Too Old for This

Photo by Andrew Ly on Unsplash

I’ve outlived reliable research on living with and treating bipolar disorder. Put it this way: drug trials performed by pharma companies when developing new psychiatric medicines, or by researchers reviewing existing medicines, use research subjects between the ages of 24 and 44. After that development of new therapies stops, even though any doctor will tell you that drugs affect the aged quite differently than younger people. Aging psych patients face a whole onslaught of somatic comorbidities that medicine may help or cause.

For instance, studies will proclaim that a disproportionate number of people with bipolar disorder die of kidney disease. Well, many older people with BP have spent a long time on lithium, and lithium wreaks havoc on kidneys. Despite this, researchers will tell us the response to drugs in older adults is the same as in the middle-aged adults in their study.

I’ve turned 62 during this episode that has had its claws in me for months and is not getting better. Medicines I’ve taken for decades don’t seem to be working anymore, and physical limitations are popping up that when combined with the psychic suffering make life pretty miserable.

I sat with my doctor as he searched for reasonable information on geriatrics and bipolar treatment. He turned toward me, frowned, and said there really isn’t any. Dr Google verified the same to me during my own search. We know very little about treating the aged with bipolar disorder. But oh, do we know they die young.

People with bipolar disorder have a four to sixfold increase in premature death. For reference, smokers have a twofold increase of dying early. And it’s not just suicide. While suicide does kill 15-30% of people with bipolar disorder, musculo-skeletal, renal, GI, dementia, and cardiac diseases plague people with bipolar disorder at much higher rates than the general population. Then there’s stress, which can set off long mixed episodes plagued with psychiatric and physical complications. Uncontrolled, despite our best efforts to manage it, stress wears us down and wears us out. So when you take out suicide, we with BP are still over three times more likely to die young. Only hypertension has an early death rate as high as bipolar disorder.

Hand a person in a panic a laptop and they will scour the web for the worst possible information that will confirm their worst fears. Well, I didn’t have to look hard to find this one. It was one of the first hits and was referred to on other sites. A University of Michigan study is tracking groups of people with and without bipolar disorder. They’ve found people with BP die 8-10 years earlier than other people their age. In fact, in the study, researchers “found that all but 2 of the 56 deaths since the study began in 2006 were from the group of 847 people in the study who had bipolar disorder.”

I was in the woods with my nephew hiking up a long, steep incline. I can walk for miles in the city, where it’s flat, but with the lookout spot we were heading to in sight above us I pulled up and tapped out. My nephew, who’s a physical therapist, was completely understanding and turned to lead me down. Then I discovered how bad my knees are. They ached and wobbled and I nearly fell once or twice. The aging body.

I’ve been feeling old recently, consumed with thoughts of limitations and outlook, and now, as my body fails so does my mental illness. It’s not the same as it was. It’s unpredictable and getting worse.

My doctor cranked up the doses on the five meds I’m now taking (this time last year I was taking two) and gave us both six weeks. If things don’t markedly improve by then we’re going to have to throw out what has worked in the past and try something new. But we’ll be flying blind. There’s little information to draw on, so we’ll make it up as we go along.

Late life with bipolar disorder is a lot like standing on that trail looking up the path at the place you thought you were going and realizing you’re not going to make it. I haven’t lost my sense of humor and I haven’t lost the love of my family, but in the woods of medical knowledge I am lost.

There’s no map from here, so we hold on and enter old age and live as well as we can. Keep the strong winds rustling the trees overhead, while down here on the path we crawl along to some safer place. Not to wait out the storm, but to discover new ways to consider our place and, maybe, new ways to live well. At this age that’s not easy. But it’s necessary.