Drugs & Aging

, Volume 12, Issue 3, pp 205–224

Assessment and Treatment of Bipolar Disorder in the Elderly

  • John H. Eastham
  • Dilip V. Jeste
  • Robert C. Young
Review Article Disease Management


The aetiology of late-onset bipolar disorder is heterogeneous because the disease is more likely to have a secondary (i.e. a medical disorder or medication-induced) cause in older than in younger patients. Elderly patients with bipolar disorder typically require lithium dosages that are 25 to 50% lower than those used in younger individuals. Information on the use of valproic acid (sodium valproate) in elderly patients with bipolar disorder is limited but encouraging. In contrast, there is virtually no information regarding the use of carbamazepine or other drugs in this patient group. Electroconvulsive therapy is well tolerated by older people and can be useful for these patients.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    National Institute on Aging. Personnel for health needs of the elderly through year 2020. Bethesda (MD): US Department of Health and Human Services, 1987Google Scholar
  2. 2.
    Jeste DV, Harris MJ, Krull A, et al. Clinical and neuropsychological characteristics of patients with late-onset schizophrenia. Am J Psychiatry 1995; 152(5): 722–30PubMedGoogle Scholar
  3. 3.
    Young RC, Klerman GL. Mania in late-life: focus on age at onset. Am J Psychiatry 1992; 149: 867–76PubMedGoogle Scholar
  4. 4.
    Kramer M, German PS, Anthony JC, et al. Patterns of mental disorders among the elderly residents of eastern Baltimore. J Am Geriatr Soc 1985; 33(4): 236–45PubMedGoogle Scholar
  5. 5.
    Yassa R, Nair V, Nastase C, et al. Prevalence of bipolar disorder in a psychogeriatric population. J Affect Disord 1988; 14: 197–201PubMedCrossRefGoogle Scholar
  6. 6.
    Stevick CP. Some demographic and diagnostic characteristics of a geriatric population in a state geriatric facility. J Am Geriatr Soc 1980; 28(9): 426–9PubMedGoogle Scholar
  7. 7.
    Snowdon J. A retrospective case-note study of bipolar disorder in old age. Br J Psychiatry 1991; 158: 485–90PubMedCrossRefGoogle Scholar
  8. 8.
    Loranger AW, Levine PM. Age at onset of bipolar affective illness. Arch Gen Psychiatry 1978; 35: 1345–8PubMedCrossRefGoogle Scholar
  9. 9.
    Summers WK. Mania with onset in the eighth decade: two cases and a review. J Clin Psychiatry 1983; 44: 141–3PubMedGoogle Scholar
  10. 10.
    Walter-Ryan WG. Mania with onset in the ninth decade [letter]. J Clin Psychiatry 1983; 44: 430–1PubMedGoogle Scholar
  11. 11.
    Ghadirian AM, Lalinec-Michaud M, Engelsmann F. Early and late onset affective disorders: clinical and family characteristics. Ann R I C P 1986; 19: 53–7Google Scholar
  12. 12.
    James NM. Early and late onset bipolar affective disorder: a genetic study. Arch Gen Psychiatry 1977; 34: 715–7PubMedCrossRefGoogle Scholar
  13. 13.
    Taylor MA, Abrams R. Manic states: a genetic study of early and late onset affective disorders. Arch Gen Psychiatry 1973; 28: 656–8PubMedCrossRefGoogle Scholar
  14. 14.
    Hopkinson G. A genetic study of affective illness in patients over 50. Br J Psychiatry 1964; 110: 244–54PubMedCrossRefGoogle Scholar
  15. 15.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994Google Scholar
  16. 16.
    Shulman K, Post F. Bipolar affective disorder in old age. Br J Psychiatry 1980; 136: 26–32PubMedCrossRefGoogle Scholar
  17. 17.
    Rice J, Reich T, Andreasen NC, et al. The familial transmission of bipolar illness. Arch Gen Psychiatry 1987; 44(5): 441–7PubMedCrossRefGoogle Scholar
  18. 18.
    Carlson GA, Davenport YB, Jamison K. A comparison of outcome in adolescent- and late-onset bipolar manic-depressive illness. Am J Psychiatry 1977; 134(8): 919–22PubMedGoogle Scholar
  19. 19.
    Young RC, Falk JR. Age, manic psychopathology and treatment response. Int J Geriatr Psychiatry 1989; 4: 73–8CrossRefGoogle Scholar
  20. 20.
    Dhingra U, Rabins P. Mania in the elderly: a 5–7 year follow-up. J Am Geriatr Soc 1991; 39: 581–3PubMedGoogle Scholar
  21. 21.
    Kocsis JH, Shaw ED, Stokes PE, et al. Neuropsychologic effects of lithium discontinuation. J Clin Psychopharmacol 1993; 13(4): 268–76PubMedCrossRefGoogle Scholar
  22. 22.
    Wood K, Harris MJ, Morreale A, et al. Drug induced psychosis and depression in the elderly. Psychiatr Clin North Am 1988; 11: 167–93PubMedGoogle Scholar
  23. 23.
    Rego MD, Giller EL. Mania secondary to amantadine treatment of neuroleptic-induced hyperprolactinemia. J Clin Psychiatry 1989; 50: 143–4PubMedGoogle Scholar
  24. 24.
    Masand P, Stern TA. Bupropion and secondary mania: is there a relationship? Ann Clin Psychiatry 1993; 5: 271–4PubMedCrossRefGoogle Scholar
  25. 25.
    Bittman BJ, Young RC. Mania in an elderly man treated with bupropion [letter]. Am J Psychiatry 1991; 148(4): 541PubMedGoogle Scholar
  26. 26.
    France RD, Krishnan KRR. Alprazolam-induced manic reaction. Am J Psychiatry 1984; 141: 1127–8PubMedGoogle Scholar
  27. 27.
    Pecknold JC, Fleury D. Alprazolam-induced manic episode in two patients with panic disorder. Am J Psychiatry 1986; 143: 652–3PubMedGoogle Scholar
  28. 28.
    Weilburg JB, Sachs G, Falk WE. Triazolam-induced brief episodes of secondary mania in a depressed patient. J Clin Psychiatry 1987; 48: 492–3PubMedGoogle Scholar
  29. 29.
    Price WA. Buspirone-induced mania. J Clin Psychopharmacol 1989; 9: 150–1PubMedCrossRefGoogle Scholar
  30. 30.
    Liegghio NE, Yeragani VK. Buspirone-induced hypomania. J Clin Psychopharmacol 1988; 8: 226–7PubMedCrossRefGoogle Scholar
  31. 31.
    Viswanathan R, Glickman L. Clonazepam in the treatment of steroid-induced mania in a patient after renal transplantation. N Engl J Med 1989; 320: 319–20PubMedCrossRefGoogle Scholar
  32. 32.
    Bakish D, Lapierre YD. Disulfiram and bipolar affective disorder: acase report. J Clin Psychopharmacol 1986; 6(3): 178–80PubMedGoogle Scholar
  33. 33.
    Young RC, Moline M, Kleyman F. Hormone replacement therapy and late-life mania. Am J Geriatr Psychiatry 1997; 5(2): 179–81PubMedGoogle Scholar
  34. 34.
    Carney MWP. Switch and s-adenosylmethionine. Ala J Med Sci 1989; 25: 316–9Google Scholar
  35. 35.
    Adler LE, Sadja L, Wilets G. Cimetidine toxicity manifested as paranoia and hallucinations. Am J Psychiatry 1980; 137(9): 1112–3PubMedGoogle Scholar
  36. 36.
    Price W, Coli L, Brandstetter RD, et al. Ranitidine-associated hallucinations. Eur J Clin Pharmacol 1985; 29(3): 375–6PubMedCrossRefGoogle Scholar
  37. 37.
    Ryback RS, Schwab RS. Manic response to levodopa therapy: report of a case. N Engl J Med 1971; 285(14): 788–9PubMedCrossRefGoogle Scholar
  38. 38.
    Stoll AL, Mayer PV, Kolbrener M, et al. Antidepressant-associated mania: a controlled comparison with spontaneous mania. Am J Psychiatry 1994; 151(11): 1642–5PubMedGoogle Scholar
  39. 39.
    Berthier ML, Kulvisevsky J. Fluoxetine-induced mania in a patient with post-stroke depression. Br J Psychiatry 1993; 163: 698–9PubMedCrossRefGoogle Scholar
  40. 40.
    Turner SM, Jacob RG, Beidel DC, et al. A second case of mania associated with fluoxetine [letter]. Am J Psychiatry 1985; 142: 274–5PubMedGoogle Scholar
  41. 41.
    Ghaziuddin M. Mania induced by sertraline in a prepubertal child [letter]. Am J Psychiatry 1994; 151: 944PubMedGoogle Scholar
  42. 42.
    Jefferson JW, Greist JH, Perse TL, et al. Fluvoxamine-associated mania/hypomania in patients with obsessive-compulsive disorder [letter]. J Clin Psychopharmacol 1991; 11: 391–2PubMedCrossRefGoogle Scholar
  43. 43.
    Dorevitch A, Frankel Y, Bar-Halperin A, et al. Fluvoxamine-associated manic behavior — a case series. Ann Pharmacother 1993; 27: 1455–7PubMedGoogle Scholar
  44. 44.
    Sotsky SM, Tossell JW. Tolmetin induction of mania. Psychosomatics 1984; 25: 316–9CrossRefGoogle Scholar
  45. 45.
    Kinzie JD, Lewinsohn P, Maricle R, et al. The relationship of depression to medical illness in an older community population. Compr Psychiatry 1986; 27(3): 241–6PubMedCrossRefGoogle Scholar
  46. 46.
    Kwentus JA, Hart RP. Normal pressure hydrocephalus presenting as mania. J Nerv Ment Dis 1987; 175(8): 500–2PubMedCrossRefGoogle Scholar
  47. 47.
    Kwentus JA, Hart RP, Calabrese V, et al. Mania as a symptom of multiple sclerosis. Psychosomatics 1986; 27(10): 729–31PubMedCrossRefGoogle Scholar
  48. 48.
    Jamieson RC, Wells CE. Manic psychosis in a patient with multiple metastatic brain tumors. J Clin Psychiatry 1979; 40: 280–2PubMedGoogle Scholar
  49. 49.
    Cohen MR, Niska RW. Localized right cerebral hemisphere dysfunction and recurrent mania. Am J Psychiatry 1980; 137(7): 847–8PubMedGoogle Scholar
  50. 50.
    Jorge RE, Robinson RG, Starkstein SE, et al. Secondary mania following traumatic injury. Am J Psychiatry 1993; 150(6): 916–21PubMedGoogle Scholar
  51. 51.
    Yassa R, Cvejic J. Valproate in the treatment of posttraumatic bipolar disorder in a psychogeriatric patient. J Geriatr Psychiatry Neurol 1994; 7: 55–7PubMedGoogle Scholar
  52. 52.
    Steinberg D, Hirsch SR, Marston SD, et al. Influenza infection causing manic psychosis. Br J Psychiatry 1972; 120: 531–5PubMedCrossRefGoogle Scholar
  53. 53.
    Binder RL, Dickman WA. Psychiatric manifestations of neurosyphilis in middle-aged patients. Am J Psychiatry 1980; 137(6): 741–2PubMedGoogle Scholar
  54. 54.
    Schwartz RB. Manic psychosis in connection with Q-fever. Br J Psychiatry 1974; 124: 140–3PubMedCrossRefGoogle Scholar
  55. 55.
    Starkstein SE, Robinson RG. Affective disorders and cerebral vascular disease. Br J Psychiatry 1989; 154: 170–82PubMedCrossRefGoogle Scholar
  56. 56.
    Fujikawa T, Yamawaki S, Touhouda Y. Silent cerebral infarctions in patients with late-onset mania. Stroke 1995; 26(6): 946–9PubMedCrossRefGoogle Scholar
  57. 57.
    Goggans FC. A case of mania secondary to vitamin B12 deficiency. Am J Psychiatry 1984; 141(2): 300–1PubMedGoogle Scholar
  58. 58.
    Kovar MG. Health of the elderly and use of health services. Public Health Rep 1977 Jan/Feb; 92: 9–19PubMedGoogle Scholar
  59. 59.
    Philpott RM. Affective disorder and physical illness in old age. Int Clin Psychopharmacol 1990; 5Suppl. 3: 7–20PubMedGoogle Scholar
  60. 60.
    Irwin M, Daniels M, Weiner H. Immune and neuroendocrine changes during bereavement. Grief Bereavement 1987; 10(3): 449–65Google Scholar
  61. 61.
    Dunner DL. Differential diagnosis of bipolar disorder. J Clin Psychopharmacol 1992; 12(1 Suppl. 1): 7S–12SPubMedCrossRefGoogle Scholar
  62. 62.
    Joyce PR. Age of onset in bipolar affective disorder and mis-diagnosis as schizophrenia. Psychol Med 1984; 14: 145–9PubMedCrossRefGoogle Scholar
  63. 63.
    Glasser M, Rabins P. Mania in the elderly. Age Ageing 1984; 13: 210–2PubMedCrossRefGoogle Scholar
  64. 64.
    Himmelhoch JM, Neil JF, May SJ, et al. Age, dementia, dyskinesias, and lithium response. Am J Psychiatry 1980; 137(8): 941–5PubMedGoogle Scholar
  65. 65.
    Stone K. Mania in the elderly. Br J Psychiatry 1989; 155: 220–4PubMedCrossRefGoogle Scholar
  66. 66.
    Murray N, Hopwood S, Balfour DJK, et al. The influence of age on lithium efficacy and side-effects in out-patients. Psychol Med 1983; 13: 53–60PubMedCrossRefGoogle Scholar
  67. 67.
    Van de Velde CD. Effectiveness of lithium carbonate in the treatment of manic-depressive illness. Am J Psychiatry 1970; 127: 345–51PubMedGoogle Scholar
  68. 68.
    O’Connell RA, Mayo JA, Flatow L, et al. Outcome of bipolar disorder on long-term treatment with lithium. Br J Psychiatry 1991; 159: 123–9PubMedCrossRefGoogle Scholar
  69. 69.
    Angst J, Weis P, Grof P, et al. Lithium prophylaxis in recurrent affective disorders. Br J Psychiatry 1970; 116(535): 604–14PubMedCrossRefGoogle Scholar
  70. 70.
    Coppen A, Abou-Saleh MT. Lithium therapy: from clinical trials to practical management. Acta Psychiatr Scand 1988; 78(6): 754–62PubMedCrossRefGoogle Scholar
  71. 71.
    Hewick DS, Newbury P, Hopwood S, et al. Age as a factor affecting lithium therapy. Br J Clin Pharmacol 1977; 4: 201–5PubMedCrossRefGoogle Scholar
  72. 72.
    Vestergaard P, Schou M. The effect of age on lithium dosage requirements. Pharmacopsychiatry 1984; 17: 199–201PubMedCrossRefGoogle Scholar
  73. 73.
    Greil W, Stoltzenburg MC, Mairhofer ML, et al. Lithium dosage in the elderly: a study with matched age groups. J Affect Disord 1985; 9: 1–4PubMedCrossRefGoogle Scholar
  74. 74.
    Wallin L, Ailing C, Aurell M. Impairment of renal function in patients on long-term lithium treatment. Clin Nephrol 1982; 18(1): 23–8PubMedGoogle Scholar
  75. 75.
    Hardy BG, Shulman KI, Mackenzie SE, et al. Pharmacokinetics of lithium in the elderly. J Clin Psychopharmacol 1987; 7(3): 153–8PubMedCrossRefGoogle Scholar
  76. 76.
    Chapron DJ, Cameron IR, White LB, et al. Observations on lithium disposition in the elderly. J Am Geriatr Soc 1982; 30: 651–5PubMedGoogle Scholar
  77. 77.
    Nielsen-Kudsk F, Amdisen A. Analysis of the pharmacokinetics of lithium in man. Eur J Clin Pharmacol 1979; 16: 271–7CrossRefGoogle Scholar
  78. 78.
    Gerner RH. Treatment of acute mania. Psychiatr Clin North Am 1993; 16(3): 443–60PubMedGoogle Scholar
  79. 79.
    Scharfer CB, Garvey MJ. Use of lithium in acutely manic elderly patients. Clin Gerontol 1984; 3: 58–60Google Scholar
  80. 80.
    Young RC, Kalayam B, Tsuboyama G, et al. Mania: response to lithium across the age spectrum [abstract 669.4]. Society for Neuroscience Annual Meeting; Anaheim (CA); 1992 Oct 25–30: vol. 18Google Scholar
  81. 81.
    Mirchandani I, Young RC. Management of mania in the elderly: an update. Ann Clin Psychiatry 1993; 5(1): 67–77PubMedCrossRefGoogle Scholar
  82. 82.
    Holroyd S, Rabins PV. A retrospective chart review of lithium side effects in a geriatric outpatient population. Am J Geriatr Psychiatry 1994; 2(4): 346–51CrossRefGoogle Scholar
  83. 83.
    Nambudiri DE, Meyers BS, Young RC. Delayed recovery from lithium neurotoxicity. J Geriatr Psychiatry Neurol 1991; 4(1): 40–3PubMedCrossRefGoogle Scholar
  84. 84.
    Foster JR, Silver M, Boksay IJE. Lithium in the elderly: a review with special focus on the use of intra-erythrocyte (RBC) levels in detecting serious impending neurotoxicity. Int J Geriatr Psychiatry 1990; 5: 1–7CrossRefGoogle Scholar
  85. 85.
    Gelenberg AJ, Jefferson JW. Lithium tremor. J Clin Psychiatry 1995; 56(7): 283–7PubMedGoogle Scholar
  86. 86.
    Chacko RC, Marsh BJ, Marmion J, et al. Lithium side effects in elderly bipolar outpatients. Hillside J Clin Psychiatry 1987; 9(1): 79–88PubMedGoogle Scholar
  87. 87.
    Smith RE, Helms PM. Adverse effects of lithium therapy in the acutely ill elderly patient. J Clin Psychiatry 1982; 43(3): 94–9PubMedGoogle Scholar
  88. 88.
    Mitchell JE, Mackenzie TB. Cardiac effects of lithium in man: a review. J Clin Psychiatry 1982; 43: 47–51PubMedGoogle Scholar
  89. 89.
    Roose SP, Nurnberger JI, Dunner DL, et al. Cardiac sinus node dysfunction during lithium treatment. Am J Psychiatry 1979; 136: 804–6PubMedGoogle Scholar
  90. 90.
    Roose SP, Bone S, Haidorfer C, et al. Lithium treatment in older patients. Am J Psychiatry 1979; 136(6): 843–4PubMedGoogle Scholar
  91. 91.
    Finley PR, Warner MD, Peabody CA. Clinical relevance of drug interactions with lithium. Clin Pharmacokinet 1995; 29(3): 172–91PubMedCrossRefGoogle Scholar
  92. 92.
    Douste-Blazy P, Rostin M, Livarek B, et al. Angiotensin converting enzyme inhibitors and lithium treatment [letter]. Lancet 1986; I: 1448CrossRefGoogle Scholar
  93. 93.
    Griffin JH, Hahn SM. Lisinopril-induced lithium toxicity [letter]. Drug Intell Clin Pharm 1991; 25: 101Google Scholar
  94. 94.
    Correa FJ, Eiser AR. Angiotensin-converting enzyme inhibitors and lithium toxicity. Am J Med 1992; 93: 108–9PubMedCrossRefGoogle Scholar
  95. 95.
    Dubovsky SL, Franks RD, Allen S. Verapamil: a new anti-manic drug with potential interactions with lithium. J Clin Psychiatry 1987; 48(9): 371–2PubMedGoogle Scholar
  96. 96.
    Binder EF, Cayabyab L, Ritchie DJ, et al. Diltiazem-induced psychosis and a possible diltiazem-lithium interaction. Arch Intern Med 1991; 151: 373–4PubMedCrossRefGoogle Scholar
  97. 97.
    Bruun NE, Ibsen H, Skott P, et al. Lithium clearance and renal tubular sodium handling during acute and long-term nifedipine treatment in essential hypertension. Clin Sci 1988; 75: 609–13PubMedGoogle Scholar
  98. 98.
    Macfie AC. Lithium poisoning precipitated by diuretics [letter]. BMJ 1975; 1(5956): 516PubMedCrossRefGoogle Scholar
  99. 99.
    MacNeil S, Hanson-Nortey E, Paschalis C, et al. Diuretics during lithium therapy [letter]. Lancet 1975; I: 1295–6CrossRefGoogle Scholar
  100. 100.
    Solomon JG. Lithium toxicity precipitated by a diuretic. Psychosomatics 1980; 21: 425–9PubMedGoogle Scholar
  101. 101.
    Kerry RJ, Ludlow JM, Owen G. Lesson of the week — diuretics are dangerous with lithium. BMJ 1980; 281: 371PubMedCrossRefGoogle Scholar
  102. 102.
    Hurtig HI, Dyson WL. Lithium toxicity enhanced by diuresis [letter]. N Engl J Med 1974; 290(13): 748–9PubMedGoogle Scholar
  103. 103.
    Huang LG. Lithium intoxication with coadministration of a loop-diuretic [letter]. J Clin Psychopharmacol 1990; 10(3): 228PubMedCrossRefGoogle Scholar
  104. 104.
    Oh TE. Frusemide and lithium toxicity. Anaesth Intensive Care 1977; 5(1): 60–2PubMedGoogle Scholar
  105. 105.
    Saffer D, Coppen A. Frusemide: a safe diuretic during lithium therapy? J Affect Disord 1983; 5(4): 289–92PubMedCrossRefGoogle Scholar
  106. 106.
    Frolich J, Leftwich R, Ragheb M, et al. Indomethacin increases plasma lithium. BMJ 1979; 1: 1115–6PubMedCrossRefGoogle Scholar
  107. 107.
    Reimann I, Frolich J. Effects of diclofenac on lithium kinetics. Clin Pharmacol Ther 1981; 30(3): 348–52PubMedCrossRefGoogle Scholar
  108. 108.
    Shelley RK. Lithium toxicity and mefenamic acid. Br J Psychiatry 1987; 151: 847–8PubMedCrossRefGoogle Scholar
  109. 109.
    Kerry RJ, Owen G, Michaelson S. Possible interaction between lithium and piroxicam. Lancet 1983; I: 418–9CrossRefGoogle Scholar
  110. 110.
    Ragheb M. Ibuprofen can increase serum lithium level in lithium-treated patients. J Clin Psychiatry 1987; 48(4): 161–3PubMedGoogle Scholar
  111. 111.
    Iyer V. Ketorolac (Toradol) induced lithium toxicity. Headache 1994; 34: 442–4PubMedCrossRefGoogle Scholar
  112. 112.
    Alderman CP, Lindsay KSW. Increased serum lithium concentration secondary to treatment with tiaprofenic acid and fosinopril. Ann Pharmacother 1996; 30: 1411–3PubMedGoogle Scholar
  113. 113.
    Ragheb M. The clinical significance of lithium-nonsteroidal anti-inflammatory drug interactions. J Clin Psychopharmacol 1990; 10(5): 350–4PubMedCrossRefGoogle Scholar
  114. 114.
    Ragheb M, Powell A. Failure of sulindac to increase serum lithium levels. J Clin Psychiatry 1986; 47(1): 33–4PubMedGoogle Scholar
  115. 115.
    Ragheb M, Powell A. Lithium interaction with sulindac and naproxen. J Clin Psychopharmacol 1986; 6(3): 150–4PubMedCrossRefGoogle Scholar
  116. 116.
    Reimann I, Diener U, Frolich J. Indomethacin but not aspirin increases plasma lithium ion levels. Arch Gen Psychiatry 1983; 40: 283–6PubMedCrossRefGoogle Scholar
  117. 117.
    Lacro JP, Eastham JH, Jeste DV, et al. Newer antipsychotics and antidepressants for elderly people. Curr Opin Psychiatry 1996; 9(4): 290–3CrossRefGoogle Scholar
  118. 118.
    Salama AA, Shafey M. A case of severe lithium toxicity induced by combined fluoxetine and lithium carbonate. Am J Psychiatry 1989; 146(2): 278PubMedGoogle Scholar
  119. 119.
    Noveske FG, Hahn KR, Flynn RJ. Possible toxicity of combined fluoxetine and lithium. Am J Psychiatry 1989; 146(11): 1515PubMedGoogle Scholar
  120. 120.
    Vesely C, Fischer P, Goessler R, et al. Mania associated with serotonin selective reuptake inhibitors [letter]. J Clin Psychiatry 1997; 58(2): 88PubMedCrossRefGoogle Scholar
  121. 121.
    Chaudhry RP, Waters BGH. Lithium and carbamazepine interaction: possible neurotoxicity. J Clin Psychiatry 1983; 44(1): 30–1PubMedGoogle Scholar
  122. 122.
    Andrus P. Lithium and carbamazepine. J Clin Psychiatry 1984; 45: 525PubMedGoogle Scholar
  123. 123.
    Shukla S, Godwin CD, Long LEB, et al. Lithium-carbamazepine neurotoxicity and risk factors. Am J Psychiatry 1984; 141(12): 1604–6PubMedGoogle Scholar
  124. 124.
    Marcoux AW. Carbamazepine-lithium drug interaction. Ann Pharmacother 1996; 30(5): 547PubMedGoogle Scholar
  125. 125.
    Perry PJ, Calloway RA, Cook BL. Theophylline precipitated alterations of lithium clearance. Acta Psychiatr Scand 1984; 69: 528–37PubMedCrossRefGoogle Scholar
  126. 126.
    Holstad SG, Perry JP, Kathol RG. The effects of intravenous theophylline infusion on lithium clearance in normal subjects. Psychiatry Res 1988; 25: 203–11PubMedCrossRefGoogle Scholar
  127. 127.
    Mester R, Toren P, Mizrachi I. Caffeine withdrawal increases lithium blood levels. Biol Psychiatry 1995; 37: 348–50PubMedCrossRefGoogle Scholar
  128. 128.
    Sylvester RK, Leitch J, Granum C. Does acyclovir increase serum lithium levels? Pharmacotherapy 1996; 16(3): 466–8PubMedGoogle Scholar
  129. 129.
    Jelliffe RW. Creatinine clearance: bedside estimate. Ann Intern Med 1973; 79(4): 604–5PubMedGoogle Scholar
  130. 130.
    Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16(1): 31–41PubMedCrossRefGoogle Scholar
  131. 131.
    Risinger RC, Risby ED, Risch SC. Safety and efficacy of divalproex sodium in elderly bipolar patients. J Clin Psychiatry 1994; 55(5): 215PubMedGoogle Scholar
  132. 132.
    McFarland BH, Miller MR, Straumfjord AA. Valproate use in the older manic patient. J Clin Psychiatry 1990; 51(11): 479–81PubMedGoogle Scholar
  133. 133.
    Sharma V, Persad E. Augmentation of valproate with lithium in a case of rapid cycling affective disorder. Can J Psychiatry 1992; 37(8): 584–5PubMedGoogle Scholar
  134. 134.
    Pope HG, McElroy SL, Satlin A. Head injury, bipolar disorder, and response to valproate. Compr Psychiatry 1988; 29: 34–8PubMedCrossRefGoogle Scholar
  135. 135.
    Kando JC, Tohen M, Castillo J, et al. The use of valproate in an elderly population with affective symptoms. J Clin Psychiatry 1996; 57(6): 238–40PubMedGoogle Scholar
  136. 136.
    Gnam W, Flint AJ. New onset rapid cycling bipolar disorder in an 87 year old woman. Can J Psychiatry 1993; 38: 324–6PubMedGoogle Scholar
  137. 137.
    Rimmer EM, Richens A. An update on sodium valproate. Pharmacotherapy 1985; 5(3): 171–84PubMedGoogle Scholar
  138. 138.
    Bowden CL, Janicak PG, Orsulak P, et al. Relation of serum valproate concentration to response in mania. Am J Psychiatry 1996; 153(6): 765–70PubMedGoogle Scholar
  139. 139.
    Lott AD, McElroy SL, Keys MA. Valproate in the treatment of behavioral agitation in elderly patients with dementia. J Neuropsychiatry 1995; 7(3): 314–9Google Scholar
  140. 140.
    Bauer LA, Davis R, Wilensky A, et al. Valproic acid clearance: unbound fraction and diurnal variations in young and elderly adults. Clin Pharmacol Ther 1985; 37: 697–700PubMedCrossRefGoogle Scholar
  141. 141.
    Redington K, Wells C, Petito F. Erythromycin and valproate interaction. Ann Intern Med 1992; 116(10): 877–8PubMedGoogle Scholar
  142. 142.
    Levy RH, Koch KM. Drug interactions with valproic acid. Drugs 1982; 24(6): 543–6PubMedCrossRefGoogle Scholar
  143. 143.
    Sharma V, Persad E, Mazmanian D, et al. Treatment of rapid cycling bipolar disorder with combination therapy of valproate and lithium. Can J Psychiatry 1993; 38(2): 137–9PubMedGoogle Scholar
  144. 144.
    Battino D, Bossi L, Croci D, et al. Carbamazepine plasma levels in children and adults: influence of age, dose and associated therapy. Ther Drug Monit 1980; 2(4): 315–22PubMedGoogle Scholar
  145. 145.
    Ladefoged SD, Mogelvang JC. Total atrioventricular block with syncopes complicating carbamazepine therapy. Acta Med Scand 1982; 212(3): 185–6PubMedCrossRefGoogle Scholar
  146. 146.
    Wroblewski BA, Singer WD, Whyte J. Carbamazepine-erythromycin interaction: case studies and clinical significance. JAMA 1986; 255: 1165–7PubMedCrossRefGoogle Scholar
  147. 147.
    Brodie MJ, MacPhee GJA. Carbamazepine neurotoxicity precipitated by diltiazem. BMJ 1986; 292: 1170–1PubMedCrossRefGoogle Scholar
  148. 148.
    Valsalan VC, Cooper GL. Carbamazepine intoxication caused by interaction with isoniazid. BMJ 1982; 285: 261–2PubMedCrossRefGoogle Scholar
  149. 149.
    Fritze J, Unsorg B, Lanczik M. Interaction between carbamazepine and fluvoxamine. Acta Psychiatr Scand 1991; 84: 583–4PubMedCrossRefGoogle Scholar
  150. 150.
    Joblin M, Ghose K. Possible interaction of sertraline with carbamazepine. N Z Med J 1994; 107: 43PubMedGoogle Scholar
  151. 151.
    MacPhee GJ, McInnes GT, Thompson GG. Verapamil potentiates carbamazepine neurotoxicity: a clinically important inhibitory interaction. Lancet 1986; I: 700–3CrossRefGoogle Scholar
  152. 152.
    Spina E, Pisani F, Perucca E. Clinically significant pharmacokinetic drug interactions with carbamazepine: an update. Clin Pharmacokinet 1996; 31(3): 198–214PubMedCrossRefGoogle Scholar
  153. 153.
    Yassa R, Nastase C, Camille Y, et al. Carbamazepine, diuretics, and hyponatremia: a possible interaction. J Clin Psychiatry 1987; 48(7): 281–3PubMedGoogle Scholar
  154. 154.
    Frankenburg FR. Clozapine and bipolar disorder. J Clin Psychopharmacol 1993; 13(4): 289–90CrossRefGoogle Scholar
  155. 155.
    Calabrese JR, Meltzer HY, Markovitz PJ. Clozapine prophylaxis in rapid cycling bipolar disorder. J Clin Pharmacol 1991; 11(6): 396–7Google Scholar
  156. 156.
    Jeste DV, Eastham JH, Lacro JP, et al. Management of late-life psychosis. J Clin Psychiatry 1996; 57Suppl. 3: 39–45PubMedGoogle Scholar
  157. 157.
    Cohen WJ, Cohen NH. Lithium carbonate, haloperidol, and irreversible brain damage. JAMA 1974; 230(9): 1283–7PubMedCrossRefGoogle Scholar
  158. 158.
    Miller F, Menninger J, Whitcup SM. Lithium-neuroleptic neurotoxicity in the elderly bipolar patient. J Clin Psychopharmacol 1986; 6(3): 176–8PubMedCrossRefGoogle Scholar
  159. 159.
    Miller F, Menninger J. Correlation of neuroleptic dose and neurotoxicity in patients given lithium and a neuroleptic. Hosp Community Psychiatry 1987; 38(11): 1219–21PubMedGoogle Scholar
  160. 160.
    Greenberg L, Fink M. The use of electroconvulsive therapy in geriatric patients. Clin Geriatr Med 1992; 8(2): 349–54PubMedGoogle Scholar
  161. 161.
    Weiner RD. Does electroconvulsive therapy cause brain damage? Behav Brain Sci 1984; 7: 1–53CrossRefGoogle Scholar
  162. 162.
    Alexopoulos GS, Shamoian CA, Lucas J. Medical problems of geriatric patients and younger controls during electroconvulsive therapy. J Am Geriatr Soc 1984; 32(9): 651–4PubMedGoogle Scholar
  163. 163.
    Burke WJ, Rubin EH, Zorumski CF, et al. The safety of ECT in geriatric psychiatry. J Am Geriatr Soc 1987; 35(6): 516–21PubMedGoogle Scholar
  164. 164.
    Kellner CH, Monroe RR, Pritchett J, et al. Weekly ECT in geriatric depression. Convuls Ther 1992; 8(4): 245–52PubMedGoogle Scholar
  165. 165.
    Sackeim HA, Prudic J, Devanand DP. Effects of stimulus intensity and electrode placement of the efficacy and cognitive effects of electroconvulsive therapy. N Engl J Med 1993; 328: 882–3CrossRefGoogle Scholar
  166. 166.
    Mukherjee S, Sackeim HA, Schnur DB. Electroconvulsive therapy of acute manic episodes: a review of 50 years’ experience. Am J Psychiatry 1994; 151(2): 169–76PubMedGoogle Scholar
  167. 167.
    Frazer RM, Glass IB. Recovery from ECT in elderly patients. Br J Psychiatry 1978; 133: 524–8CrossRefGoogle Scholar
  168. 168.
    Madden JS. Alcohol and depression. Br J Hosp Med 1993; 50(5): 261–3PubMedGoogle Scholar
  169. 169.
    Ganzini L, Walsh JR, Millar SB. Drug-induced depression in the aged: what can be done? Drugs Aging 1993; 3(2): 147–58PubMedCrossRefGoogle Scholar
  170. 170.
    Biriell C, McEwen J, Sanz E. Depression associated with diltiazem. BMJ 1989; 299: 796PubMedCrossRefGoogle Scholar
  171. 171.
    Hullett FJ, Potkin SG, Levy AB, et al. Depression associated with nifedipine-induced calcium channel blockade. Am J Psychiatry 1988; 145: 1277–9PubMedGoogle Scholar
  172. 172.
    Eisendrath SJ, Sweeney NA. Toxic neuropsychiatric effects of digoxin at therapeutic serum concentrations. Am J Psychiatry 1987; 144: 506–7PubMedGoogle Scholar
  173. 173.
    Crowser MK, Pate JK. A case report of cimetidine-induced depressive syndrome. Am J Psychiatry 1980; 137: 1451Google Scholar
  174. 174.
    Jefferson JW. Central nervous system toxicity of cimetidine: a case of depression. Am J Psychiatry 1979; 136: 346PubMedGoogle Scholar
  175. 175.
    Billings RF, Stein MB. Depression associated with ranitidine. Am J Psychiatry 1986; 143: 915–6PubMedGoogle Scholar
  176. 176.
    Okada F. Depression after treatment with thiazide diuretics for hypertension. Am J Psychiatry 1988; 142: 1101–2Google Scholar
  177. 177.
    Himmelhoch JM, Detre T, Kupfer DJ, et al. Treatment of previously intractable depressions with tranylcypromine and lithium. J Nerv Ment Dis 1972; 155: 216–20PubMedCrossRefGoogle Scholar
  178. 178.
    Goodwin FK, Jamison KR. Manic depressive illness. New York: Oxford University Press, 1990: 48Google Scholar
  179. 179.
    Freeman TW, Clothier JL, Pazzaglia P, et al. A double-blind comparison of valproate and lithium in the treatment of acute mania. Am J Psychiatry 1992; 149: 108–11PubMedGoogle Scholar
  180. 180.
    Bowden CL, Brugger AM, Swann AC, et al. Efficacy of divalproex vs lithium and placebo in the treatment of mania. JAMA 1994; 271: 918–24PubMedCrossRefGoogle Scholar
  181. 181.
    Gitlin MJ. Lithium-induced renal insufficiency. J Clin Psychopharm 1993; 132(4): 276–9Google Scholar
  182. 182.
    Hetmar O, Povlsen UJ, Ladefoged J, et al. Lithium: long-term effects on the kidney — a prospective follow-up study ten years after kidney biopsy. Br J Psychiatry 1991; 158: 53–8PubMedCrossRefGoogle Scholar
  183. 183.
    Lokkegaard H, Andersen NF, Henriksen E, et al. Renal function in 153 manic-depressive patients treated with lithium for more than five years. Acta Psychiatr Scand 1985; 71: 347–55PubMedCrossRefGoogle Scholar
  184. 184.
    Conte G, Vazzola A, Saccetti E. Renal function in chronic lithium-treated patients. Acta Psychiatr Scand 1989; 79: 503–4PubMedCrossRefGoogle Scholar
  185. 185.
    Kallner G, Petterson U. Renal, thyroid and parathyroid function during lithium treatment: laboratory tests in 207 people treated 1–30 years. Acta Psychiatr Scand 1995; 91: 48–51PubMedCrossRefGoogle Scholar
  186. 186.
    Ballenger JC, Post RM. Therapeutic effects of carbamazepine in affective illness: a preliminary report. Comm Psychopharmacol 1978; 2: 159–75Google Scholar
  187. 187.
    White E, Cheung P, Silverstone T. Depot antipsychotics in bipolar affective disorder. Int Clin Psychopharmacol 1993; 8(2): 119–22PubMedCrossRefGoogle Scholar
  188. 188.
    Mirchandani I, Abrams RC, Pollak C, et al. One year follow-up of continuation convulsive therapy prescribed for depressed elderly patients. Int J Geriatr Psychiatry 1994; 9: 31–6CrossRefGoogle Scholar
  189. 189.
    Miklowitz DJ. Psychotherapy in combination with drug treatment for bipolar disorder. J Clin Psychopharmacol 1996; 16Suppl. 1: 56S–66SPubMedCrossRefGoogle Scholar
  190. 190.
    Bauer M, McBride L. Psychosocial treatments for bipolar disorder. In: Bauer M, McBride L. Structured group psychotherapy for bipolar disorder: the life goals program. New York: Springer, 1996: 69–83Google Scholar

Copyright information

© Adis International Limited 1998

Authors and Affiliations

  • John H. Eastham
    • 1
  • Dilip V. Jeste
    • 1
    • 2
  • Robert C. Young
    • 3
    • 4
  1. 1.Geriatric Psychiatry Clinical Research CenterUniversity of CaliforniaSan DiegoUSA
  2. 2.Department of PsychiatryVeterans Affairs Medical CenterSan DiegoUSA
  3. 3.Department of PsychiatryCornell University Medical CollegeNew YorkUSA
  4. 4.Department of PsychiatryThe New York Hospital-Cornell Medical Center, Westchester DivisionWhite PlainsUSA
  5. 5.San Diego Veterans Affairs Medical Center (116A-1)San DiegoUSA

Personalised recommendations