Bipolar disorder and suicide: signs of danger

Bipolar disorder is a serious mental illness that causes dramatic changes in mood. It’s well established that people with the condition are much more likely to die by suicide than those who do not have it. Between 20 and 60 percent will attempt suicide at least once, according to a 2019 review in the journal Medicina, and between 4 and 19 percent will ultimately take their own lives.

What is bipolar disorder?

Once known as manic-depressive illness, bipolar disorder causes unusually intense emotional states that occur in distinct periods. These are called “mood episodes,” according to Muffy Walker, co-founder of the International Bipolar Foundation.

“These episodes can include ‘manic states’ which include feelings of being overly joyful or excited or ‘depressed states’ of feeling extremely sad or hopeless,” says Walker. “Sometimes, symptoms include both mania and depression, resulting in a mixed state.”

Though it may seem contradictory, it’s common for people with bipolar to experience the highs and the lows at the same time. These mixed-state episodes tend to include negative thinking alongside restlessness, agitation, and high energy.

How is bipolar disorder treated?

People with bipolar disorder should discuss treatment with a healthcare provider (HCP) and do what works best for their situation.

Typically, treatment includes medications such as mood stabilizers and/or antipsychotics. Most people with bipolar are able to tolerate these drugs without significant negative effects, though some may experience a reaction. Finding the correct medication or combination of medications can take time and involve some trial and error. It’s important to keep trying, however, as the right mix could greatly improve mental well-being.

In addition to medication, treatment often includes talk therapy and social support for the person with bipolar disorder and their family. Balanced nutrition, good sleep hygiene, exercise, and abstinence from taking drugs and alcohol round out the approach.

Suicide and bipolar disorder

When people with bipolar disorder attempt suicide, they are more likely to die from the attempt than people without mental illness. In general, the suicide risk in people with bipolar is strongly connected to depressive episodes. Longer depressive episodes increase the chances, as do delays in diagnosis and treatment. Having bipolar I, a type of the disorder involving more intense manic episodes, also raises risk.

Additionally, a study published in Nature in 2021 suggested that a history of trauma, and especially post-traumatic stress disorder (PTSD), increased the risk of both suicide attempts and deaths in people with bipolar disorder. Research is ongoing, but these findings highlight the need to prioritize treating and preventing residual effects of trauma.

Common suicide risk factors

While there is no perfect formula that can predict whether a person with bipolar disorder will attempt suicide, there are some identifiable risk factors. These include the following.

• Previous attempts: These are thought to the most significant risk factor for additional attempts and eventually, death.
• Family history: This includes a parent or sibling who have bipolar or have attempted or died by suicide.
• Substance abuse: People with bipolar are more likely than most to misuse drugs and alcohol, which increases suicide risk.
• Long periods without treatment: Extended wait times for diagnosis and treatment increase suicide risk.

Suicide warning signs

The warning signs of suicide aren’t always clear. Sometimes the decision to take one’s life is sudden, and there’s no way of seeing it coming. Walker says, however, that these behaviors could suggest a suicide attempt is imminent:

• Talk of suicide or wanting to die
• “Putting one’s affairs in order” by giving things away or updating a will
• Acquiring information online about suicide or researching materials to help one commit suicide
• Acquiring a weapon or hoarding medication

It’s often a friend or family member who notices such symptoms, so it’s extremely important to be attuned to the signs.

Suicide prevention

What can one do to minimize the likelihood that a loved one with bipolar disorder will commit suicide? Steps to take include securing or not owning firearms, treating or preventing substance abuse, helping the person build a support group, and being vigilant with those who have lost a close relative to suicide.

As another precautionary step is to have a written plan in place. “The midst of the crisis is not the best time to figure out what to do,” says Walker. Such a plan could include the following:

• Name and numbers of a psychiatrist and therapist to call
• Phone numbers for suicide hotlines in your area
• Name and directions of the chosen hospital or emergency room
• Insurance information if you need to go to the emergency room
• Written list of all medications
• For bipolar patients, a list of “reasons to live” and “why suicide thoughts are distorted,” to reference when thinking of suicide

People considering suicide should contact the 988 Suicide & Crisis Lifeline by calling, texting, or chatting the number 988. If you’re with someone who is actively considering suicide, do not leave that person alone. Call 911 right away or go to the nearest emergency room. “One of the best suicide preventers is to help the person discover what it is that they have to give to other people and the world, and to help them develop that talent,” says Thomas Jensen MD, former Medical Director of the International Bipolar Association. “Without believing one has something of value to contribute, it is extremely difficult to address social isolation and poor self-esteem.”