Suicide and Bipolar – How to manage the risks

Suicide is the most prevalent cause of death worldwide. It is on the extreme point of the suicidal spectrum of suicidal thoughts and behaviours. This spectrum ranges from risk-taking personality to different degrees of suicidal acts and even complete suicide. It has been long debated upon that suicide is a sudden act of vulnerability, but on a deeper level of analysis, it is long-considered ideation based upon hopelessness and collective unfortunate circumstances.

For some, it is a combination of both, a momentary action and a thought-through decision. Each person who has attempted suicide or has been thinking about suicide goes through different suffering. Their families and friends, people around them too has to deal with these emotions and ideas. For those families and friends who have lost someone through the act of suicide, it is an unimaginable loss with excruciating guilt and devastation.

Suicide is triggered by many vulnerabilities that a person has. Serious mental illnesses can have suicide as their common fatal end. Of these many illnesses, few are powerful and can make a person move towards self-harm and self-infliction. These illnesses are affective disorders (depression, bipolar disorders), schizophrenia, personality disorders such as borderline and antisocial personality disorder, substance abuse.

In the case of bipolar disorders, the suicidal risk prevalence has increased to 15% in recent decades. It is difficult to address and understand the epidemiology of suicidal behaviours with such mental illnesses. The lifetime prevalence of suicidal acts in mood disorders ranges from 6% to somewhat higher numbers in cases of manic disorder. Suicide cases usually occur when the person is in a depressive episode, after a frequent episode of elevated mood.

According to Latalova et. al. (2014), there are many factors associated with the frequent incidence of suicidal acts and bipolar disorders. They can be classified as Distal and Proximal factors:

  1. Distal factors such as the family history of suicides and suicidal behaviours, hereditary factors, personality traits such as hostility, reservedness; thinking styles (narrow thinking, pessimism), abusive and violent environment, childhood traumatic events. It has been reported that the first blood relations and childhood negative experiences develop the suicidal tendency in the young adults by 12% than those who have had recent life events as an epidemiological factor.

  2. Proximal factors such as recent life events, psychopathology, acquired traits such as hopelessness, learned helplessness etc. can affect the suicidal behaviour in bipolar patients. Recent life events may include divorce, family disputes, substance abuse, unemployment, lack of social life.

But in recent years, there have been better interventions that are customized for each individual with bipolar disorder. Majorly two therapeutic interventions can be helpful in recovery from this illness – pharmacological and psychotherapy interventions.

  • Lithium and anticonvulsants have been some of the most effective drugs used for the treatment of bipolar disorders and suicidal behaviours. Lithium had promising reviews with the findings pointing out the decrease in suicidal rates, even when there is a presence of genetic risk factor. On the other hand, anticonvulsants are not supported by significant literature.

  • Psychotherapeutic interventions such as Cognitive Behaviour therapy, family-focused therapy, interpersonal and social rhythm therapy and other adjunct psychotherapies are rooted in efficacy for the treatment of bipolar disorders in a combination of pharmacotherapy. Also, for severe cases, randomized controlled trials are being supported by relevant journals.

  • Prevention of suicidal acts and frequent episodes of major depression can be done through family psychoeducation, group therapies and support groups of specific cases.

Addcounsel and Orchestrate Health have all the proven effective techniques with the assistance of expert professionals, catering to your individualized needs and problems. Dealing with bipolar disorders with major depressive episodes can be a huge toll on the client and their family. At Addcounsel, you will have your private medical care with world-class facilities so that your recovery is quick, making you a better person in life.


  1. Latalova K, Kamaradova D, Prasko J. Suicide in bipolar disorder: a review. Psychiatr Danub. 2014 Jun;26(2):108-14. PMID: 24909246.

  2. Malhi GS, Outhred T, Das P, Morris G, Hamilton A, Mannie Z. Modeling suicide in bipolar disorders. Bipolar Disorders, 20(4):334-348, 2018.


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