Growing Older with Bipolar
Bipolar disorder may become easier to manage in later life, but it’s important to stay alert to changes in physical health and how well your medication works.

By Robin L. Flanigan

One day you notice your smile lines have turned into wrinkles. Or maybe your back and knees creak after a flag football game. It’s inevitable: The passage of time brings changes in the body, in relationships, in outlook. The mantle of maturity often fosters a stronger sense of self, even as midlife marks the creeping arrival of “senior moments” and medical issues. Parents have to adapt to an empty nest, which can be an emotional challenge even as it leaves more time and freedom to focus on personal pursuits. Ditto for those who step back from the workplace.

How does bipolar play into all of this?

Mood shifts may change or intensify. Medications that worked for decades may lose their potency or start contributing to other health conditions. Yet years of accumulated knowledge can yield a better grasp of how to maintain balance.

Of course, everyone’s journey with bipolar is different. At 69, Dennis hasn’t noticed any differences in his bipolar I symptoms.

“They always say that as we get older, we change,” he says. “I’ve been doing well on the same dose of medication for 25 years. Maybe these things happen a little later than people think.”

Or maybe some credit goes to Dennis’s daily walks around Boston and longtime involvement with a local Depression and Bipolar Support Alliance chapter.

Anything that helps you stay active and socially connected will make the third act of life run more smoothly. It turns out “functional age” — how we perform daily tasks, whether we exercise, what we do for fun—may trump chronological age.

“There’s more data now that supports we have control over how we age, above and beyond whatever our inherited genetics are going to predict for us,” says Brent P. Forester, MD, MSc, chief of the Division of Geriatric Psychiatry at McLean Hospital, an affiliate of Harvard Medical School. “We can impact the way we age because we can impact the way we live our life.”

One of the cornerstones of aging well is nurturing social connections, Forester says: “People who maintain relationships with other people tend to do better. That’s really, really important.”

Of course, that’s also a well-documented factor in recovery from psychiatric disorders. Beverly of Virginia counts staying close to the people in her support network, including family and dear friends, as one of her key coping strategies. Also on the list: eight to nine hours of sleep a night.

“The sleep takes a lot of discipline to manage, as I used to be quite a night owl,” she says, “but as I succeed, I’m motivated to try harder so I can keep succeeding.”

Beverly, who was diagnosed with bipolar II in 1997, is weathering a number of changes at midlife. Now 53, she has fewer upswings than in her 30s and 40s—a pattern of “flattening” in mood that others have reported as well.

It’s not uncommon for eyeglass prescriptions to get updated several times around age 50 after remaining constant for years; the same thing may happen with psychiatric prescriptions. Medication that Beverly found effective for years hasn’t been working as well.

“It’s kind of holding me at a moderate level of depression,” she says.

She’s also noticing a major alteration in concentration and memory. Not so long ago, she was handling a high-stress job as a speech pathologist in public schools. Recently it took her four hours to pay four bills.

As a result, she now finds herself able to commit to only one task each day, such as going to an appointment or taking a shower.

“But I see myself as a person who never loses hope,” she says. “I eventually come back to, ‘It will get better.’”

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