Does bipolar disorder get worse with age?

Bipolar disorder is a mental health condition that involves changes in your energy levels and mood.  

Overall, bipolar disorder may sometimes involve feeling low and unmotivated (depressive) and other times feeling euphoric and energetic (mania). These changes may be subtle or more significant, depending on different factors.

The National Institutes of Health (NIH) clarifies that there are three types of bipolar disorder:

• Bipolar I disorder: The main criterion for this diagnosis is the presence of manic symptoms. Some people with bipolar I disorder may also experience depressive episodes, but this is not required to reach a diagnosis.
• Bipolar II disorder: It requires at least one episode of major depression and one of hypomania (mild mania). 
• Cyclothymic disorder: It also involves both depressive and hypomania episodes but not as intense as with bipolar I and II disorders. 

Bipolar disorder may also present with symptoms of psychosis. Psychosis refers to a perception of reality that is different from what most people in the same situation perceive. For example, you may see or hear things when other people do not. Not all people with bipolar disorder will experience symptoms of psychosis.

Do bipolar disorder symptoms worsen with age? 

Mental health professionals often diagnose bipolar disorder in early adulthood or late adolescence. The average age at diagnosis is 25 years old.

For most people, bipolar disorder requires long-term management. The symptoms of bipolar disorder usually respond well to professional support.

Understanding your symptoms and triggers, and getting treatment, may make bipolar disorder easier to manage over time.  

Untreated bipolar disorder may lead to more severe and frequent symptoms, and you may feel that your condition gets worse as you age. 

Bipolar disorder affects each person differently, so how the condition develops over the years may vary. 

A 2015 task force report suggests that older adults with bipolar disorder may experience: 

• fewer psychotic symptoms 
• more depressive episodes 
• fewer suicidal thoughts or attempts

Experts have noted that treating bipolar disorder may prevent worsening symptoms with age and may lead to the disorder showing up slightly differently in older adults. 

Late onset bipolar disorder 

Some people may become aware, develop symptoms, or get a diagnosis of bipolar disorder later in life. Those who develop symptoms later in life may also experience the condition differently than those receiving a diagnosis earlier in life. 

According to research published in 2021, experts suggest that some people who receive a diagnosis at age 50 years or older may experience: 

• increased irritability 
• resistance to treatment  
• fewer mania symptoms
• less severe mania symptoms during their first episode 
• lower chance of experiencing psychosis 

More research is needed to understand whether a later bipolar disorder onset manifests differently and with more or less intensity compared with a diagnosis earlier in life.

Signs bipolar disorder may be getting worse 

Experiencing longer, more frequent, or severe depressive, mania, or hypomania episodes of mania may be signs that you’re experiencing worsening bipolar disorder symptoms. 

The following are typical symptoms based on the type of episode:

1. During a manic episode:

• intense irritability
• euphoria or feeling energetic and invincible 
• experiencing reduced need for sleep 
• feeling wired (having nervous energy and finding it hard to relax) or jumpy (easily startled)
• talking fast or about many things at once 
• racing thoughts 
• experiencing fantasies or thoughts of power and fame 
• craving food, alcohol, and other activities more often or intensely than usual 

2. During a depressive episode:

• feeling restless or slowed down 
• experiencing sadness, hopelessness, or emptiness
• experiencing changes in your sleep cycle (sleeping more or fewer hours) 
• talking slowly or having a hard time finding things to say 
• having difficulty concentrating or making decisions
• losing interest in activities that you used to enjoy
• experiencing shame or guilt 

What external factors may worsen bipolar disorder? 

You bipolar disorder symptoms may be increasing in intensity if you persistently experience:

• Sleep deprivation: Research published in 2017 suggests that not sleeping at least 7 hours every day may trigger a manic or hypomanic episode.
• Not taking your medication as advised: Discontinuing or missing your medications or not taking them as advised by your health provider could make your bipolar disorder symptoms worse. 
• Lifestyle habits: Limited physical activity such as exercising, eating low nutrient foods, and coping with unmanaged stress may worsen some of your symptoms. 
• Not having a routine: Regular routines seem to help manage bipolar disorder. If you don’t follow a stable routine for sleeping or mealtimes, for example, symptoms like irritability and mania may intensify. 
• Caffeine, substances, and alcohol use: Caffeine, alcohol, and recreational drugs may trigger changes in mood or intensify the episodes you go through. 
• Stress management: Some older research suggests that going through a time of physical or emotional stress may intensify bipolar disorder symptoms. 

Does bipolar disorder ever resolve on its own? 

Bipolar disorder often requires long-term treatment. With medication and psychotherapy, you may manage your symptoms and reduce the chance of manic and depressive episodes.

Being consistent with your treatment may also prevent bipolar disorder from getting worse with age or in the face of triggers. 

How is bipolar disorder treated? 

Professional support for bipolar disorder may involve psychotherapy, medications, and psychoeducational. The latter refers to learning how to cope with your symptoms and take care of yourself when having a mood episode.

Common talk therapy approaches for bipolar disorder may include: 

• cognitive behavioral therapy (CBT)
• interpersonal and social rhythm therapy
• family-focused therapy

Your healthcare professional may complement the treatment by prescribing medications to help balance your mood. These may include:

• lithium to stabilize your mood
• antipsychotics like olanzapine (Zyprexa), lurasidone (Latuda), or risperidone (Risperdal)
• anticonvulsants like valproic acid (Depakene) and lamotrigine (Lactimal) 
• antidepressants like sertraline (Zoloft) or escitalopram (Lexapro), together with an antipsychotic or mood stabilizer

These medications may not be suitable for everyone as some can trigger manic episodes in people with bipolar I disorder. Your healthcare professional will tailor the treatment to your symptoms and needs.

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What happens if I stop bipolar disorder treatment? 

Discontinuing or changing your bipolar disorder treatment, particularly medications, without the support of a healthcare professional may intensify your symptoms.

Medication for bipolar disorder is most effective when taken consistently, even when you don’t have any symptoms.  

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Summary 

Bipolar disorder does not necessarily get worse with age. How the condition progresses may depend on your individual health, lifestyle, treatment, and other factors.  

With professional support and consistency, some people may find bipolar disorder symptoms are easier to manage as time goes by.