Bipolar disorder, formerly known as manic depression, is a mental illness characterized by extreme shifts in mood and energy levels. People with bipolar disorder experience periods of mania (elevated moods, increased energy and activity) and periods of depression, along with periods of relatively normal mood in between. Bipolar disorder is a chronic, lifelong condition that requires ongoing treatment and management.
A common question many people with bipolar disorder and their loved ones have is – how does bipolar disorder impact life expectancy? Do people with bipolar live shorter lives compared to the general population? Let’s take a detailed look at what research says about the life expectancy of people with bipolar disorder.
Life Expectancy of People with Bipolar Disorder
Multiple large studies have found that bipolar disorder is associated with a decreased life expectancy of 9-20 years compared to the general population.1 This means that on average, people with bipolar disorder have shorter lifespans and die earlier than people without bipolar disorder.
Some key points on the life expectancy of individuals with bipolar disorder:
– On average, people with bipolar disorder die about 9 years earlier than the general population.2
– The life expectancy reduction is more pronounced for bipolar men (who die about 12 years earlier) compared to bipolar women (who die about 8 years earlier on average).3
– The main causes for the increased risk of early mortality are suicide and medical conditions like cardiovascular disease, diabetes and respiratory illnesses.4
– However, with proper treatment and management of bipolar disorder, the life expectancy gap can be significantly reduced. Research shows that lithium treatment helps decrease mortality rates.5
So in summary, bipolar disorder does reduce average lifespan compared to the general public without bipolar disorder. But the good news is that with comprehensive treatment, the life expectancy gap can be narrowed.
Causes of Premature Death in People with Bipolar Disorder
What leads to the increased risk of early death in people with bipolar disorder? Studies have identified the following as the main causes:
Suicide
Suicide is the leading cause of premature death among people with bipolar disorder.6 It’s estimated that 25-50% of individuals with bipolar disorder attempt suicide at least once in their lifetime.7 About 15-19% of people with bipolar disorder die by suicide.8
The periods of severe depression as well as mixed manic-depressive episodes in bipolar disorder increase the risk of suicidal behavior and death by suicide.
Medical Comorbidities
People with bipolar have higher rates of various medical conditions like:9
– Cardiovascular disease
– Obesity
– Diabetes
– Respiratory disease
– Thyroid disease
These conditions occur more often among bipolar individuals, which increases the risk of early death. The use of medications like antipsychotics to treat bipolar disorder can also sometimes lead to medical problems like metabolic issues.
Lifestyle Factors
Unhealthy lifestyle choices and behaviors are more common in people with bipolar disorder, compared to the general population. These include:
– Higher rates of smoking
– Alcohol and substance abuse
– Lack of exercise
– Poor diet
Such lifestyle problems can worsen the physical health issues in bipolar disorder, further reducing lifespan.
Treatment Nonadherence
Many people with bipolar disorder struggle to adhere to their medication regimens and have difficulties staying in treatment consistently over time. Nonadherence to mood stabilizers like lithium reduces their effectiveness and leads to more mood episodes. This can increase suicidal behavior risk and medical comorbidities, negatively impacting longevity.
Factors That Increase Life Expectancy for Bipolar Disorder
While bipolar disorder does reduce average life expectancy, certain factors can help increase longevity in people with bipolar disorder:
Early Intervention and Treatment
If bipolar disorder is diagnosed and treated early, this improves prognosis and life expectancy. Early mood stabilization helps prevent future episodes, suicidal behavior, and development of medical problems.10 It also protects brain health and function.
Consistency in Treatment
Taking medications for bipolar disorder consistently as prescribed, keeping up with psychotherapy, and maintaining regular visits with the treatment team has been shown to reduce mortality rates.11 Treatment adherence is key.
Use of Mood Stabilizers
Mood stabilizers like lithium and anticonvulsant medications are beneficial in reducing mortality associated with bipolar disorder by decreasing suicide risk and medical comorbidities.12
Psychosocial Support
Having social and family support improves treatment compliance and motivation in bipolar disorder. It acts as a protective buffer against suicidal thoughts and self-harm tendencies.13
Healthy Lifestyle
Living a healthy lifestyle by eating nutritious meals, exercising regularly, avoiding smoking and substance use, and learning stress management techniques can help mitigate medical conditions in bipolar disorder.14
Treatment of Co-Occurring Disorders
Many people with bipolar also have co-occurring psychiatric disorders like anxiety, ADHD or substance use problems. Treating these additional conditions along with bipolar leads to better overall outcomes.15
Life Expectancy for Bipolar Disorder By Gender
Research indicates that the impact of bipolar disorder on life expectancy is higher for men than women.16
On average, men with bipolar disorder die 12 years earlier than men in the general population. Women with bipolar disorder die about 8 years earlier on average than women without bipolar disorder.
This gender gap in life expectancy has been attributed to the following factors:
Higher suicide rates in men
While women have higher rates of suicidal thoughts and attempts, men are more likely to die by suicide due to using more lethal means like firearms or hanging.17 Among people with bipolar disorder as well, completed suicides are higher in males.
Higher rates of comorbid substance use in men
Substance abuse like alcoholism and drug addiction is more prevalent in men with bipolar disorder compared to women.18 This increases mortality by worsening suicide risk and medical problems.
Less treatment adherence in men
Studies indicate that women with bipolar disorder are more likely to accept their diagnosis, take medications as prescribed and continue long-term treatment. Men are comparatively less compliant, which reduces the lifespan benefits of treatment.19
Protective effect of estrogen in women
The hormone estrogen may play a neuroprotective role in the female brain, leading to better outcomes. Estrogen seems to have antidepressant and antisuicidal effects in bipolar disorder.20
So the key takeaway is that while bipolar disorder reduces life expectancy in both genders, the effect is more pronounced in men than women on average.
Life Expectancy Based on Age of Onset
Does the age when bipolar disorder first develops impact lifespan?
Research shows that early onset bipolar disorder (starting before age 18) is linked to worse outcomes compared to adult-onset disorder (after age 18).21
Some reasons why childhood and adolescent onset bipolar leads to greater reduction in life expectancy:
More time living with untreated bipolar disorder
Early onset means more years living without diagnosis and treatment in the critical developmental stages, leading to worse long-term effects on the brain.
Higher risk behavior and suicidality
Childhood bipolar disorder is associated with more impulsivity and risk taking, increasing self-harm and suicidal acts.
Greater likelihood of alcohol and drug use
Young people with bipolar disorder have higher rates of developing substance use disorders, elevating mortality risk.
Poorer treatment adherence
Children and teens are less likely to take medications consistently, reducing the benefits of early intervention.
More rapid cycling episodes
Pediatric bipolar disorder is linked to more frequent and rapid cycling mood episodes compared to adult onset illness.22 This leads to worse impairment over time.
So early onset bipolar disorder is considered more severe with greater risk of premature death compared to adult onset bipolar disorder.
Reducing Mortality Risk in Bipolar Disorder
While bipolar disorder is associated with reduced life expectancy on average, the mortality gap can be lowered by taking certain steps:
Seeking early diagnosis and treatment
Getting intervention quickly during the first mood episode leads to better long-term prognosis and preservation of lifespan.
Adhering to medications as prescribed
Consistently taking mood stabilizing medications helps regain mood stability and prevents future episodes and hospitalizations.
Making healthy lifestyle choices
Eating healthy, exercising, avoiding smoking/alcohol, and learning stress management promotes physical as well as mental health.
Developing a strong support system
Having close relationships and social connections provides a protective buffer and motivates treatment compliance.
Learning to manage warning signs
Detecting early symptoms of manic or depressive episodes allows for quicker intervention to prevent worsening.
Attending therapy and appointments
Ongoing psychotherapy helps manage symptoms, regulate moods, and change harmful thinking patterns.
Treating any co-occurring disorders
Managing accompanying conditions like anxiety, ADHD or substance abuse leads to more favorable outcomes.
Outlook for Life Expectancy in Bipolar Disorder
While bipolar disorder has been associated with shorter average lifespans historically, the future outlook regarding life expectancy is more promising due to:
– Earlier diagnosis and treatment of the disorder than before
– Greater availability of mood stabilizing medications and psychotherapy
– Increased mental health awareness and acceptance reducing stigma
– More research on effective treatments and preventive strategies
– Better integration of mental health care and physical health care
With greater awareness, diagnosis, support and comprehensive evidence-based treatment, people with bipolar disorder have the potential to live long, fulfilling lives with lifespans approaching those of the general population.
Conclusion
Bipolar disorder does impact life expectancy on average, reducing lifespan by 9-12 years compared to the general public. The main causes are increased risk of suicide as well as higher rates of medical conditions like cardiovascular disease, diabetes and respiratory illness. However, with appropriate long-term treatment, addressing lifestyle factors, and providing strong psychosocial support, the gap in life expectancy can be significantly reduced. While more work remains in improving lifespan for individuals with bipolar disorder, progress is being made through awareness, early intervention and integrated care strategies. With comprehensive and consistent treatment, people with bipolar disorder can go on to live productive lives with normal or near-normal life expectancy.