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Do Bipolar 1 Symptoms Get Worse With Age?

Medically reviewed by Paul Ballas, D.O.
Written by Emily Wagner, M.S.
Posted on May 13, 2024

As you age, your body, thoughts, and emotions continue changing over time. The same can also be said of your bipolar 1 disorder symptoms. Research shows that for some people, symptoms may become worse with age.

In this article, we’ll discuss the symptoms of bipolar 1 disorder and how they may change or get worse over time. We’ll also cover the importance of working with your mental health care provider and sticking to your treatment plan to better manage your symptoms and improve your quality of life.

What Are the Symptoms of Bipolar 1 Disorder?

Bipolar 1 disorder is a serious mood disorder that causes mood swings or episodes of mania (excitation) and depression. The National Institute of Mental Health (NIMH) explains that bipolar 1 disorder is defined by having:

  • Manic episodes lasting seven or more days, or manic symptoms that are severe enough to require hospitalization
  • Depressive episodes, which often last at least 14 days

Research shows that people with bipolar 1 disorder tend to experience more depressive mood episodes as they age.

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You may also have depressive episodes with mixed features — symptoms of both mania and depression at the same time.

Can Bipolar 1 Disorder Symptoms Get Worse Over Time?

The average age at diagnosis for bipolar disorder is 25 years. Studies have found that older adults can also develop bipolar disorder. Several studies show that 5 percent to 10 percent of people with bipolar disorder experienced their first manic episode at age 50 or older.

On average, the life expectancy of someone with bipolar disorder is around 66.9 years (64.6 for men and 70.5 for women), according to the The British Journal of Psychiatry. This means that you may live anywhere from 15 to 40 years or more with the condition. As you age and live longer with bipolar 1 disorder, your symptoms may change or get worse.

More Depressive, Fewer Manic Episodes

Research shows that people with bipolar 1 disorder tend to experience more depressive mood episodes as they age. One study of people with bipolar 1 disorder followed three age groups:

  • Youngest — 18 to 29 years old
  • Middle — 30 to 44 years old
  • Oldest — Over 44 years old

The authors collected data for 20 years. They found that participants in the youngest and middle age groups experienced a significant increase in depressive symptoms over the course of the study. Specifically, the authors measured how many participants had depressive episodes for most of a five-year period. The study comprised four periods totaling 20 years.

Studies have found that older adults who had bipolar disorder for longer had less gray matter in their brains.

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The chances of the youngest age group experiencing depressive episodes for the majority of a period rose by 53.4 percent. This means that as participants in the youngest age group got older, they experienced more depressive episodes. Participants in the middle age group were 37.4 percent more likely to have depressive symptoms as they aged.

Overall, there were no differences in mood episodes based on sex.

The study authors also found that participants didn’t experience more manic episodes as they aged. Other research suggests that adults diagnosed with bipolar disorder after 40 have fewer episodes of mania and experience milder symptoms.

What Factors Affect Bipolar 1 Disorder With Age?

There’s no one specific reason depressive episodes increase as people with bipolar 1 disorder get older. Instead, researchers believe that a combination of brain changes, medication resistance, and other health conditions may come into play.

Changes to the Brain’s Structure and Function

As you age, the structure of your brain changes. Studies have found that older adults who had bipolar disorder longer had less gray matter in the front of their brains.

Gray matter is made of neurons (nerve cells) that send signals in your brain. When you lose gray matter, you’re more likely to have cognitive impairment (cognitive decline) — problems with thinking, reasoning, decision-making, and judgment.

Researchers believe that these brain changes can affect your ability to process and regulate emotions. This may mean you experience worsening mood episodes as you age. Interestingly, studies have found that people with bipolar 1 disorder who took lithium had more gray matter over time. Sticking with your treatment plan may help prevent brain changes and worsening symptoms as you age.

Resistance to Bipolar 1 Disorder Medications

Studies show that adults over 50 with older age bipolar disorder can become resistant to treatments. This means that the treatment stopped working or no longer worked as well. If that happens, you may experience worsening bipolar 1 disorder symptoms. By working with your doctor, you can try new medications to avoid resistance and manage your symptoms.


You may need to switch bipolar 1 disorder treatments as you get older.

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Co-Occurring Health Conditions

Many people living with bipolar 1 disorder have other health conditions at the same time. These are known as comorbidities, or comorbid conditions. Common comorbidities seen in people with bipolar disorder include:

  • Diabetes
  • Cardiovascular disease and high blood pressure
  • High cholesterol
  • Kidney disease
  • Thyroid disease

As you age, your chances of developing comorbidities increase. One study of nearly 31 million people on Medicare found that 62 percent of participants ages 65 to 74 had at least two comorbid conditions. This increased to 81.5 percent for those 85 and older.

Research shows that people with bipolar disorder and comorbid conditions are more likely to have severe symptoms. There’s also a greater chance that their treatments don’t work as well, putting them at risk of rapid cycling. According to NIMH, rapid cycling means having four or more manic or depressive episodes within one year.

Other factors that fact affect your life and severity of symptoms with bipolar 1 disorder include:

  • Less access to high-quality medical care
  • Unhealthy lifestyle factors, like stress, lack of sleep, and smoking
  • Medication side effects
  • Your genetics

Work With Your Mental Health Provider as You Age

Aging is a fact of life for everyone, and your bipolar 1 disorder symptoms will likely change over time. It’s important to regularly check in with a mental health professional to monitor your symptoms.

Be sure to let your doctor know if you’re experiencing any new or worsening manic or depressive symptoms. They’ll check how well your current medications are working or decide if any changes are needed.

Possible Treatment Changes

Because you can develop resistance to certain bipolar 1 disorder treatments, you may need to switch meds at some point. Luckily, plenty of options are available, including:

  • Mood stabilizers, like lithium, lamotrigine (Lamictal), and carbamazepine (Carbatrol)
  • Antipsychotics, like olanzapine and samidorphan (Lybalvi), lurasidone (Latuda), and aripiprazole (Abilify)
  • Antidepressants, like fluoxetine (Prozac), sertraline (Zoloft), and citalopram (Celexa)

Be sure to let your doctor know if you experience any side effects after starting a new treatment. They may need to adjust your dose.

Varied Approaches for Treating Bipolar 1

Psychotherapy (talk therapy) is also a key part of bipolar 1 disorder treatment. Your doctor may recommend cognitive behavioral therapy or interpersonal and social rhythm therapy to help treat your symptoms.

It’s also important to take care of both your physical health and your mental health when living with bipolar 1 disorder. Unhealthy lifestyle choices can cause worse symptoms, so you may help manage your condition by taking extra steps to eat healthier, reduce stress, and quit smoking.

Talk With Others Who Understand

MyDepressionTeam is the social network for people with depression and related conditions and their loved ones. On MyDepressionTeam, more than 146,000 members diagnosed with depression and related conditions come together to ask questions, give advice, and share their stories with others who understand life with depression and bipolar disorder.

Have you noticed your bipolar 1 disorder symptoms getting worse with age? What steps have you taken to treat them? Share your experience in the comments below, or start a conversation by posting on your Activities page.

    Posted on May 13, 2024
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    Paul Ballas, D.O. is an attending psychiatrist at Friends Hospital in Philadelphia, Pennsylvania. Review provided by VeriMed Healthcare Network. Learn more about him here.
    Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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