EPA-1620 – The challenge of treating bipolar disorder in elderly people

Background Bipolar affective disorder in the elderly is a complex entity not only in its clinical dimension but also in its therapeutic management. Elderly patients are very sensitive to pharmacological secondary effects. The objective of this study is to longitudinally analyze the pharmacological route of a sample of outpatients above 65 years old. Method Review of clinical histories and data collection from a sample of 12 patients over 65 years old. Results Current age Years of evolution Somatic background Previous treatment Cause of modification Current treatment Side effets N1 79 59 Arrhythmia, high blood pressure Lithium Renal failure gabapentine Tremor, drowssiness N2 76 60 Cholecistectomy Haloperidol, lithium biperiden, zolpidem Extrapyramidal syndrome Lithium, trazodone, lorazepam Distal tremor, cognitive impairment N3 72 25 Ischemic heart disease, high blood pressure, VHB. Essential tremor, cognitive impairment Fluoxetine, lamotrigine Inefective Quetiapine, valproic acid Worsening Cognitive impairment, drowsiness Oxcarbazepine Neutropenia Haloperidol Extrapyramidal syndrome olanzapine Gain Weigth N4 68 38 Diabetes mellitus Tryciclic antidepressants, valproic acid, lithium Drowsiness, gastric discomfort, fatigue Risperidone, zolpidem Tremor, dependence on zolpidem Conclusions Most of the patients experienced at least three drugs prior to their current treatment. The fundamental reason for changes were intolerable adverse effects and, in one of them, irreversible (kidney failure). The trend is to replace drugs by atypical antipsychotic or antiepileptic ones. The prescription of gabapentin is not based on scientific evidence but with a positive response. The available literature is still limited to justify these decisions based on clinical experience, somatic background and tolerance of the patient.