As you age, your body, thoughts, and emotions change over time. The same can 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 worsen over time. We’ll also cover the importance of working with your mental healthcare 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 — sometimes written as bipolar I disorder — is a serious mood disorder. This mental health condition causes mood swings — particularly episodes of mania (periods when your mood is elevated) and depression (periods of sadness and low energy). The National Institute of Mental Health defines bipolar 1 disorder as 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

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 age of onset for bipolar disorder is, on average, about 25. 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 just under 67 years (64.6 years for men and 70.5 years for women), according to The British Journal of Psychiatry. People with the condition often have it for many years. As you age and live longer, it is helpful to understand that your symptoms of bipolar disorder 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 in the journal Psychological Medicine followed three age groups of people with bipolar 1 disorder:

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

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

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.

The proportion of people in the youngest age group who experienced depressive episodes for the majority of a five-year time period rose by 53.4 percent over the 20-year period. As participants in the youngest age group got older, they experienced more depressive episodes.

The proportion of people in the middle age group who had depressive symptoms for the majority of a five-year time period increased by 37.4 percent during the 20-year study.

Overall, the study showed no differences in mood episodes between men and women.

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

At the same time, older people with bipolar disorder are more likely to experience cognitive problems that make treatment more difficult. Cognitive problems affect mental functioning, such as problems with memory, thinking, reasoning, decision-making, and judgment. Some medication used in the treatment of bipolar disorder may worsen cognitive functioning as a side effect.

What Factors Affect Bipolar 1 Disorder With Age?

There’s no one specific reason why 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 shown that people of older age who have had bipolar disorder longer had less gray matter in the front of their brains. Gray matter is the tissue in the brain that helps control mental functions. When you lose gray matter, you’re more likely to have cognitive impairment (cognitive decline).

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

Researchers believe these brain changes can affect your ability to process and regulate emotions. This may be a cause of 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 bipolar disorder symptoms as you age. Even though healthy adults also lose some cognitive function as they age, those with bipolar disorder have been shown to decline faster in their older years.

Resistance to Bipolar 1 Disorder Medications

Studies show that adults over 50 with bipolar disorder can become resistant to treatments. This means that the treatment stopped working or no longer works as well. If treatment becomes ineffective, mood episodes can occur more frequently and other cognitive problems may develop.

By working with your healthcare team, you can try new medications to avoid treatment resistance and manage your symptoms better.

Studies show that adults over 50 with bipolar disorder can become resistant to their treatments.

Nonadherence to Medication

As many as 50 percent of people with bipolar disorder don’t stay on their treatment plans. This can cause symptoms to worsen as someone ages. Furthermore, aging can lead to other problems in receiving adequate treatment for bipolar disorder, such as mobility issues or financial problems.

Co-Occurring Health Conditions

Many people living with bipolar 1 disorder have other medical conditions as well. These are known as comorbidities. Common comorbidities seen in people with bipolar disorder include:

• Diabetes
• Heart 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 health 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 bipolar symptoms. There’s also a greater chance that their treatments won’t work as well, putting them at risk of rapid cycling — having four or more manic or depressive episodes within one year.

Comorbid conditions can also lead to poor drug interactions if someone is being treated for more than one condition at the same time. It’s important to let all of your healthcare providers know about every medication you’re taking.

Other factors that can 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 advise you if any changes are needed.

Possible Treatment Changes

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

• Mood stabilizers
• Antipsychotics
• Antidepressants

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

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 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 improve your well-being. Consider whether you might get more regular exercise, eat healthier, reduce stress, or 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 150,000 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 manage them? Share your experience in the comments below, or start a conversation by posting on your Activities page.