Bipolar Disorder Emergencies and Suicide Prevention
In this article
Bipolar disorder may raise the risk of suicide. Mania and depression, the hallmarks of bipolar disorder, can be dangerous. During a manic phase, a person with bipolar disorder may be reckless. In about half the cases, people with mania can become psychotic -- hearing or sometimes seeing things that aren't real. During a depressive state, things may seem so hopeless that life doesn't seem worth living. Manic or depressed phase episodes that involve mixed features (symptoms of mania during a depressive episode, or symptoms of depression during a manic episode) are particularly dangerous: A person might feel depressed but keyed-up, agitated and energized at the same time.
Suicide is a very real risk for people with bipolar disorder, particularly when they're in a manic or depressive episode -- 10%-15% of people with bipolar disorder kill themselves. Many more attempt suicide. It's an alarming statistic, but you have to remember that treatment greatly lowers the risk.
Mixed features refers to the presence of high and low symptoms occurring at the same time, or as part of a single episode, in people experiencing an episode of mania or depression. In most forms of bipolar disorder, moods alternate between elevated and depressed over time. A person with mixed features experiences symptoms of both mood "poles" -- mania and depression -- simultaneously or in rapid sequence.
Anyone who cares for someone with bipolar disorder needs to know what to do in an emergency.
You need to take suicidal threats or behavior seriously. Signs include:
Talking about suicide or death
Writing a suicide note
Abusing drugs or alcohol
Putting one's affairs in order, as if preparing for death
Doing dangerous or potentially life-threatening things
Traumas and starting or stopping medication may also increase the risk of suicide. If your loved one is in a crisis and immediately threatening to harm himself, you should:
Call 911 or emergency services.
Make sure your loved one isn't left alone.
Take away any weapons, large amounts or medication, or anything else potentially dangerous. In some cases, this may include car keys.
Your loved one may reveal suicidal feelings in confidence. He or she may not want you to tell anyone else. But if you think your friend or loved one is at risk, you can't afford to keep it a secret. Get help.
Talking about suicide isn't easy. But you need to. Discussing it won't make it more likely to happen. See if your loved one will agree to a "plan for life," a set of steps that he or she will follow in a crisis to stay safe.
SOURCES: Diagnostic and Statistical Manual of Mental Disorders Fourth edition, Text Revision. Washington, D.C.: American Psychiatric Association, 2000. The Nation's Voice on Mental Illness. Depression and Bipolar Support Alliance. American Psychiatric Association. National Institute of Mental Health. WebMD Medical Reference: "Bipolar Disorder." Compton, M. Depression and Bipolar Disorder, ACP Medicine. Medscape: "Psychiatry and Mental Health."