Bipolar Depression Across the Life Span: Enhancing Diagnosis and Management From Youth to Older Age

Bipolar disorder affects individuals of various ages, but the diagnosis, treatment, and outcomes are not the same in all patient populations. Although bipolar disorder is most commonly diagnosed in early adulthood, about half of adults with the disorder experienced onset in childhood or adolescence.1 Up to 2 million US children and adolescents suffer from bipolar spectrum disorders.2 Childhood-onset bipolar disorder is associated with delayed diagnosis and a more severe course of illness. Bipolar disorder in older adults is also a growing concern. Given the aging US population and the chronic nature of bipolar disorder, individuals ≥60 years of age now represent about 25% of patients with bipolar disorder.3 Additionally, some patients experience onset of bipolar disorder later in life, typically after age 50. There are substantial gaps in the recognition and management of bipolar disorder in older adults. Bipolar depression is often the prevalent mood polarity and is one of the more difficult aspects of bipolar disorder to diagnose and manage in youth and older age. Clinicians often extrapolate evidence from mixed-age groups to a specific stage of development such as youth or older age. Competence in the management of bipolar depression requires comprehension of the illness at all stages of human development. It is important to be aware of existing efficacy data for bipolar depression treatment in specific age groups such as pediatric patients and older patients. Further, adverse-event profiles of pharmacotherapy for bipolar disorder differ according to age. In this symposium, expert faculty will summarize the latest insights on diagnosis and management of patients with bipolar depression, focusing on recent data on children, adolescents, and older adults. The discussion will emphasize practical approaches to differential diagnosis, up-to-date evidence-based treatment strategies, and metabolic and cognitive considerations.