CNS Drugs

, Volume 17, Issue 7, pp 491–511

Suicidal Behaviour in Bipolar Disorder

Risk and Prevention
  • Leonardo Tondo
  • Göran Isacsson
  • Ross J. Baldessarini
Therapy in Practice

DOI: 10.2165/00023210-200317070-00003

Cite this article as:
Tondo, L., Isacsson, G. & Baldessarini, R.J. CNS Drugs (2003) 17: 491. doi:10.2165/00023210-200317070-00003


Bipolar (manic-depressive) disorder is a common and severe illness. It is also potentially fatal as a result of accidents and increased mortality associated with comorbid substance use and medical illnesses, but its highest lethality results from suicide. Suicide rates, averaging 0.4% per year in men and women diagnosed with bipolar disorder, are >20-fold higher than in the general population. Suicidal acts often occur early in the illness course and in association with severe depressive and dysphoric-agitated mixed phases of illness, especially following repeated, severe depressions.

Systematic consideration of risk and protective factors enhances assessment of potentially suicidal patients. Short-term interventions employed empirically to manage acute suicidality include close clinical supervision, rapid hospitalisation and use of electroconvulsive treatment. Several plausible therapeutic interventions have limited evidence of long-term effectiveness against mortality risks associated with any psychiatric disorder, including antidepressant, antimanic, antipsychotic and electroconvulsive, as well as psychosocial, treatments. However, in bipolar disorder and other major affective disorders, lithium maintenance treatment is a notable exception, with strong and consistent evidence that it reduces suicidal risk.

The growing range of drugs being introduced to treat acute and long-term phases of bipolar disorder, including antiepileptic drugs, atypical antipsychotics and relatively safe, modern antidepressants, require research assessment for their ability to limit premature mortality from suicide and other causes. For now, however, more can be done to improve treatment in major affective illnesses by application of current knowledge in a systematic fashion, with close and sustained clinical follow-up of patients at risk, hopefully with a resulting reduction of mortality rates.

Copyright information

© Adis Data Information BV 2003

Authors and Affiliations

  • Leonardo Tondo
    • 1
    • 2
  • Göran Isacsson
    • 3
  • Ross J. Baldessarini
    • 2
  1. 1.Department of PsychologyUniversity of Cagliari, Centro Lucio Bini-Stanley Medical Research Institute Research CenterCagliariItaly
  2. 2.Bipolar & Psychotic Disorders Program, Department of PsychiatryHarvard Medical School and the International Consortium for Bipolar Disorder Research, McLean Division of Massachusetts General HospitalBelmontUSA
  3. 3.Division of Psychiatry, Neurotec Institution, Karolinska InstituteHuddinge University HospitalStockholmSweden
  4. 4.Bipolar Disorder Research Unit, North Belknap IIIMcLean HospitalBelmontUSA