The diagnosis and treatment of mania in the elderly.

Mania in late life is often complicated by comorbid medical conditions, medication intolerance, and inadequate medication response. Lithium remains the primary medication in the acute and prophylactic treatment of mania in the elderly. However, certain anticonvulsants (valproic acid and carbamazepine) have a number of advantages, including a more tolerable side effect profile and increased efficacy in subgroups of patients, such as patients with secondary mania due to neurological and other medical disorders. Future research is needed to focus on the double-blind trials of somatic treatments, including ECT, in the elderly.