Age and Age at Onset of Bipolar Disorder Affect Response to Treatment

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According to a report from Medwire News, researchers claim differences in response to treatment emerge when patients with bipolar disorder are grouped by age and their age at bipolar onset.

The researchers evaluated patients from the European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) study. Of the patients, 1191 were below the age of 50, and 240 were older than 60-years-old. The team reported 134 of the patients in the older group had been diagnosed with bipolar disorder before the age of 50 years (early onset) whereas 63 were aged 50-years-old or older at diagnosis (late onset).

The team observed that baseline characteristics were largely similar between the groups, except where influenced by factors such as disease duration. For the most part, issues such as recovery, remission, recurrence, and relapse did not affect the findings.

“These results suggest that in the older patients, remission and recovery are as easy to achieve but more difficult to maintain compared with that in younger patients”, say lead researcher Frits Oostervink (GGZ Haagstreek Rivierduinen, Leidschendam, the Netherlands) and co-workers.

Frits and his team suggest a few reasons for this, including a progressive disease course, medical comorbidities and nonadherance to medication. They also note that antidepressants were more frequently used by older patients rather than younger patients, which may be associated with, or even cause, a higher cycle frequency.

Within the older group, patients with late-onset bipolar disorder were significantly more likely to recover than those with a longer duration of disease. When compared to the younger group, older patients with early onset were also significantly less likely to recover, and significantly more likely to relapse.

In addition to being more likely to be given antidepressants, older patients were also less likely to be taking atypical antipscyhotics and more likely to be receiving concomitant psychiatric medications. They were also less likely to be using lithium.

“Combined medication treatment was the rule rather than the exception in all four groups”, notes the team in the International Journal of Geriatric Psychiatry. “This is consistent with evidence-based treatment guidelines and may reflect the complexity of managing bipolar disorder.”

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