Suicide and Bipolar Disorder: Symptoms, Treatment, and Prevention

What the research says

According to the National Institute of Mental Health (NIMH), an estimated 4.4% of people will experience bipolar disorder in their lives. In any given year, about 2.8% of people in the United States age 18 and older are diagnosed with bipolar disorder.

The condition can range from moderate to severe, but roughly 82% of people with bipolar disorder experience a severe form, enough to substantially impact their quality of life.

Living with bipolar disorder puts you at a higher risk of suicide, especially if you are not actively receiving treatment or sufficient support.

A 2019 review of studies reported that people with bipolar disorder have a 10 to 30 times greater risk of dying by suicide than the general population. The authors found that, especially in untreated bipolar disorder, up to 20% of people will die by suicide, and 20% to 60% will attempt suicide at least once.

Other mental health disorders include a risk of suicide, including major depression. Still, bipolar disorder has a higher risk of suicide than even major depression. People with bipolar disorder are twice as likely to die by suicide than people with major depression.

Risk factors

In addition to not being in treatment, there are certain risk factors that make someone with bipolar disorder more likely to attempt or die by suicide.

These include:

• family history of bipolar disorder or suicide
• being single or divorced
• a history of childhood abuse or trauma
• unemployment
• younger age at onset of bipolar disorder
• attention deficit hyperactivity disorder (ADHD)
• substance misuse
• hospitalization with bipolar disorder
• higher levels of depression when hospitalized
• having bipolar disorder with mixed features

The longer bipolar disorder goes untreated after diagnosis, the higher the risk of suicide. Seeking care and managing your bipolar disorder can substantially reduce suicide risk and is the most important thing you can do for your health and safety.

Symptoms

People living with bipolar disorder tend to cycle between mood states, which can include mania, hypomania, and depression. Between these episodes, there are periods of relatively stable mood called euthymia.

There are two main types of bipolar disorder: bipolar 1 and bipolar 2. Bipolar 1 involves more severe episodes of mania and depression. People with bipolar 2 will experience a more subdued form of mania called hypomania, along with depression.

Here’s a simple breakdown:

Bipolar disorder shares some symptoms of other mental health conditions, and it’s common for people to be misdiagnosed at first. For example, one study found that an estimated 37% of people with bipolar disorder were first diagnosed with depression. Schizophrenia is also a potential misdiagnosis in people who have bipolar disorder.

The symptoms of bipolar disorder vary from one person to another. Although the two main mood states of the disorder are mania and depression, some people experience mixed episodes as well. In mixed episodes, features of both mania and depression are present.

Manic episodes

Mania can look like the following:

• feeling “high” and excitable, having more energy than usual
• feeling irritable or angry
• less need for sleep, insomnia
• racing thoughts or speech
• in rare cases, psychosis or hallucination

These episodes can cause an inflated sense of invincibility and self-esteem, leading to reckless decision making. While mania is often associated with contributing to “creative genius,” untreated mania shouldn’t be romanticized, as it can be very dangerous.

Hypomania manifests as a more subdued form of these symptoms and may be harder to spot. Hypomania can feel like being more energetic or productive than usual.

Depressive episodes

The depressive phase of bipolar disorder isn’t just about feeling sad or tired. It’s natural to feel down sometimes in response to troubling life events or bad days, but depression refers to a more severe state.

In bipolar disorder, depressive episodes can look like:

• feeling hopeless
• feeling down about yourself, low self-esteem
• trouble focusing, lack of interest in hobbies or activities
• isolating yourself, avoiding friends and family
• difficulty taking care of yourself and your space
• thoughts of death, dying, or suicide (suicidal ideation)
• engaging in forms of self-harm

Treatment

There are several treatment options for bipolar disorder. The gold standard is considered a combination of medication and therapy. Having an emotional support network is also key to long-term stability and helping you stick with a treatment plan.

• Medication. Most people with bipolar disorder will need to take medication to manage their symptoms. Some people need to take more than one, and it may take several tries to find a med that works for you. Commonly prescribed medications include:
  • mood stabilizers, most commonly lithium
  • atypical antipsychotics
  • medications to help with sleep and anxiety
  • antidepressants may be prescribed during a depressive episode
• Therapy. There are several types of therapy to treat bipolar disorder, including:
  • interpersonal therapy
  • social rhythm therapy (IPSRT)
  • talk therapies, such as cognitive behavioral therapy (CBT)
  • family-focused therapy
• Lifestyle changes. It may be necessary to make adjustments to your habits and schedule to improve your overall health, which impacts moods. This includes eating a balanced diet, getting enough sleep, and being physically active.

Prevention

Bipolar disorder is a chronic condition, meaning it needs to be managed lifelong.

While your treatment needs may change, it’s important to not suddenly stop medication or therapy because you “feel better.” This can create a mental health crisis. For people with bipolar disorder, consistency is key to staying stable and safe.

Seeking care and adhering to your care regimen is the best prevention against further manic and depressive episodes and against suicidal ideation.

These measures include:

• creating and maintaining a strong emotional support network
• staying in touch with your doctors and other healthcare professionals, even when feeling stable
• attending all doctor and psychiatrist appointments regularly
• taking medication(s) as directed
• practicing health lifestyle habits, including proper sleep hygiene and exercise
• updating your care team with any changes to your moods, or troubling new symptoms

When to seek help

Being in treatment for bipolar disorder isn’t a guarantee you won’t have mood episodes, although treatment can lessen their severity. There may be times when you have a mental health crisis and need immediate care.

Pay attention to your moods, and reach out to your doctors and support network if you are feeling overwhelmed or unsafe. Remember: You’re not alone, and help is available.

Understanding the features of manic, hypomanic, and depressive episodes can help you or loved ones identify a possible flare. Some people find it helpful to keep a diary of their symptoms to spot any concerning patterns.

If you think you or someone you care about with bipolar disorder is thinking about harming themselves, it’s imperative that you seek immediate assistance.

This can include:

• calling the National Suicide Prevention Lifeline, 1-800-273-TALK (8255)
• contacting the therapist or psychiatrist you are working with
• calling an ambulance or having a loved one take you to the hospital for evaluation

If you believe someone is suicidal, do not leave them alone. Make sure they don’t have access to any means to harm themselves or others. This might mean removing medications or weapons from the area.

Takeaway

People with bipolar disorder are at increased risk of attempting and completing suicide than the general population. This is particularly true for people with untreated bipolar disorder.

Bipolar disorder is a lifelong condition, but it can be effectively managed. Seeking care and maintaining a consistent treatment plan — including medication, therapy, and certain lifestyle changes — is the best suicide prevention tool.