Bipolar disorder is a frequent disorder in the elderly, with a prevalence of 0.1 a 0.4%; a 10% of bipolar patients have mania onset after 50 years old. It has in ageing a more heterogeneous clinical presentation. The manic episodes are less severe, mixed depression is common, as well as confusion and cognitive impairment. A first manic episode in ageing can be secondary to medical illness. Treatment for bipolar disorder in ageing is similar to treatment for young patients. The differences are due to pharmacocinetic changes because of the age, with the comorbidity and with the etiology, if it is a secondary mania. Lithium can be the first choice for treating mania in patients with antecedent of good response and have tolerance to adverse effects, but because of its toxicity and secondary effects other possibilities may be considered: divalproate, cabamazepine, antipsychotics. There are some little studies that show lamotrigine efficacy in bipolar depression in elderly. We need more specific studies about bipolar disorder treatment in aging.