Skip to main content
SpringerLink
Log in

Bipolar Disorder and Suicide: a Review

  • Bipolar Disorders (R Hirschfeld, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Bipolar disorder has the highest rate of suicide of all psychiatric conditions and is approximately 20–30 times that of the general population. The purpose of this review is to discuss findings relevant to bipolar disorder and suicide.

Recent Findings

Risk factors include male gender, living alone, divorced, no children, Caucasian, younger age (< 35 years), elderly age (> 75 years), unemployment, and a personal history of suicide attempt and family history of suicide attempt or suicide completion, as well as predominant depressive polarity. Suicide is associated with the depressed or mixed subtypes, not mania. Although there are emerging treatments for bipolar depression, such as ketamine and TMS, lithium remains the only medication associated with lowered suicide rates in bipolar disorder.

Summary

Understanding clinical and demographic risk factors for suicide in bipolar disorder remains the best way to prevent suicidal behavior. Early intervention and treatment with anti-suicidal medications, such as lithium, along with close observation and follow-up is the best way to mitigate suicide in patients with bipolar disorder.

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

Access this article

Log in via an institution

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

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Grande I, Berk M, Birmaher B, Vieta E. Bipolar disorder. Lancet. 2016;387:1561–72. This is a comprehensive review of bipolar disorder and emphasizes the importance of accurate diagnosis.

    Google Scholar 

  2. American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub

  3. Alonso J, Petukhova M, Vilagut G, Chatterji S, Heeringa S, Üstün TB, et al. Days out of role due to common physical and mental conditions: results from the WHO World Mental Health surveys. Mol Psychiatry. 2011;16:1234–46.

    CAS  PubMed  Google Scholar 

  4. Merikangas KR, Akiskal HS, Angst J, Greenberg PE, Hirschfeld RMA, Petukhova M, et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Arch Gen Psychiatry. 2007;64:543–52.

    PubMed  PubMed Central  Google Scholar 

  5. Baldessarini RJ, Undurraga J, Vázquez GH, Tondo L, Salvatore P, Ha K, et al. Predominant recurrence polarity among 928 adult international bipolar I disorder patients. Acta Psychiatr Scand. 2012;125:293–302.

    CAS  PubMed  Google Scholar 

  6. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:617–27.

    PubMed  PubMed Central  Google Scholar 

  7. Grande I, Goikolea JM, de Dios C, González-Pinto A, Montes JM, Saiz-Ruiz J, et al. Occupational disability in bipolar disorder: analysis of predictors of being on severe disablement benefit (PREBIS study data). Acta Psychiatr Scand. 2013;127:403–11.

    CAS  PubMed  Google Scholar 

  8. Martinez-Aran A, Vieta E, Torrent C, Sanchez-Moreno J, Goikolea JM, Salamero M, et al. Functional outcome in bipolar disorder: the role of clinical and cognitive factors. Bipolar Disord. 2007;9:103–13.

    CAS  PubMed  Google Scholar 

  9. Ketter TA. Diagnostic features, prevalence, and impact of bipolar disorder. J Clin Psychiatry. 2010;71:e14.

    PubMed  Google Scholar 

  10. • da Costa LS, Alencar ÁP, PJN N, et al. Risk factors for suicide in bipolar disorder: a systematic review. J Affect Disord. 2015;170:237–54. A useful review of risk factors for suicide in bipolar disorder.

    Google Scholar 

  11. de Abreu LN, Nery FG, Harkavy-Friedman JM, de Almeida KM, Gomes BC, Oquendo MA, et al. Suicide attempts are associated with worse quality of life in patients with bipolar disorder type I. Compr Psychiatry. 2012;53:125–9.

    PubMed  Google Scholar 

  12. Michalak EE, Yatham LN, Kolesar S, Lam RW. Bipolar disorder and quality of life: a patient-centered perspective. Qual Life Res. 2006;15:25–37.

    PubMed  Google Scholar 

  13. Michalak EE, Yatham LN, Lam RW. Quality of life in bipolar disorder: a review of the literature. Health Qual Life Outcomes. 2005;3:72.

    PubMed  PubMed Central  Google Scholar 

  14. WHO, World Health Organization (1993) The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. World Health Organization

  15. Berk M, Dodd S, Callaly P, Berk L, Fitzgerald P, de Castella AR, et al. History of illness prior to a diagnosis of bipolar disorder or schizoaffective disorder. J Affect Disord. 2007;103:181–6.

    CAS  PubMed  Google Scholar 

  16. Goldberg JF, Harrow M, Whiteside JE. Risk for bipolar illness in patients initially hospitalized for unipolar depression. Am J Psychiatry. 2001;158:1265–70.

    CAS  PubMed  Google Scholar 

  17. (2018) WHO mortality database. In: World Health Organization. https://www.who.int/news-room/fact-sheets/detail/suicide. Accessed 20 Sept 2019

  18. Pompili M, Gonda X, Serafini G, Innamorati M, Sher L, Amore M, et al. Epidemiology of suicide in bipolar disorders: a systematic review of the literature. Bipolar Disord. 2013;15:457–90.

    PubMed  Google Scholar 

  19. Blasco-Fontecilla H, Artieda-Urrutia P, de Leon J. A proposal for using the ratio of attempted to completed suicides across several countries worldwide. Epidemiol Psychiatr Sci. 2019;28:473–7.

    CAS  PubMed  Google Scholar 

  20. Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A, et al. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry. 2008;192:98–105.

    PubMed  PubMed Central  Google Scholar 

  21. Dong M, Zeng L-N, Lu L, Li X-H, Ungvari GS, Ng CH, et al. Prevalence of suicide attempt in individuals with major depressive disorder: a meta-analysis of observational surveys. Psychol Med. 2019;49:1691–704.

    PubMed  Google Scholar 

  22. Baldessarini RJ, Tondo L, Pinna M, Nuñez N, Vázquez GH. Suicidal risk factors in major affective disorders. Br J Psychiatry. 2019:1–6.

  23. Dong M, Lu L, Zhang L, Zhang Q, Ungvari GS, Ng CH, et al. Prevalence of suicide attempts in bipolar disorder: a systematic review and meta-analysis of observational studies. Epidemiol Psychiatr Sci. 2019;29:e63 1–9.

    PubMed  Google Scholar 

  24. Gonda X, Pompili M, Serafini G, Montebovi F, Campi S, Dome P, et al. Suicidal behavior in bipolar disorder: epidemiology, characteristics and major risk factors. J Affect Disord. 2012;143:16–26.

    PubMed  Google Scholar 

  25. Sadock BJ, Sadock VA, Ruiz P (2015) Kaplan & Sadock’s synopsis of psychiatry, 11th ed. Wolters Kluwer.

  26. Plans L, Barrot C, Nieto E, Rios J, Schulze TG, Papiol S, et al. Association between completed suicide and bipolar disorder: a systematic review of the literature. J Affect Disord. 2019;242:111–22.

    CAS  PubMed  Google Scholar 

  27. Osby U, Brandt L, Correia N, Ekbom A, Sparén P. Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry. 2001;58:844–50.

    CAS  PubMed  Google Scholar 

  28. McIntyre RS, Muzina DJ, Kemp DE, Blank D, Woldeyohannes HO, Lofchy J, et al. Bipolar disorder and suicide: research synthesis and clinical translation. Curr Psychiatry Rep. 2008;10:66–72.

    PubMed  Google Scholar 

  29. Takizawa T. Suicide due to mental diseases based on the vital statistics survey death form. Nihon Koshu Eisei Zasshi. 2012;59:399–406.

    PubMed  Google Scholar 

  30. Høyer EH, Mortensen PB, Olesen AV. Mortality and causes of death in a total national sample of patients with affective disorders admitted for the first time between 1973 and 1993. Br J Psychiatry. 2000;176:76–82.

    PubMed  Google Scholar 

  31. Sani G, Tondo L, Koukopoulos A, Reginaldi D, Kotzalidis GD, Koukopoulos AE, et al. Suicide in a large population of former psychiatric inpatients. Psychiatry Clin Neurosci. 2011;65:286–95.

    PubMed  Google Scholar 

  32. Osborn D, Levy G, Nazareth I, King M. Suicide and severe mental illnesses. Cohort study within the UK general practice research database. Schizophr Res. 2008;99:134–8.

    PubMed  Google Scholar 

  33. Goldstein TR, Ha W, Axelson DA, Goldstein BI, Liao F, Gill MK, et al. Predictors of prospectively examined suicide attempts among youth with bipolar disorder. Arch Gen Psychiatry. 2012;69:1113–22.

    PubMed  PubMed Central  Google Scholar 

  34. Tondo L, Isacsson G, Baldessarini R. Suicidal behaviour in bipolar disorder: risk and prevention. CNS Drugs. 2003;17:491–511.

    CAS  PubMed  Google Scholar 

  35. Baldessarini RJ, Pompili M, Tondo L. Suicide in bipolar disorder: risks and management. CNS Spectr. 2006;11:465–71.

    PubMed  Google Scholar 

  36. Altamura AC, Dell’Osso B, Berlin HA, Buoli M, Bassetti R, Mundo E. Duration of untreated illness and suicide in bipolar disorder: a naturalistic study. Eur Arch Psychiatry Clin Neurosci. 2010;260:385–91.

    PubMed  Google Scholar 

  37. Daban C, Colom F, Sanchez-Moreno J, García-Amador M, Vieta E. Clinical correlates of first-episode polarity in bipolar disorder. Compr Psychiatry. 2006;47:433–7.

    PubMed  Google Scholar 

  38. •• Pallaskorpi S, Suominen K, Rosenström T, et al. Predominant polarity in bipolar I and II disorders: a five-year follow-up study. J Affect Disord. 2019;246:806–13. This 5-year follow up study concluded that predominant polarity has predictive value for illness course, including suicidal behavior.

    PubMed  Google Scholar 

  39. Colom F, Vieta E, Daban C, Pacchiarotti I, Sánchez-Moreno J. Clinical and therapeutic implications of predominant polarity in bipolar disorder. J Affect Disord. 2006;93:13–7.

    CAS  PubMed  Google Scholar 

  40. Angst J, Felder W, Frey R, Stassen HH. The course of affective disorders. Archiv für Psychiatrie und Nervenkrankheiten Vereinigt mit Zeitschrift für die Gesamte Neurologie und Psychiatrie. 1978;226:57–64.

    CAS  Google Scholar 

  41. Carvalho AF, Quevedo J, McIntyre RS, Soeiro-de-Souza MG, Fountoulakis KN, Berk M, et al. Treatment implications of predominant polarity and the polarity index: a comprehensive review. Int J Neuropsychopharmacol. 2014. https://doi.org/10.1093/ijnp/pyu079.

    PubMed  Google Scholar 

  42. Chaudhury SR, Grunebaum MF, Galfalvy HC, Burke AK, Sher L, Parsey RV, et al. Does first episode polarity predict risk for suicide attempt in bipolar disorder? J Affect Disord. 2007;104:245–50.

    PubMed  PubMed Central  Google Scholar 

  43. Belizario GO, Silva M, Lafer B. Impact of predominant polarity on long-term outcome in bipolar disorder: a 7-year longitudinal cohort study. J Affect Disord. 2018;241:37–40.

    PubMed  Google Scholar 

  44. Tondo L, Lepri B, Baldessarini RJ. Suicidal risks among 2826 Sardinian major affective disorder patients. Acta Psychiatr Scand. 2007;116:419–28.

    CAS  PubMed  Google Scholar 

  45. Novick DM, Swartz HA, Frank E. Suicide attempts in bipolar I and bipolar II disorder: a review and meta-analysis of the evidence. Bipolar Disord. 2010;12:1–9.

    PubMed  PubMed Central  Google Scholar 

  46. Dennehy EB, Marangell LB, Allen MH, Chessick C, Wisniewski SR, Thase ME. Suicide and suicide attempts in the systematic treatment enhancement program for bipolar disorder (STEP-BD). J Affect Disord. 2011;133:423–7.

    PubMed  PubMed Central  Google Scholar 

  47. • Schaffer A, Isometsä ET, Tondo L, et al. International Society for Bipolar Disorders Task Force on Suicide: meta-analyses and meta-regression of correlates of suicide attempts and suicide deaths in bipolar disorder. Bipolar Disord. 2015;17:1–16. This meta-analysis reports on risk factors for suicidal behavior and completed suicide. The latter is associated with male sex and a family history of suicide.

    PubMed  PubMed Central  Google Scholar 

  48. Simon GE, Hunkeler E, Fireman B, Lee JY, Savarino J. Risk of suicide attempt and suicide death in patients treated for bipolar disorder. Bipolar Disord. 2007;9:526–30.

    PubMed  Google Scholar 

  49. Pompili M, Rihmer Z, Innamorati M, Lester D, Girardi P, Tatarelli R. Assessment and treatment of suicide risk in bipolar disorders. Expert Rev Neurother. 2009;9:109–36.

    PubMed  Google Scholar 

  50. Coryell W, Kriener A, Butcher B, Nurnberger J, McMahon F, Berrettini W, et al. Risk factors for suicide in bipolar I disorder in two prospectively studied cohorts. J Affect Disord. 2016;190:1–5.

    PubMed  Google Scholar 

  51. Leverich GS, Altshuler LL, Frye MA, Suppes T, Keck PE Jr, McElroy S, et al. Factors associated with suicide attempts in 648 patients with bipolar disorder in the Stanley Foundation Bipolar Network. J Clin Psychiatry. 2003;64:506–15.

    PubMed  Google Scholar 

  52. Angst J, Angst F, Gerber-Werder R, Gamma A. Suicide in 406 mood-disorder patients with and without long-term medication: a 40 to 44 years’ follow-up. Arch Suicide Res. 2005;9:279–300.

    PubMed  Google Scholar 

  53. Cassidy F. Risk factors of attempted suicide in bipolar disorder. Suicide Life Threat Behav. 2011;41:6–11.

    PubMed  Google Scholar 

  54. Hawton K, Sutton L, Haw C, Sinclair J, Harriss L. Suicide and attempted suicide in bipolar disorder: a systematic review of risk factors. J Clin Psychiatry. 2005;66:693–704.

    PubMed  Google Scholar 

  55. Goodwin FK, Fireman B, Simon GE, Hunkeler EM, Lee J, Revicki D. Suicide risk in bipolar disorder during treatment with lithium and divalproex. JAMA. 2003;290:1467–73.

    CAS  PubMed  Google Scholar 

  56. Marangell LB, Bauer MS, Dennehy EB, Wisniewski SR, Allen MH, Miklowitz DJ, 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;8:566–75.

    PubMed  Google Scholar 

  57. Harris EC, Barraclough B. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry. 1997;170:205–28.

    CAS  PubMed  Google Scholar 

  58. Owen R, Gooding P, Dempsey R, Jones S. A qualitative investigation into the relationships between social factors and suicidal thoughts and acts experienced by people with a bipolar disorder diagnosis. J Affect Disord. 2015;176:133–40.

    PubMed  Google Scholar 

  59. Bottlender R, Jäger M, Strauss A, Möller HJ. Suicidality in bipolar compared to unipolar depressed inpatients. Eur Arch Psychiatry Clin Neurosci. 2000;250:257–61.

    CAS  PubMed  Google Scholar 

  60. Johnson SL, McMurrich SL, Yates M. Suicidality in bipolar I disorder. Suicide Life Threat Behav. 2005;35:681–9.

    PubMed  Google Scholar 

  61. Dilsaver SC, Chen YW, Swann AC, Shoaib AM, Krajewski KJ. Suicidality in patients with pure and depressive mania. Am J Psychiatry. 1994;151:1312–5.

    CAS  PubMed  Google Scholar 

  62. McGuffin P, Perroud N, Uher R, Butler A, Aitchison KJ, Craig I, et al. The genetics of affective disorder and suicide. Eur Psychiatry. 2010;25:275–7.

    CAS  PubMed  Google Scholar 

  63. Gonzalez-Pinto A, Mosquera F, Alonso M, López P, Ramírez F, Vieta E, et al. Suicidal risk in bipolar I disorder patients and adherence to long-term lithium treatment. Bipolar Disord. 2006;8:618–24.

    CAS  PubMed  Google Scholar 

  64. Black DW, Winokur G, Nasrallah A. Suicide in subtypes of major affective disorder. A comparison with general population suicide mortality. Arch Gen Psychiatry. 1987;44:878–80.

    CAS  PubMed  Google Scholar 

  65. Rihmer Z. Suicide risk in mood disorders. Curr Opin Psychiatry. 2007;20:17–22.

    PubMed  Google Scholar 

  66. Coryell W, Solomon D, Turvey C, Keller M, Leon AC, Endicott J, et al. The long-term course of rapid-cycling bipolar disorder. Arch Gen Psychiatry. 2003;60:914–20.

    PubMed  Google Scholar 

  67. Tsai S-YM, Kuo C-J, Chen C-C, Lee H-C. Risk factors for completed suicide in bipolar disorder. J Clin Psychiatry. 2002;63:469–76.

    PubMed  Google Scholar 

  68. • Huber RS, Coon H, Kim N, Renshaw PF, Kondo DG. Altitude is a risk factor for completed suicide in bipolar disorder. Med Hypotheses. 2014;82:377–81. This study presents data supporting the intriguing possibility that altitude is a risk factor for suicide in bipolar disorder.

    PubMed  PubMed Central  Google Scholar 

  69. Pompili M, Rihmer Z, Akiskal HS, Innamorati M, Iliceto P, Akiskal KK, et al. Temperament and personality dimensions in suicidal and nonsuicidal psychiatric inpatients. Psychopathology. 2008;41:313–21.

    PubMed  Google Scholar 

  70. Rihmer A, Rozsa S, Rihmer Z, Gonda X, Akiskal KK, Akiskal HS. Affective temperaments, as measured by TEMPS-A, among nonviolent suicide attempters. J Affect Disord. 2009;116:18–22.

    PubMed  Google Scholar 

  71. Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. 2011;168:1266–77.

    PubMed  PubMed Central  Google Scholar 

  72. Posner K, Oquendo MA, Gould M, Stanley B, Davies M. Columbia Classification Algorithm of Suicide Assessment (C-CASA): classification of suicidal events in the FDA’s pediatric suicidal risk analysis of antidepressants. Am J Psychiatry. 2007;164:1035–43.

    PubMed  PubMed Central  Google Scholar 

  73. Chehil S, Kutcher SP (2012) Suicide risk management: a manual for health professionals. Wiley.

  74. Fazel S, Wolf A, Larsson H, Mallett S, Fanshawe TR. The prediction of suicide in severe mental illness: development and validation of a clinical prediction rule (OxMIS). Transl Psychiatry. 2019;9:98.

    PubMed  PubMed Central  Google Scholar 

  75. Hawes M, Yaseen Z, Briggs J, Galynker I. The Modular Assessment of Risk for Imminent Suicide (MARIS): a proof of concept for a multi-informant tool for evaluation of short-term suicide risk. Compr Psychiatry. 2017;72:88–96.

    PubMed  Google Scholar 

  76. Saunders KEA, Hawton K. Clinical assessment and crisis intervention for the suicidal bipolar disorder patient. Bipolar Disord. 2013;15:575–83.

    PubMed  Google Scholar 

  77. Angst F, Stassen HH, Clayton PJ, Angst J. Mortality of patients with mood disorders: follow-up over 34-38 years. J Affect Disord. 2002;68:167–81.

    CAS  PubMed  Google Scholar 

  78. Grande I, Vieta E. Pharmacotherapy of acute mania: monotherapy or combination therapy with mood stabilizers and antipsychotics? CNS Drugs. 2015;29:221–7.

    CAS  PubMed  Google Scholar 

  79. Cipriani A, Pretty H, Hawton K, Geddes JR. Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic review of randomized trials. Am J Psychiatr. 2005;162:1805–19.

    PubMed  Google Scholar 

  80. Cipriani A, Hawton K, Stockton S, Geddes JR. Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. BMJ. 2013;346:f3646.

    PubMed  Google Scholar 

  81. •• Song J, Sjölander A, Joas E, Bergen SE, Runeson B, Larsson H, et al. Suicidal behavior during lithium and valproate treatment: a within-individual 8-year prospective study of 50,000 patients with bipolar disorder. Am J Psychiatry. 2017;174:795–802. A large study from Sweden again confirms the benefit of lithium carbonate treatment in reducing risk of suicide-related events in bipolar disorder patients.

    PubMed  Google Scholar 

  82. Schatzberg AF, Charles DeBattista DMH (2019) Schatzberg’s manual of clinical psychopharmacology, 9th Edition. American Psychiatric Pub.

  83. Wasserman D, Rihmer Z, Rujescu D, Sarchiapone M, Sokolowski M, Titelman D, et al. The European Psychiatric Association (EPA) guidance on suicide treatment and prevention. Eur Psychiatry. 2012;27:129–41.

    CAS  PubMed  Google Scholar 

  84. 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 discussion 111–6.

    CAS  PubMed  Google Scholar 

  85. Wilkinson ST, Ballard ED, Bloch MH, Mathew SJ, Murrough JW, Feder A, et al. The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta-analysis. Am J Psychiatry. 2018;175:150–8.

    PubMed  Google Scholar 

  86. Zhan Y, Zhang B, Zhou Y, Zheng W, Liu W, Wang C, et al. A preliminary study of anti-suicidal efficacy of repeated ketamine infusions in depression with suicidal ideation. J Affect Disord. 2019;251:205–12.

    CAS  PubMed  Google Scholar 

  87. Ballard ED, Yarrington JS, Farmer CA, Richards E, Machado-Vieira R, Kadriu B, et al. Characterizing the course of suicidal ideation response to ketamine. J Affect Disord. 2018;241:86–93.

    CAS  PubMed  PubMed Central  Google Scholar 

  88. Gibbons RD, Hur K, Brown CH, Mann JJ. Relationship between antiepileptic drugs and suicide attempts in patients with bipolar disorder. Arch Gen Psychiatry. 2009;66:1354–60.

    CAS  PubMed  PubMed Central  Google Scholar 

  89. Leon AC, Solomon DA, Li C, Fiedorowicz JG, Coryell WH, Endicott J, et al. Antiepileptic drugs for bipolar disorder and the risk of suicidal behavior: a 30-year observational study. Am J Psychiatry. 2012;169:285–91.

    PubMed  PubMed Central  Google Scholar 

  90. Patorno E, Bohn RL, Wahl PM, Avorn J, Patrick AR, Liu J, et al. Anticonvulsant medications and the risk of suicide, attempted suicide, or violent death. JAMA. 2010;303:1401–9.

    CAS  PubMed  Google Scholar 

  91. Yerevanian BI, Koek RJ, Mintz J, Akiskal HS. Bipolar pharmacotherapy and suicidal behavior Part 2. The impact of antidepressants. J Affect Disord. 2007;103:13–21.

    CAS  PubMed  Google Scholar 

  92. Gibbons RD, Brown CH, Hur K, Marcus SM, Bhaumik DK, Mann JJ. Relationship between antidepressants and suicide attempts: an analysis of the Veterans Health Administration data sets. Am J Psychiatry. 2007;164:1044–9.

    PubMed  Google Scholar 

  93. Musil R, Zill P, Seemüller F, Bondy B, Meyer S, Spellmann I, et al. Genetics of emergent suicidality during antidepressive treatment—data from a naturalistic study on a large sample of inpatients with a major depressive episode. Eur Neuropsychopharmacol. 2013;23:663–74.

    CAS  PubMed  Google Scholar 

  94. Pacchiarotti I, Bond DJ, Baldessarini RJ, Nolen WA, Grunze H, Licht RW, et al. The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders. Am J Psychiatry. 2013;170:1249–62.

    PubMed  PubMed Central  Google Scholar 

  95. Yatham LN, Kennedy SH, Schaffer A, Parikh SV, Beaulieu S, O'Donovan C, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009. Bipolar Disord. 2009;11:225–55.

    CAS  PubMed  Google Scholar 

  96. Yerevanian BI, Koek RJ, Mintz J. Bipolar pharmacotherapy and suicidal behavior Part 3: impact of antipsychotics. J Affect Disord. 2007;103:23–8.

    CAS  PubMed  Google Scholar 

  97. Fink M, Kellner CH, McCall WV. The role of ECT in suicide prevention. J ECT. 2014;30:5–9.

    PubMed  Google Scholar 

  98. Prudic J, Sackeim HA. Electroconvulsive therapy and suicide risk. J Clin Psychiatry. 1999;60(Suppl 2):104–10 discussion 111–6.

    PubMed  Google Scholar 

  99. American Psychiatric Association (2008) The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging (A Task Force Report of the American Psychiatric Association). American Psychiatric Pub

  100. Liang C-S, Chung C-H, Ho P-S, Tsai C-K, Chien W-C. Superior anti-suicidal effects of electroconvulsive therapy in unipolar disorder and bipolar depression. Bipolar Disord. 2018;20:539–46.

    CAS  PubMed  Google Scholar 

  101. Chiles JA, Strosahl KD, Roberts LW (2018) Clinical manual for assessment and treatment of suicidal patients. American Psychiatric Pub.

  102. Dell’Osso B, Mundo E, D’Urso N, et al. Augmentative repetitive navigated transcranial magnetic stimulation (rTMS) in drug-resistant bipolar depression. Bipolar Disord. 2009;11:76–81.

    PubMed  Google Scholar 

  103. Tamas RL, Menkes D, El-Mallakh RS. Stimulating research: a prospective, randomized, double-blind, sham-controlled study of slow transcranial magnetic stimulation in depressed bipolar patients. J Neuropsychiatr Clin Neurosci. 2007;19:198–9.

    Google Scholar 

  104. Carnell BL, Clarke P, Gill S, Galletly CA. How effective is repetitive transcranial magnetic stimulation for bipolar depression? J Affect Disord. 2017;209:270–2.

    PubMed  Google Scholar 

  105. Carreno FR, Frazer A. Vagal nerve stimulation for treatment-resistant depression. Neurotherapeutics. 2017;14:716–27.

    PubMed  PubMed Central  Google Scholar 

  106. Stanley B, Brodsky B, Nelson JD, Dulit R. Brief dialectical behavior therapy (DBT-B) for suicidal behavior and non-suicidal self injury. Arch Suicide Res. 2007;11:337–41.

    PubMed  Google Scholar 

  107. Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry. 2006;63:757–66.

    PubMed  Google Scholar 

  108. Rudd MD, David Rudd M, Williams B, Trotter DRM (2009) The psychological and behavioural treatment of suicidal behaviour. Oxford Textb Suicidol Suicide Prev 428–438.

  109. Magno LAV, Santana CVN, Sacramento EK, Rezende VB, Cardoso MV, Maurício-da-Silva L, et al. Genetic variations in FOXO3A are associated with bipolar disorder without confering vulnerability for suicidal behavior. J Affect Disord. 2011;133:633–7.

    CAS  PubMed  Google Scholar 

  110. Magno LAV, Miranda DM, Neves FS, Pimenta GJ, Mello MP, De Marco LA, et al. Association between AKT1 but not AKTIP genetic variants and increased risk for suicidal behavior in bipolar patients. Genes Brain Behav. 2010;9:411–8.

    CAS  PubMed  Google Scholar 

  111. Mirkovic B, Laurent C, Podlipski M-A, Frebourg T, Cohen D, Gerardin P. Genetic association studies of suicidal behavior: a review of the past 10 years, progress, limitations, and future directions. Front Psychiatry. 2016;7:158.

    PubMed  PubMed Central  Google Scholar 

  112. Mullins N, Bigdeli TB, Børglum AD, Coleman JRI, Demontis D, Mehta D, et al. GWAS of suicide attempt in psychiatric disorders and association with major depression polygenic risk scores. Am J Psychiatry. 2019;176:651–60.

    PubMed  Google Scholar 

  113. Taylor WD, Payne ME, Krishnan KR, Wagner HR, Provenzale JM, Steffens DC, et al. Evidence of white matter tract disruption in MRI hyperintensities. Biol Psychiatry. 2001;50:179–83.

    CAS  PubMed  Google Scholar 

  114. Pompili M, Innamorati M, Mann JJ, Oquendo MA, Lester D, del Casale A, et al. Periventricular white matter hyperintensities as predictors of suicide attempts in bipolar disorders and unipolar depression. Prog Neuro-Psychopharmacol Biol Psychiatry. 2008;32:1501–7.

    Google Scholar 

  115. Grangeon MC, Seixas C, Quarantini LC, Miranda-Scippa A, Pompili M, Steffens DC, et al. White matter hyperintensities and their association with suicidality in major affective disorders: a meta-analysis of magnetic resonance imaging studies. CNS Spectr. 2010;15:375–81.

    PubMed  PubMed Central  Google Scholar 

  116. Pompili M, Ehrlich S, De Pisa E, et al. White matter hyperintensities and their associations with suicidality in patients with major affective disorders. Eur Arch Psychiatry Clin Neurosci. 2007;257:494–9.

    PubMed  Google Scholar 

  117. Tighe SK, Reading SA, Rivkin P, Caffo B, Schweizer B, Pearlson G, et al. Total white matter hyperintensity volume in bipolar disorder patients and their healthy relatives. Bipolar Disord. 2012;14:888–93.

    PubMed  PubMed Central  Google Scholar 

  118. Belvederi Murri M, Prestia D, Mondelli V, Pariante C, Patti S, Olivieri B, et al. The HPA axis in bipolar disorder: systematic review and meta-analysis. Psychoneuroendocrinology. 2016;63:327–42.

    CAS  PubMed  Google Scholar 

  119. Kamali M, Saunders EFH, Prossin AR, Brucksch CB, Harrington GJ, Langenecker SA, et al. Associations between suicide attempts and elevated bedtime salivary cortisol levels in bipolar disorder. J Affect Disord. 2012;136:350–8.

    CAS  PubMed  Google Scholar 

  120. Black DW, Monahan PO, Winokur G. The relationship between DST results and suicidal behavior. Ann Clin Psychiatry. 2002;14:83–8.

    PubMed  Google Scholar 

  121. Daban C, Vieta E, Mackin P, Young AH. Hypothalamic-pituitary-adrenal axis and bipolar disorder. Psychiatr Clin North Am. 2005;28:469–80.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA

    Jacob N. Miller

  2. Department of Psychiatry, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 2-126b Medical Education Building, Iowa City, IA, 52242, USA

    Donald W. Black

Authors
  1. Jacob N. Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Donald W. Black
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Donald W. Black.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Bipolar Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Miller, J.N., Black, D.W. Bipolar Disorder and Suicide: a Review. Curr Psychiatry Rep 22, 6 (2020). https://doi.org/10.1007/s11920-020-1130-0

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-020-1130-0

Keywords

Search

Navigation