Bipolar Disorder and Suicide: Signs of Danger

bipolar disorder spelled out in alphabet blocks

Medically reviewed in January 2021

Bipolar disorder is a mental condition widely known for its dramatic mood swings. But, unlike other disorders, patients suffering from bipolar disorder can be especially prone to thoughts of suicide – even to the point of acting on them. In fact, people with bipolar disorder have about a one in five chance of completing suicide, and their risk for suicide is more than 20 times that of the general population. 

What Is Bipolar Disorder?

Previously known as Manic-Depressive Illness, bipolar disorder is a biochemical brain disorder which causes unusually intense emotional states that occur in distinct periods called “mood episodes,” according to Muffy Walker, president and CEO of the International Bipolar Foundation. “These episodes can include ‘manic states’ which include feelings of being overly joyful or excited, to ‘depressed states’ of feeling extremely sad or hopeless,” says Walker.  “Sometimes, symptoms include both mania and depression -- resulting in a mixed state.”

How Is Bipolar Disorder Treated?

Treatment typically includes medication and talk therapy. However, many of the medications have side effects that those with bipolar disorder find intolerable. “Patients may prefer not to take their meds and to ‘risk’ an episode,” says Walker. “In other cases, some patients like the ‘manic’ high energy they feel. Medications can also be very expensive and therefore unaffordable.”

But medications can’t do all the work: Social support for the patient and family, good nutrition, good sleep hygiene, exercise and abstinence from drugs and alcohol round out the treatment approach.

3 Common Suicide Risk Factors

While there is no perfect formula that can predict who will make a suicide attempt, Walker notes that the top three include:

  1. A mother, father, sister, or brother who has committed suicide.
  2. Substance abuse. “A majority of suicide victims have drugs or alcohol in their system at the time,” notes Walker.
  3. Inadequate mood stabilization and the presence of mixed mental states – euphoria and depression. “We need to stay away from medicines like antidepressants and steroids that are known to induce mixed states,” says Walker.

Suicide Warning Signs

Unfortunately, the signs aren’t always clear. “We see people in the ER that are at the end of their rope,” says, Darria Long Gillespie, MD, an emergency room doctor and Chief Doctor at Sharecare. “But it can be challenging to know when that point is. Often people who feel this way are good at hiding their true feelings, even from those closest to them.”

Sometimes the decision to take one’s life is sudden, and there’s no way of seeing it coming. Walker says these behaviors could suggest a suicide attempt is imminent: 

  • Talk of suicide or death, or just references to death.
  • “Putting their affairs in order” by giving things away or updating a will.
  • Acquiring information online about suicide or researching materials to help one commit suicide.
  • Rehearsal, in the form of visiting the place one plans to commit suicide, tying a rope, or dry firing a gun.

“Of the people that we see in the ER, often it's a friend or family member that notices the signs or ‘mini calls for help,’” says Dr. Gillespie. “We're seeing extremely high numbers of suicidal patients in the ER because they and their family literally have nowhere else to turn. Many people who need help have significant trouble finding the care that they need, especially if their insurance doesn’t cover all psychiatric care.”

Suicide Prevention

What can one do to minimize the likelihood that a loved one with bipolar disorder will commit suicide? Basics include securing firearms, treating or preventing substance abuse, helping the person to build a support group, and being vigilant with those who have lost a close relative to suicide.

As another precautionary step, 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:

  1. Name and numbers of a psychiatrist and therapist to call.
  2. Phone numbers for suicide hotlines in your area.
  3. A reminder that calling 911 is a safe thing to do if one is feeling suicidal and is having trouble accessing the psychiatrist or therapist.
  4. Name and directions of the chosen hospital or emergency room.
  5. Insurance information if you need to go to the emergency room.
  6. Written list of all medications.
  7. For bipolar patients, a list of “reasons to live” and “why suicide thoughts are distorted,” to reference when thinking of suicide. 

Still, “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, 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.”

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