"I had been getting more and more depressed and had thought about killing myself, but somewhere in there I decided to finally do it. One night I came home from work to my apartment and went through a whole ritual, 1 had decided I was going to do it by overdosing on my lithium, since that's the drug I had the most of. I took it, little by little, throughout the evening, pill after pill, and then 1 got in the shower, but by then I was starting to puke and got the runs really badly. ... I think 1 lost consciousness at some point, and somewhere in there 1 had the presence of mind to call Dylan [boyfriend], who called the paramedics, and they took me to the hospital. I ended up there with a catheter and the whole thing. 1 looked awful and felt awful. Everybody was telling me how fortunate I was to be alive, but that made me feel worse. I sure didn't feel fortunate."
—A 28-year-old woman witfi bipolar 1 disorder, recounting her first suicide attempt
If you are cycling into a period of depression, it is common to have thoughts of ending your life. You may have been having these thoughts all along, but they can become more severe if your depression is getting worse. You may also find that your suicidal thoughts go along with an increase in your anxiety and worry. Some people feel suicidal chronically, not just when they are depressed. One patient said, "I know I'll kill myself someday. It's gonna happen. The only question is when."
Suicide can be accomplished in a sudden impulsive act or a carefully planned event. It usually occurs during a depressive or a mixed episode, but some people with bipolar disorder kill themselves accidentally or on impulse when they are psychotic and in the manic phase.
By some estimates, people with bipolar disorder are at 15 times the risk for committing suicide of people in the general population (Harris & Barraclough, 1997). Up to 15% of people with bipolar disorder die by suicide; as many as 50% attempt suicide at least once in their lives (Jamison, 2000b; Simpson & Jamison, 1999). Tragically, suicidal thoughts and feelings are a part of bipolar illness, connected with its biological and genetic mechanisms. We know that levels of serotonin are lower in the brains of people who attempt or complete suicide (Mann et al., 1999; Asberg et al., 1986; Arango et al., 1995). In other words, suicidal impulses are related to the neurophysiology of your disorder; they are not caused by a moral failing or weakness on your part.
Therefore, you should not feel alone with, or ashamed of, suicidal thoughts. Virtually every person with bipolar disorder has entertained the idea of suicide at one point or another. In fact, many people without the disorder have thought about it, even if just in passing. But among people with bipolar disorder, the thoughts often become frequent and intense and are more likely to be articulated into a plan of action (for example, to kill yourself with pills at a specific time). For first-person accounts of suicidal feelings and actions among people with bipolar disorder, read Kay Jamison's 1995 autobiography, An Unquiet Mind, or her recent book on suicide, Night Fails Fast (JamiSon> 2000a).
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