Suicide in Bipolar Disorder

Bipolar disorder has a strong association with suicide, which represents one of the leading causes of premature death in patients. Suicidal behavior is most frequent during depressive or mixed episodes, though manic and hypomanic states can also increase risk. Major predictors include prior suicide attempts, early illness onset, comorbid psychiatric or substance use disorders, family history, and adverse psychosocial or biological factors, while traits such as impulsivity and aggression further heighten vulnerability. Protective factors include social support, treatment adherence, problem-solving skills, and especially pharmacotherapy with lithium, which consistently reduces suicide risk. In suicide prevention, the role of antidepressants remains controversial, while mood stabilizers and certain antipsychotics offer modest benefit. Novel strategies, including ketamine and neuromodulation, are showing emerging promise. Given the difficulty of predicting suicide in bipolar disorder, early diagnosis, comprehensive risk assessment, and individualized management are essential for prevention.