Bipolar Disorder: A Silent Killer with a High Suicide Risk

Heston Blumenthal, the celebrity chef known for his experimental cuisine, recently shared his experience of being sectioned under the UK’s Mental Health Act, saying it was “the best thing” that could have happened to him. His openness about living with bipolar disorder highlights the little-discussed fact that people with this condition face one of the highest suicide risks of any mental illness.

A Complex and Debilitating Disorder

Bipolar disorder is a severe mental illness characterised by episodes of mania (high energy, impulsivity) and depression (hopelessness, fatigue). Suicidal thoughts and behavior are a core feature of the disorder, with fluctuating risk that can persist over long periods.

Why is Suicide So Common in Bipolar Disorder?

Understanding why suicide is so common in people with this disorder is difficult. But one major factor is mood instability. Rapid shifts between emotional highs and lows, as well as mixed states where symptoms of mania (impulsivity) and depression (despair) occur together, can be particularly dangerous. Social and economic factors also play a role, as research has shown that the population suffering from bipolar disorder has become poorer over the last two decades, leading to financial strain, social isolation, and poorer access to healthcare.

Challenges in Treating Bipolar Disorder

While bipolar disorder cannot be cured, it can be managed. The most commonly used drug, lithium, has been found to reduce suicide risk significantly in some patients. However, people with the condition struggle to take it regularly due to its side-effects, which can affect the kidneys, thyroid, metabolism, cognition, and cardiovascular health. Other treatments, such as antipsychotics, mood stabilizers, and electroconvulsive therapy, can also be effective in some types and phases of bipolar, but they come with their own harms and limitations.

Why Are There So Few Effective Treatments?

Despite the significant effect that bipolar disorder has on individuals, families, and society, the development of new drugs has been frustratingly slow. Lithium, first used in the 1940s, remains the go-to treatment, while most other drugs were originally designed to treat schizophrenia. No truly new treatments have emerged in decades, partly due to the complexity of bipolar disorder, which is not a single disorder but a spectrum of conditions, rendering the one-size-fits-all approach inadequate. New treatments also face strict approval hurdles because lithium, despite its limitations, is highly effective for some patients, leading to slow treatment development and leaving patients with limited options.

A Path Forward

Research is underway to develop new treatments, including artificial intelligence platforms to help find new drugs quicker and personalize treatments based on patients’ genetic and clinical profiles. AI could lead to faster, more effective therapies tailored to individual needs. However, new approaches also raise concerns about whether it is ethical to involve patients in trials, and it is essential to include people with the disorder who have experienced suicidal thoughts and behavior to better understand their mindset and decision-making.

Conclusion

While the statistics on bipolar disorder are alarming, the message should be one of hope. The condition is treatable and suicide is preventable, but only if we commit to improving access to care, reducing stigma, and advancing research. By acknowledging the complexity of bipolar disorder and the challenges in treating it, we can work towards a future where people with the condition receive the support they need to manage their symptoms and live fulfilling lives.

FAQs

Q: What is bipolar disorder?
A: Bipolar disorder is a severe mental illness characterized by episodes of mania (high energy, impulsivity) and depression (hopelessness, fatigue).
Q: What is the suicide risk in bipolar disorder?
A: People with bipolar disorder face one of the highest suicide risks of any mental illness, with 50% attempting suicide at least once and 15-20% dying by suicide.
Q: What is the current treatment for bipolar disorder?
A: The most commonly used drug is lithium, which has been found to reduce suicide risk significantly in some patients, but people with the condition struggle to take it regularly due to its side-effects.
Q: Why is it challenging to develop new treatments for bipolar disorder?
A: The disorder is complex and not a single disorder, but a spectrum of conditions, rendering the one-size-fits-all approach inadequate. New treatments also face strict approval hurdles due to the effectiveness of lithium.