Bipolar disorder carries one of the highest suicide risks among mental illnesses, says Professor Dr. Tania Gergel from UCL Psychiatry. In a recent article, she explores why suicide is so common in people with this condition and what can be done to reduce it.
Bipolar disorder affects about 2% of the population. It causes mood swings between mania—periods of high energy and impulsiveness—and depression, marked by deep sadness and fatigue.
Around half of those with bipolar disorder attempt suicide, and 15-20% die by suicide, far higher than in the general population. Unlike overall global suicide rates, suicide deaths in bipolar disorder have not decreased.
One main reason for the high risk is mood instability. Quick shifts between mania and depression, or mixed states where both happen together, can be especially dangerous. Social and economic issues add to the risk.
Research from Swansea University shows people with bipolar disorder have become poorer over the last 20 years. Financial struggles, social isolation, and poor healthcare access lead to worse outcomes, including earlier death from preventable illnesses like heart disease.
While bipolar disorder cannot be cured, it can be managed. Lithium, the most common drug used, can significantly reduce suicide risk. However, many patients struggle to take it regularly because of side effects affecting kidneys, thyroid, metabolism, and more. These require constant monitoring, which makes long-term use difficult. Patients sometimes stop medication during manic phases, thinking they are cured.
Other treatments, such as antipsychotics and electroconvulsive therapy, can help in certain cases but come with their own risks. Some doctors question whether lifelong treatment is needed for all patients.
Healthcare systems also face challenges. Suicide risk is highest shortly after discharge from psychiatric hospitals. Many who die by suicide recently visited emergency rooms, but care was delayed or insufficient. Current tools to assess suicide risk, like checklists and interviews, often miss people at danger because they focus too much on past events rather than current distress.
New drug development for bipolar disorder has been slow. Lithium, used since the 1940s, remains the main treatment. The disorder is complex and varies widely among patients, making drug trials difficult. Ethical concerns and strict approval rules slow progress further. However, new research using artificial intelligence aims to speed up drug discovery and personalize treatments.
Heston Blumenthal, the celebrity chef, recently shared how being hospitalized under the UK’s Mental Health Act saved his life. Yet stigma around psychiatric hospital stays stops many from seeking help. Experts say hospitalization can be lifesaving, but it’s not enough on its own. Better long-term care, especially after hospital discharge, improved risk assessment, and easier access to treatment are vital.
Though suicide rates in bipolar disorder remain alarming, the outlook can improve. The condition is treatable, and suicide is preventable if care access improves, stigma reduces, and research advances.
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