Question: Do older adults need to take special precautions when taking medications for bipolar disorder?
Answer: Older adults in general need to be followed more closely when taking any psychotropic medications, or for that matter, any medications at all.
Side effects are more prominent; very typically the blood levels that are achieved from the same dose of medications are greater in older people because of changes in how they metabolize medications and eliminate them.
Certain medications have side effects that are more problematic in an older person, who may have some cognitive changes, or some sensory changes.
In general, I try to encourage people to be very careful about taking these medications and mindful that they can have broad effects upon cognition and thinking.
That being said, depression and mania should be treated in the very elderly folks.
Often, it's necessary too, to look for potential medical causes of the depression or the mania because it may be that what needs to be done is to manage the medical condition that is causing mania to appear rather than to treat bipolar disorder.
It would be most unfortunate to miss a brain tumor, or a metabolic disorder, or some other kind of problem that was showing up as someone who looked manic, but actually was ill medically.
And particularly, in and elderly person who's never had mania before, or for that matter never had depression before, we want to make sure that an appropriate and elaborate medical work-up was done to rule out medical causes and contributors.