Pharmacological Treatment of Bipolar Disorder in the Elderly

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Asenapine in the treatment of older adults with bipolar disorder. Int J Geriatr Psychiatry. 2015;30(7):710–9. • Rej S, Yu C, Shulman K, Herrmann N, Fischer HD, Fung K, et al. Medical comorbidity, acute medical care use in late-life bipolar disorder: a comparison of lithium, valproate, and other pharmacotherapies. Gen Hosp Psychiatry. 2015;37(6):528–32 This study is a population-based retrospective cohort study of 1388 older adult patients with bipolar disorder (age >65). The study showed that older adults who use lithium do not develop higher rates of medical comorbidity or higher medical service utilization than patients who use valproate or antipsychotic medications. This study emphasizes the relative safety of lithium for the geriatric population. Mezuk B, Morden NE, Ganoczy D, Post EP, Kilbourne AM. Anticonvulsant use, bipolar disorder, and risk of fracture among older adults in the Veterans Health Administration. 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This post hoc analysis evaluated the efficacy of lurasidone, a fairly new medication treatment, in adults age 55 and older with bipolar disorder. Lurasidone was shown to be safe and effective in the geriatric population both as monotherapy and as adjunctive therapy. This is one of only a few studies that looks at treatment efficacy of newer medications specifically among geriatric patients. Sajatovic M, Paulsson B, editors. Quetiapine for the treatment of depressive episodes in adults aged 55 to 65 years with bipolar disorder. American Association of Geriatric Psychiatry Annual Meeting; 2007 March 1–4, 2007; New Orleans, LA. Tohen M, Vieta E, Calabrese J, Ketter TA, Sachs G, Bowden C, et al. Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression. Arch Gen Psychiatry. 2003;60(11):1079–88. Brown EB, McElroy SL, Keck Jr PE, Deldar A, Adams DH, Tohen M, et al. 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Bipolar Disord. 2014;16(6):617–23 This study performed MR imaging on 54 adults with bipolar disorder (BD). BD was associated with lower total gray matter volumes, and total years of antipsychotic agent exposure were related to lower hippocampal volumes. This is one of the first studies to evaluate the long-term effects of bipolar disorder on brain structure and suggests that BD is a neuroprogressive disorder. Delaloye C, de Bilbao F, Moy G, Baudois S, Weber K, Campos L, et al. Neuroanatomical and neuropsychological features of euthymic patients with bipolar disorder. Am J Geriatr Psychiatry: Off J Am Assoc Geriatr Psychiatry. 2009;17(12):1012–21. •• Gildengers AG, Butters MA, Aizenstein HJ, Marron MM, Emanuel J, Anderson SJ, et al. Longer lithium exposure is associated with better white matter integrity in older adults with bipolar disorder. Bipolar Disord. 2015;17(3):248–56 This study examined cognitive and imaging data in 58 patients with BD. 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