If you live with bipolar and experience suicidal thoughts, it may help you to know that they’re an extremely common symptom of bipolar – and that there are lots of practical strategies to help you manage them.

Nearly everyone with bipolar has had suicidal thoughts, with one survey finding that 90% of over 2000 respondents living with bipolar had experienced suicidal thoughts at some point.

When bipolar is undiagnosed, untreated, or when someone hasn’t found the right combination of treatment and support yet, the risk of experiencing suicidal thoughts is especially high.

Suicidal thoughts and feelings can happen across the bipolar mood spectrum. They are especially common when someone is in a depressed or mixed state. You can read more about symptoms of bipolar here.

Having suicidal thoughts can be frightening, and often lead to feelings of shame, fear and guilt. If you’ve experienced any of this, you are not alone. Suicidal thoughts are a symptom of the illness, not a personal weakness.

8 ways to help manage suicidal thoughts

1. Stay connected

Reaching out when you’re struggling can be one of the hardest but most effective steps you can take.

Letting a trusted friend or family member know what’s going on can reduce the sense of loneliness that often comes with suicidal thinking.

Peer support, whether by phone, online or in person, can be a reminder that you are not alone and that others really do understand what you’re going through.

2. Spot early warning signs

Learning your patterns that lead to suicidal thinking can make a big difference. For example, changes in sleep, withdrawing from social contact or relying more heavily on alcohol or drugs can show your mood is changing.

The earlier you recognise these patterns and take action, the better.  

Many people with bipolar tell us that using our free Mood Tracker app every day helps them to notice their patterns. You can download it here.

3. Create a ‘suicide prevention toolbox’

Many people living with bipolar find it helpful to create a personal ‘toolbox’ of things they can turn to in difficult moments. This could include:

• writing down reasons that make your life worth living
• saving a folder of mood-lifting photos on your phone
• creating a playlist of gentle mood-lifting music on your phone  
• keeping a list of distractions such as activities, errands or people to call
• using a shoebox to store kind comments you’ve heard on sticky notes  

4. Learn to challenge unhelpful thinking patterns  

Using Cognitive Behavioural Therapy (CBT) techniques to challenge unhelpful thoughts can sometimes break a pattern of recurring suicidal thinking in the short term. When you notice unhelpful thoughts, these examples may help:

• If you think, ‘I’ll never get better,’ you can ask yourself, ‘What evidence do I have for and against this thought?’
• If you think, ‘I’m always going to feel like this’ you can ask yourself, ‘Have there been times when I have felt even a little bit better?’
• If you think, ‘I can’t cope with this pain,’ you can remind yourself, ‘This is extremely hard right now, but I have managed difficult feelings before and can use my coping strategies to get through this moment.’

5. Focus on your self-care

Looking after your body and mind can create a stronger foundation for managing suicidal thoughts.

When you’re really struggling, even a small act of self-care, such as washing your face or making some toast, is a big achievement.

Take whatever actions you can manage, that you know will help, and what feels important to you in the moment. It’s important not to try to do everything at once.

In the longer-term, focusing on getting into a good routine with your sleep, diet, physical activity and time outdoors will help to regulate your circadian rhythm (the ‘body clock’ that drives many of your body’s functions including sleep, thirst and appetite) and support your recovery.

6. Stay in the present moment

When you’re feeling really low, it can be overwhelming to think about the future. Some people tell us it can be helpful to focus just on today, half a day, or the next hour or few minutes, and on whatever will help you get through.

For example,

• For the rest of the day, I’m going to allow myself to rest
• For the next hour, I’m going to watch this TV show
• For the next three minutes, I’m going to listen to this song

7. Use a grounding technique

Some people who are having recurring suicidal thoughts tell us that using a simple grounding technique can be a helpful way to manage overwhelm.

Try naming out loud five things you can see, four things you can hear, three things you can touch, two things you can smell and one thing you can taste.

8. Get support from your healthcare team

Your GP, psychiatrist and mental healthcare team are there to help you manage any symptoms of bipolar you’re having, including suicidal thinking. Ask them to:

• Help you create a safety plan so you have an agreed set of actions to follow whenever you feel at risk.
• Help you write an Advance Choice Document to ensure that your wishes are taken into account if you become really unwell.
• Review your medication to ensure you’re taking the right combination and doses for you. If you’re not already, you might also want to consider taking lithium as there is strong evidence that lithium can reduce suicide risk in people with bipolar. You can read more about lithium here.