Onika L. Dainty

Aging with Bipolar disorder can significantly impact women’s mental health, oftentimes leading to more depressive episodes, increased rapid cycling and mixed episodes and a higher likelihood of co-occurring disorders like anxiety or substance use disorder. As women with Bipolar disorder age they may experience a shift in their symptoms from hypomanic and manic episodes to more frequent and longer depressive episodes, and a possible increase in the number of mood episodes especially around perimenopause. 

Perimenopause and Bipolar Disorder 

Perimenopause is the transitional period leading up to menopause, characterized by fluctuating hormone levels and changes in menstrual cycles, potentially causing symptoms like hot flashes, irregular periods, and mood changes. Perimenopause has been linked to a higher risk of developing Bipolar disorder or experiencing the exacerbation of existing symptoms related to the mood disorder due to the hormonal shifts that occur specifically the decline in estrogen. For women with pre-existing Bipolar disorder perimenopause can lead to more intense and frequent mood episodes.

Depressive Episodes and Aging

As women with Bipolar disorder age there is a shift toward more depressive episodes and fewer manic episodes however these depressive episodes may be more prolonged. Some research has shown with the passage of decades in the Bipolar disorder illness there is an increase in the predominance of depressive symptoms including lowered motivation, changes in sleep patterns and appetite changes. Some women may also experience cognitive issues as they age in this illness. There is also the possibility that symptoms become resistant to medications that worked previously. If you are noticing any of these changes in your Bipolar disorder illness it's important to consult your medical team for support during this time of transition.    

Understanding Your Needs

Aging with Bipolar disorder is a part of the process that is sometimes overlooked. Just like aging is different for men as for women, transitioning from decade to decade with a severe mental illness will also look different. As women there is more to consider such as perimenopause, menopause, mood fluctuations due to hormonal shifts and how the illness of itself ages with you. It’s important to know your needs when dealing with mental illness and be aware of the changes in your cycle. Relying on your past knowledge of Bipolar disorder can help you understand who you were in your illness rather than where your mood disorder is going as you age and what your unique needs are as you transition.    

Emotional and Psychological Impact of Aging with Bipolar Disorder: A Woman’s Insight

When I was in my 20s and 30s dealing with my illness my focus was on medication and symptom management. Because I deal with Bipolar I disorder, I have always focused on the emergence of manic symptoms as my baseline leans toward hypomania. I’m now in my 40’s and I have started to experience several depressive episodes, though temporary in nature they surprised me. My lack of understanding of what I need psychologically and physiologically in this next phase of my Bipolar disorder journey has led me to start doing my research on what this mood disorder looks like in this season of my life. 

I recently went to see my OBGYN regarding irregularities in my menstrual cycle. In my 30s I was advised due to my medication regime I was experiencing fluctuations in my cycle and after a few months my period stopped completely. A week or so before my 40th birthday my cycle returned but it was irregular and caused concerns. For the past two years though, I have felt almost normal with the return of my cycle. I have also experienced emotional and psychological ups and downs including rapid cycle manic episodes and major depressive episodes. My OBGYN said the irregular cycle is due to my age and because he is not an expert in mental health he was unable to address the psychological changes that were occurring. 

It was an older friend in her 50s that mentioned I could be experiencing perimenopause, the transitional period leading to menopause. So, I began to do my research and discovered the emotional and psychological complexities of Bipolar disorder can become more challenging during this transitional period as well as during menopause. It is well known that Bipolar disorder is derived from chemical imbalances so when women age there are fluctuations in body chemistry that affect the way mood episodes occur. For example, I find myself crying more often and experiencing days when I’m unable to get out of bed. My energy is high one minute and low the next. Recently, I went on vacation and experienced a two day manic episode, one of the shortest I’ve ever had which was brought on by lack of sleep. I have also experienced moments of visual hallucination in the past few months. 

After speaking with my psychiatrist, he advised that we shorten the time between our sessions and that I continue to monitor these fluctuations in mood. He also ordered a full blood work-up to determine whether or not there needs to be adjustments made to my treatment plan. He recommended that if unexplainable mood episodes occur to contact him right away to schedule an appointment. I have been fortunate to work with a healthcare provider that listens to my concerns, keeps an open mind and provides proactive treatment solutions. 

Bipolar disorder is a continuous rollercoaster of emotional and psychological challenges but managing your symptoms is key especially as we age. Oftentimes when you feel you have a handle on this illness life will throw you a curve ball and everything feels brand new again. It's important to remember that you have the strength and resilience to manage your mood disorder regardless of the challenges that come your way. Through self-care, support, psychoeducation, medical management and self-compassion aging with Bipolar disorder will become a phase in life you conquer rather than one that defeats you. If you are currently dealing with symptoms of aging with Bipolar disorder consult your healthcare professional for information on how you can proactively manage these new challenges.       

Medication and Treatment Adjustments for Older Women with Bipolar Disorder

When you are aging and dealing with a mental illness like Bipolar disorder it's important to remember that the illness changes as you change, psychologically, physically and emotionally therefore medication and treatment adjustments may need to be made. If you are noticing a difference in medication effectiveness or treatment strategies contact your healthcare provider to discuss adjustments that can help you continue to manage your mental illness effectively. For example, there are several medications in the categories of mood stabilizers, anti-psychotics or anticonvulsants that may currently be in your medication regime that require careful monitoring to mitigate side effects or toxicity. In other words, the medications that previously worked to manage your symptoms may need readjustment in dosage or frequency as you age to remain effective. 

Lifestyle changes should also be considered to promote mental health, physical health and to avoid developing other health concerns like diabetes, high cholesterol and blood sugar or blood pressure issues from arising and creating further health challenges. A healthy lifestyle, including regular exercise, a balanced diet and adequate sleep can play a significant role in managing Bipolar disorder especially as one ages. Also seeking the counsel of a therapist, groups or peer support can prove valuable as they have knowledge and understanding of the challenges you may face during this transitional phase.

Whichever route you choose as you grow and change in your Bipolar disorder journey it's important to remember there are supports in your community and on your team to assist you in understanding how to navigate the new path of aging and managing Bipolar disorder. The complexities of managing a severe mood disorder along with the process of aging with your illness will have its challenges but with time, research, support and continued resilience you can overcome the physical, psychological and emotional trials that often come with aging and Bipolar disorder.        

Practical Strategies for Coping with Aging and Bipolar Disorder

Coping with aging and Bipolar disorder can be challenging. Below are some practical strategies for maintaining a balanced lifestyle while dealing with this new transition and managing your mood disorder.

Establish and Maintain Structure, Routine and Good Habits

• Sleep Hygiene: Aim for a consistent sleep schedule, wake-up and go to bed at the same time daily even on weekends as disturbances in sleep can trigger mood swings.

• Structured Daily Activities: Incorporate a daily routine of activities such as exercise, regular meals and social activities like groups or meeting with friends.

• Medication Management: Take your medication daily and/or as prescribed and discuss side effects or concerns with your healthcare provider as issues arise. 

Physical and Mental Health

• Nutrition: Limit processed foods and incorporate a balanced diet rich in vegetables, fruits and whole grains. Instead of take-out food consider cooking meals daily based on your budget.  

• Exercise: Engage in physical activities you enjoy like hiking, cardio workouts, daily walking or yoga. Exercising releases endorphins and dopamine, the feel good chemicals that can combat feelings of stress or depression. 

• Stress Management: Incorporate relaxation practices like medication, breathing exercises or grounding in the morning or before bedtime to release stress. 

• Mental Stimulation: Engage in activities that stimulate the brain like reading, puzzles or learning a new skill such as refinishing furniture or crocheting. 

Build a Strong Support System

• Connect with Others: Build and maintain relationships with family, friends and support groups who can support you during difficult times.

• Professional Support: Seek the help of professionals such as psychologists, counselors or psychiatrists who can address mood fluctuations and help you develop coping skills.

• Self-Advocacy: Communicate your needs to your healthcare team and support network. Openly share your experiences to find circles of support from like-minded individuals.  

More Strategies

• Address Age-Related Changes: Monitor potential age-related changes in your emotional and psychological cycle to address with your healthcare providers. 

• Manage Chronic Conditions: If you have any other chronic conditions such as diabetes or blood pressure concerns, work with your healthcare team to manage them effectively. 

• Stay Active and Engaged: Continue to do activities that bring you joy and fill your life with purpose. 

• Memory Aids: Use tools like calendars, to-do lists, daily planners, reminders and alarms to help keep track of medications and appointments. 

Final Thoughts

Aging with Bipolar disorder presents unique challenges, but with the right strategies, support, and self-awareness, women can navigate this journey with confidence. From understanding how symptoms change over time to adjusting treatment plans and nurturing relationships, the key is to remain proactive and practice self-compassion. When you grow and change so will your Bipolar disorder and how you manage your symptoms. Aging has never been an easy process with everyday, year or decade that passes so does the emotional and psychological needs of women. Remember Bipolar disorder is a lifelong  and complex condition. How you handle the challenges and pitfalls of this complicated mood disorder is up to you. Through psychoeducation and vigilant observation of your changing Bipolar cycle it's possible to maintain control of your journey to wellness especially during the aging process.   

If you or a loved one are facing aging with Bipolar disorder, it’s essential to seek out professional guidance, stay connected with supportive networks, and develop practical coping mechanisms. Remember every day is an opportunity to do something you’ve never done before, so today embrace the process of aging with Bipolar disorder and prioritize your mental health  and wellness every step of the way.

I’m writing this today as a 41-year-old woman diagnosed with Bipolar I disorder, speaking to both my 16-year-old self who first began to struggle, and my 24-year-old self who smoked that last marijuana joint just before my life turned upside down. I want to share with you what I wish I’d known back then, when the warning signs were there, but I couldn’t yet see them for what they were.

The Beginning of Anxiety and Depression

At 16 years-old, I felt anxious all the time. There was this constant knot in my stomach that never seemed to go away. My mind would race at night, making it nearly impossible to sleep. During the day, I would try to appear fine—going to school, hanging out with friends—but deep down, there was a sadness I couldn’t shake. I didn’t know then that these were early signs of Bipolar I disorder. No one talks about mental health in a way that connects with you when you’re young, especially when you grow up in a family where the focus is on getting through the day.

I was living in a home where my mother worked as a registered nurse and my father was an Ontario government real estate manager, providing stability for the family. We had recently moved from Scarborough to the Durham Region. My parents, like many immigrant families, focused on hard work and survival rather than emotions. Mental health was never a topic we sat around and discussed at the dinner table. And because I didn’t understand what I was going through, I dismissed it as “normal teenage stuff.”

But now, looking back, I wish I had known it wasn’t normal. That it was more than just mood swings. Anxiety and Depression were the first signs of something deeper that would unravel my mind in the years ahead.

The Long Road Ahead: It's a Lifelong Illness

One of the hardest truths I had to learn is that Bipolar I disorder is lifelong. It doesn’t go away. There is no “cure” or a quick fix. As a young woman, I held onto the hope that maybe if I could just get through the tough days, the rest would somehow fall into place. But what I didn’t realize is that the highs and lows would continue, and often get worse, if left untreated.

To my 16-year-old self, I wish I could say this: You are not broken, but this is going to be part of your life forever. It's not your fault, you were born with this chemical imbalance and it’s something you’ll have to learn to manage. This disorder will touch every part of your life—your relationships, your career, your body, and your mind. The sooner you learn about it, the better. The earlier you start managing it, the better your life will be.

For anyone facing a Bipolar I diagnosis, I encourage you to read my post, How to Start Managing Bipolar Disorder: A Comprehensive Guide. It’s a resource I wish I had back then, offering practical first steps in taking control of your mental health.

The Reality of Hospitalization

I also wish I had known that hospitalization would become a regular part of my life. As a teenager, I never could have predicted that I’d be in and out of psychiatric hospitals during my twenties and thirties. No one prepares you for the moments when your mind completely betrays you, when the Mania becomes so intense that hospitalization becomes your only option, for your safety and the safety of those around you. 

The first time I was hospitalized, I was terrified. It felt like I had lost control of everything—my mind, my body, my future. Being in a psychiatric ward, restrained, treated like I was dangerous—it was dehumanizing. I felt more like a chained animal than a person. The recovery from each manic episode took months, sometimes longer. The weight of it all was unbearable at times, and I wish I had known earlier that this was part of the reality of living with Bipolar I disorder.

To my younger self: Hospitalization is not a failure. It’s a safety net when you can’t trust your own mind. It’s a place to heal, even though it feels like a prison. And to anyone reading this now who has been hospitalized for mental illness, know that you are not alone, and that it doesn’t define your worth.

Childhood Trauma and Its Impact

I wish someone had told me sooner that my Bipolar I disorder was rooted in childhood trauma. Growing up, I didn’t understand how much my early experiences had shaped the way my brain developed. Trauma has a way of weaving itself into the fabric of who you are, influencing everything—from how you respond to stress to how you manage emotions.

The highs and lows I experienced weren’t just random; they were the result of deep-seeded wounds that had never been addressed. It took me years to understand that my mental health was tied to the trauma I experienced as a child. Trauma isn’t something that just goes away because you grow up. It follows you, and for many people like me, it becomes the foundation for mental illness.

If I could go back, I would tell my younger self: Heal the wounds from your past. Get help to unpack the trauma. Doing that earlier might have changed the course of your life.

The Double-Edged Sword of Medication

Medication is both a blessing and a curse. To this day, I take mood stabilizers and antipsychotics to keep my Bipolar I disorder in check. They help, but they come with their own set of challenges. The side effects can be brutal—weight gain, tremors, constant fatigue. Some days, it feels like the medication that’s supposed to make me better is also making me worse. But without it, I wouldn’t be stable.

To my 24-year-old self, just before I smoked that last joint, I wish I could have told you that the marijuana you were using to cope was only making things worse. Drugs like marijuana and cocaine exacerbated my Bipolar I disorder, throwing me into deeper and more dangerous manic episodes.

I wish I had known that the road to stability would involve so many trade-offs. The medication would save my life, but it would also change my body in ways I hadn’t anticipated.

For those struggling with medication management, I also recommend reading my post, Best Tools and Resources for Managing Bipolar Disorder in 2024. It’s important to find the right balance between treatment and quality of life.

Dangerous Manic Behaviors

Mania is seductive. It makes you feel invincible. During my twenties, I chased that high, not fully understanding how dangerous it was. My manic episodes put me in constant danger, both physically and emotionally. I took risks with my body, my money, and my relationships that I now look back on with disbelief.

I became sexually irresponsible, engaging in behaviors that I later regretted. I was financially reckless, spending money I didn’t have. And through it all, I was completely out of control of my mind. Mania is not just about feeling good—it’s about losing touch with reality.

To my 24-year-old self: You’re not invincible. Mania will take you to places you never imagined—places you may never recover from. Protect yourself. Learn to recognize the signs before you spiral out of control.

The Devastation of Depression

On the other side of Mania is Depression. If Mania felt like flying too close to the sun, Depression felt like falling into a pit I couldn’t climb out of. The depressive episodes that followed were so debilitating, I couldn’t move, couldn’t think, couldn’t care about anything. They felt endless.

Depression wasn’t just sadness; it was a complete shutdown of my mind and body. It stole months of my life at a time, leaving me in a fog of hopelessness. Recovery from these episodes took everything out of me.

To my younger self: The lows will be dark, but you will survive them. Even when it feels like you can’t keep going, you can. You will come out on the other side, even when it feels impossible.

The Strain on Relationships

One of the hardest parts of living with Bipolar I disorder has been the strain it’s placed on my relationships. My family loves me, but they don’t always understand me. I know that some of them fear me, even though they care. My manic episodes scared them, and my depressive episodes made me a stranger to them.

I’ve exhausted my friends and alienate people I care about because of my illness. When you live with Bipolar I disorder, you often feel like you’re dragging the people around you through the mud. The weight of that guilt is something I carry with me every day.

To my younger self: Some people will leave, and it will hurt. But the people who stay will love you in ways you never imagined. And you will learn to forgive yourself for the strain you put on others.

Final Thoughts

If there’s anything I wish I had known before my Bipolar I disorder diagnosis, it’s that this journey isn’t a solitary one. You will feel isolated at times, and you will feel misunderstood, but there are people who understand—people who have walked this path before you.

You are not alone. And though Bipolar I disorder will be a part of your life forever, it doesn’t have to define you. There is hope, there is healing, and there is life beyond the diagnosis.

To my 16-year-old self: Don’t be afraid to ask for help. To my 24-year-old self: You’re about to go through hell, but you will come out stronger. And to anyone reading this who is struggling with mental illness: Hold on. The journey is long, but you are not alone and you are more than your diagnosis.