Review of Bipolar Disorder in Older Adults: ECT is There

 Out on PubMed is this review:

Evaluation and treatment of older-age bipolar disorder: a narrative review.

Tampi RR, Joshi P, Bhattacharya G, Gupta S.Drugs Context. 2021 May 27;10:2021-1-8. doi: 10.7573/dic.2021-1-8. eCollection 2021.PMID: 34113387

The abstract is copied below:

Objectives: This narrative review aims to synthesize information from the literature regarding older-age bipolar disorder (OABD) in order to provide up-to-date information on this important illness.

Methods: We searched Ovid (Medline, Embase and PsychInfo) on October 1, 2020, using the keywords "bipolar disorder", "older adults" and "elderly" to identify relevant articles on OABD. Additionally, the bibliography of identified articles was reviewed for pertinent studies.

Discussions: OABD is a term that is used to describe bipolar disorder (BD) occurring amongst individuals ≥50 years of age. Evidence indicates that OABD accounts for a quarter of all cases of BD. When compared to individuals with early-onset BD, individuals with OABD have a greater association with cerebrovascular disease and other neurological disorders, less family history of mood disorders, and utilize almost four times the total amount of mental health services. In addition, they are four times more likely to have psychiatric hospitalizations when compared to age-matched controls. Despite a dearth of controlled studies on the use of pharmacotherapy amongst individuals with OABD, available evidence from mixed-age studies indicates the efficacy of commonly used medications in individuals with early-onset BD. Additionally, psychosocial treatments have been found to be effective as adjunctive management strategies amongst individuals with OABD. Furthermore, electroconvulsive therapy may be effective in the treatment of refractory cases of OABD.

Conclusions: There is a great need for an improved understanding of the phenomenology and neurobiology of OABD. Additionally, research into effective treatments for this serious psychiatric disorder will mitigate the suffering of individuals with OABD.

Keywords: antipsychotics; bipolar disorder; early-onset bipolar disorder; electroconvulsive therapy; lithium; mood stabilizers; older-age bipolar disorder; psychosocial treatments.

The pdf is here.





This narrative review of bipolar disorder in older adults has the above section on ECT. While neither comprehensive nor authoritative, at least ECT is given reasonable coverage. The oversimplification that bilateral and unilateral electrode placement are equivalent in efficacy, but that the former causes more adverse effects, might, unfortunately, lead one to question why bilateral is ever used. 
One criticism I have with the terminology used in this review is the lack of consistency in the terms "older-age bipolar disorder" (OABD) and "early-onset bipolar disorder" (EOBD). Is the older group only late onset?
The pharmacology section in this paper is adequate and a good review of what the (still sparse) literature shows.
A full read is ~15 minutes.

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