Skip to main content

Advertisement

Log in

Bipolar disorder and suicide: Research synthesis and clinical translation

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Attempted suicide and suicide are prevalent in individuals with bipolar disorder (BD). Extant evidence indicates that history of suicide attempts, percentage of time spent in a depressed state, and hostility are factors associated with suicide attempts and completed suicide. Childhood adversity (eg, sexual and physical abuse) is emerging as a risk factor for suicide attempts in adults with BD. The pertinacity of medical comorbidity (eg, obesity, metabolic syndrome) in the bipolar population is further underscored by its preliminary association with suicidality. Biomarkers such as cerebrospinal fluid monoamine metabolite levels may be predictive of suicide attempts and lethality in BD. Compelling evidence supports an antisuicide effect of long-term lithium prophylaxis; lithium’s salutary effect is mediated primarily by reduced lethality of suicidal acts. Conventional unimodal antidepressants may engender or exacerbate suicidality in susceptible individuals with BD. A nascent database suggests that adjunctive psychosocial interventions may further reduce suicide risk in bipolar individuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. McIntyre RS, Konarski JZ: Bipolar disorder: a national health concern. CNS Spectr 2004, 9(Suppl 12):6–15.

    PubMed  Google Scholar 

  2. Tsai SY, Lee CH, Kuo CJ, et al.: A retrospective analysis of risk and protective factors for natural death in bipolar disorder. J Clin Psychiatry 2005, 66:1586–1591.

    Article  PubMed  Google Scholar 

  3. Osby U, Brandt L, Correia N, et al.: Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry 2001, 58:844–850.

    Article  PubMed  CAS  Google Scholar 

  4. Leverich GS, Altshuler LL, Frye MA, et al.: Factors associated with suicide attempts in 648 patients with bipolar disorder in the Stanley Foundation Bipolar Network. J Clin Psychiatry 2003, 64:506–515.

    Article  PubMed  Google Scholar 

  5. Yatham LN, Kennedy SH, O’Donovan C, et al.: Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: consensus and controversies. Bipolar Disord 2005, 7(Suppl 3):5–69.

    Article  PubMed  Google Scholar 

  6. McElroy SL, Kotwal R, Kaneria R, et al.: Antidepressants and suicidal behavior in bipolar disorder. Bipolar Disord 2006, 8:596–617.

    Article  PubMed  CAS  Google Scholar 

  7. Harris EC, Barraclough B: Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry 1997, 170:205–228.

    PubMed  CAS  Google Scholar 

  8. Harris EC, Barraclough B: Excess mortality of mental disorder. Br J Psychiatry 1998, 173:11–53.

    Article  PubMed  CAS  Google Scholar 

  9. Angst F, Stassen HH, Clayton PJ, et al.: Mortality of patients with mood disorders: follow-up over 34–38 years. J Affect Disord 2002, 68:167–181.

    Article  PubMed  CAS  Google Scholar 

  10. Rihmer Z, Kiss K: Bipolar disorders and suicidal behaviour. Bipolar Disord 2002, 4(Suppl 1):21–25.

    Article  PubMed  Google Scholar 

  11. Rihmer Z, Barsi J, Arato M, et al.: Suicide in subtypes of primary major depression. J Affect Disord 1990, 18:221–225.

    Article  PubMed  CAS  Google Scholar 

  12. Tondo L, Baldessarini RJ, Hennen J, et al.: Suicide attempts in major affective disorder patients with comorbid substance use disorders. J Clin Psychiatry 1999, 60(Suppl 2):63–69.

    PubMed  Google Scholar 

  13. MacQueen GM, Young LT: Bipolar II disorder: symptoms, course, and response to treatment. Psychiatr Serv 2001, 52:358–361.

    Article  PubMed  CAS  Google Scholar 

  14. Wyatt RJ, Henter I: An economic evaluation of manicdepressive illness-1991. Soc Psychiatry Psychiatr Epidemiol 1995, 30:213–219.

    PubMed  CAS  Google Scholar 

  15. Lopez P, Mosquera F, de Leon J, et al.: Suicide attempts in bipolar patients. J Clin Psychiatry 2001, 62:963–966.

    Article  PubMed  CAS  Google Scholar 

  16. Muzina DJ: What physicians can do to prevent suicide. Cleve Clin J Med 2004, 71:242–250.

    PubMed  Google Scholar 

  17. Marangell LB, Bauer MS, Dennehy EB, et al.: Prospective predictors of suicide and suicide attempts in 1,556 patients with bipolar disorders followed for up to 2 years. Bipolar Disord 2006, 8:566–575.

    Article  PubMed  Google Scholar 

  18. Tsai SY, Lee JC, Chen CC: Characteristics and psychosocial problems of patients with bipolar disorder at high risk for suicide attempt. J Affect Disord 1999, 52:145–152.

    Article  PubMed  CAS  Google Scholar 

  19. Fagiolini A, Frank E, Scott JA, et al.: Metabolic syndrome in bipolar disorder: findings from the Bipolar Disorder Center for Pennsylvanians. Bipolar Disord 2005, 7:424–430.

    Article  PubMed  Google Scholar 

  20. Judd LL, Schettler PJ, Akiskal HS, et al.: Long-term symptomatic status of bipolar I vs. bipolar II disorders. Int J Neuropsychopharmacol 2003, 6:127–137.

    Article  PubMed  Google Scholar 

  21. Valtonen HM, Suominen K, Mantere O, et al.: Prospective study of risk factors for attempted suicide among patients with bipolar disorder. Bipolar Disord 2006, 8:576–585.

    Article  PubMed  Google Scholar 

  22. Grunebaum MF, Ramsay SR, Galfalvy HC, et al.: Correlates of suicide attempt history in bipolar disorder: a stress-diathesis perspective. Bipolar Disord 2006, 8:551–557.

    Article  PubMed  Google Scholar 

  23. McElroy SL, Strakowski SM, Keck PE, Jr, et al.: Differences and similarities in mixed and pure mania. Compr Psychiatry 1995, 36:187–194.

    Article  PubMed  CAS  Google Scholar 

  24. MacKinnon DF, Potash JB, McMahon FJ, et al.: Rapid mood switching and suicidality in familial bipolar disorder. Bipolar Disord 2005, 7:441–448.

    Article  PubMed  Google Scholar 

  25. Simon NM, Zalta AK, Otto MW, et al.: The association of comorbid anxiety disorders with suicide attempts and suicidal ideation in outpatients with bipolar disorder. J Psychiatr Res 2007, 41:255–264.

    Article  PubMed  Google Scholar 

  26. Galfalvy H, Oquendo MA, Carballo JJ, et al.: Clinical predictors of suicidal acts after major depression in bipolar disorder: a prospective study. Bipolar Disord 2006, 8:586–595.

    Article  PubMed  Google Scholar 

  27. Allen MH, Chessick CA, Miklowitz DJ, et al.: Contributors to suicidal ideation among bipolar patients with and without a history of suicide attempts. Suicide Life Threat Behav 2005, 35:671–680.

    Article  PubMed  Google Scholar 

  28. Meaney MJ, Diorio J, Francis D, et al.: Early environmental regulation of forebrain glucocorticoid receptor gene expression: implications for adrenocortical responses to stress. Dev Neurosci 1996, 18:49–72.

    Article  PubMed  CAS  Google Scholar 

  29. Meaney MJ, Szyf M: Environmental programming of stress responses through DNA methylation: life at the interface between a dynamic environment and a fixed genome. Dialogues Clin Neurosci 2005, 7:103–123.

    PubMed  Google Scholar 

  30. Leverich GS, McElroy SL, Suppes T, et al.: Early physical and sexual abuse associated with an adverse course of bipolar illness. Biol Psychiatry 2002, 51:288–297.

    Article  PubMed  Google Scholar 

  31. Neria Y, Bromet EJ, Carlson GA, Naz B: Assaultive trauma and illness course in psychotic bipolar disorder: findings from the Suffolk county mental health project. Acta Psychiatr Scand 2005, 111:380–383.

    Article  PubMed  CAS  Google Scholar 

  32. Goldberg JF, Garno JL: Development of posttraumatic stress disorder in adult bipolar patients with histories of severe childhood abuse. J Psychiatr Res 2005, 39:595–601.

    Article  PubMed  Google Scholar 

  33. Brown GR, McBride L, Bauer MS, et al.: Impact of childhood abuse on the course of bipolar disorder: a replication study in U.S. veterans. J Affect Disord 2005, 89:57–67.

    Article  PubMed  Google Scholar 

  34. Coverdale JH, Turbott SH: Sexual and physical abuse of chronically ill psychiatric outpatients compared with a matched sample of medical outpatients. J Nerv Ment Dis 2000, 188:440–445.

    Article  PubMed  CAS  Google Scholar 

  35. McIntyre RS, Soczynska JK, Beyer JL, et al.: Medical comorbidity in bipolar disorder: re-prioritizing unmet needs. Curr Opin Psychiatry 2007, 20:406–416.

    Article  PubMed  Google Scholar 

  36. Turecki G: Suicidal behavior: is there a genetic predisposition? Bipolar Disord 2001, 3:335–349.

    Article  PubMed  CAS  Google Scholar 

  37. Miklowitz DJ, Taylor DO: Family-focused treatment of the suicidal bipolar patient. Bipolar Disord 2006, 8:640–651.

    Article  PubMed  Google Scholar 

  38. Sher L, Carballo JJ, Grunebaum MF, et al.: A prospective study of the association of cerebrospinal fluid monoamine metabolite levels with lethality of suicide attempts in patients with bipolar disorder. Bipolar Disord 2006, 8:543–550.

    Article  PubMed  CAS  Google Scholar 

  39. Lopez VA, Detera-Wadleigh S, Cardona I, et al.: Nested association between genetic variation in tryptophan hydroxylase II, bipolar affective disorder, and suicide attempts. Biol Psychiatry 2007, 61:181–186.

    Article  PubMed  CAS  Google Scholar 

  40. Sachs GS, Nierenberg AA, Calabrese JR, et al.: Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med 2007, 356:1711–1722.

    Article  PubMed  CAS  Google Scholar 

  41. Baldessarini RJ, Leahy L, Arcona S, et al.: Patterns of psychotropic drug prescription for U.S. patients with diagnoses of bipolar disorders. Psychiatr Serv 2007, 58:85–91.

    Article  PubMed  Google Scholar 

  42. McElroy SL, Kotwal R, Kaneria R, et al.: Antidepressants and suicidal behavior in bipolar disorder. Bipolar Disord 2006, 8:596–617.

    Article  PubMed  CAS  Google Scholar 

  43. Gelenberg AJ: Can lithium help to prevent suicide? Acta Psychiatr Scand 2001, 104:161–162.

    Article  PubMed  CAS  Google Scholar 

  44. Schou M: Suicidal behavior and prophylactic lithium treatment of major mood disorders: a review of reviews. Suicide Life Threat Behav 2000, 30:289–293.

    PubMed  CAS  Google Scholar 

  45. Burgess S, Geddes J, Hawton K, et al.: Lithium for maintenance treatment of mood disorders. Cochrane Database Syst Rev 2001, 2:CD003013.

    PubMed  Google Scholar 

  46. Baldessarini RJ, Tondo L, Davis P, et al.: Decreased risk of suicides and attempts during long-term lithium treatment: a meta-analytic review. Bipolar Disord 2006, 8:625–639.

    Article  PubMed  CAS  Google Scholar 

  47. Cipriani A, Pretty H, Hawton K, et al.: Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic review of randomized trials. Am J Psychiatry 2005, 162:1805–1819.

    Article  PubMed  Google Scholar 

  48. Coryell W, Arndt S, Turvey C, et al.: Lithium and suicidal behavior in major affective disorder: a case-control study. Acta Psychiatr Scand 2001, 104:193–197.

    Article  PubMed  CAS  Google Scholar 

  49. Baldessarini RJ, Tondo L, Hennen J: Effects of lithium treatment and its discontinuation on suicidal behavior in bipolar manic-depressive disorders. J Clin Psychiatry 1999, 60(Suppl 2):77–84.

    PubMed  CAS  Google Scholar 

  50. Miklowitz DJ, Otto MW, Frank E, et al.: Psychosocial treatments for bipolar depression: a 1-year randomized trial from the systematic treatment enhancement program. Arch Gen Psychiatry 2007, 64:419–426.

    Article  PubMed  Google Scholar 

  51. Rucci P, Frank E, Kostelnik B, et al.: Suicide attempts in patients with bipolar I disorder during acute and maintenance phases of intensive treatment with pharmacotherapy and adjunctive psychotherapy. Am J Psychiatry 2002, 159:1160–1164.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Roger S. McIntyre.

Rights and permissions

Reprints and permissions

About this article

Cite this article

McIntyre, R.S., Muzina, D.J., Kemp, D.E. et al. Bipolar disorder and suicide: Research synthesis and clinical translation. Curr Psychiatry Rep 10, 66–72 (2008). https://doi.org/10.1007/s11920-008-0012-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-008-0012-7

Keywords

Navigation