Bipolar disorder is a serious mental health condition characterized by significant shifts in mood, energy, activity levels, and concentration. These periodic, intense emotional states are known as mood episodes, which can range from extreme highs (mania or hypomania) to severe lows (depression). Individuals with bipolar disorder face a significantly elevated risk of suicidal behavior compared to the general population.
Why Bipolar Disorder Increases Suicide Risk
The fluctuating nature of bipolar disorder contributes to a heightened suicide risk, with specific mood episodes posing distinct dangers. Severe depressive episodes, marked by intense sadness, hopelessness, worthlessness, and despair, are major contributors to suicidal thoughts and actions. During these periods, individuals may feel overwhelmed by their symptoms.
Manic or mixed episodes also elevate suicide risk. Mania can lead to impulsive behaviors, poor judgment, and agitation. Mixed episodes, which involve symptoms of both mania and depression simultaneously, can be particularly distressing and confusing. Rapid cycling, defined as four or more mood episodes within a year, is also linked to a higher risk of suicide attempts.
Co-occurring conditions with bipolar disorder can amplify suicide risk. Substance use disorders can worsen mood instability and impair judgment. Anxiety disorders, often present, can add to overall distress and feelings of being overwhelmed.
Recognizing Suicidal Warning Signs
Recognizing when someone with bipolar disorder may be at risk of suicide involves identifying observable signs and statements. Direct verbal cues, such as “I wish I were dead” or “I can’t go on,” should be taken seriously. Indirect cues, like talking about feeling trapped, being a burden, or expressing a lack of interest or hope for the future, also warrant attention.
Behavioral changes signal a heightened risk. These may include increased isolation, giving away cherished possessions, or making arrangements for dependents. A sudden calmness or apparent improvement after deep depression can be a concerning sign, indicating a decision about self-harm.
Other indicators include increased substance use, engaging in reckless activities, or a decline in personal hygiene. Mood changes, beyond typical bipolar shifts, include severe agitation, extreme despair, or increased irritability. A cluster of these symptoms often points to concern, even if individual signs seem minor.
Responding to a Suicidal Crisis
When someone suspects a person with bipolar disorder is suicidal, immediate steps are necessary. Take all threats and expressions of suicidal ideation seriously. Directly ask about suicidal intent in a non-judgmental way, such as “Are you thinking about suicide?” or “Are you having thoughts of harming yourself?”. Openly discussing suicide does not plant the idea but rather opens a path for communication.
Connect the individual with immediate resources. In the United States, the 988 Suicide & Crisis Lifeline offers 24-hour, confidential support by phone, text, or chat. Emergency services (911) are also available for life-threatening situations. Stay with the person until professional help arrives.
Remove means of self-harm, such as weapons, medications, or other dangerous objects. While waiting for professional help, offer realistic hope by emphasizing that treatment is available and effective, and that mood episodes are temporary. Listen actively and empathetically, without judgment.
Ongoing Prevention and Support
Long-term strategies manage bipolar disorder and reduce suicide risk. Consistent professional treatment, typically involving both medication and psychotherapy, is central to this approach. Mood stabilizers, like lithium, are frequently prescribed and reduce suicide risk. Antipsychotics and, in some cases, antidepressants (used with careful supervision to avoid triggering manic episodes) may also be part of a medication regimen.
Psychotherapy, including cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT), helps individuals develop coping skills, manage symptoms, and address underlying issues. Family-focused therapy can also be beneficial, helping family members understand the condition and provide appropriate support. These therapies equip individuals with strategies to navigate mood swings and reduce distress that can lead to suicidal thoughts.
A strong support system, encompassing family, friends, and support groups, is important for ongoing prevention. These networks provide emotional support, encouragement, and a sense of belonging, which can counteract feelings of isolation and hopelessness. Lifestyle factors contribute to stable well-being, including a regular sleep schedule, stress management, and avoiding substance abuse.
Proactive measures like developing a safety plan with a healthcare provider, outlining steps to take during a crisis, help individuals manage their condition effectively.