","article-title":"Adapting a Psychosocial Intervention for Smartphone Delivery to Middle-Aged and Older Adults with Serious Mental Illness","volume":"25","author":"Fortuna","year":"2017","journal-title":"Am. J. Geriatr. Psychiatry"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/6\/587\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:11:59Z","timestamp":1760163119000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/6\/587"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,8]]},"references-count":115,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6]]}},"alternative-id":["medicina57060587"],"URL":"https:\/\/doi.org\/10.3390\/medicina57060587","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,8]]}}}