Bipolar Disorder: Emergencies and Suicide Prevention

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 rare 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. Mixed states are particularly dangerous: A person might feel depressed but keyed-up at the same time.

Suicide is a very real risk for people with bipolar disorder, whether 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.

Anyone who cares for someone with bipolar disorder needs to know what to do in an emergency.

You need to take suicidal threats or behavioral seriously. Signs include:

• Talking about suicide or death
• Writing a suicide note
• Feeling hopeless
• 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 him- or herself, 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.

Reviewed by the doctors at The Cleveland Clinic Department of Psychiatry and Psychology.