Recent scientific breakthroughs indicate that the chemical target for ASIB in bipolar depression may be modulated by the brain's NMDA receptor.

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*These drugs are investigational and not approved by the US FDA


Bipolar Depression in Patients with Acute Suicidal Ideation/Behavior (ASIB)

Bipolar depression is a potentially lethal disease affecting up to three million Americans, as it can sometimes lead to Acute Suicidal Ideation/Behavior (ASIB). This means they have suicidal thoughts, potentially also with a method in mind.


Patients with Bipolar Depression are 20-30x more likely to attempt suicide than the general population.1 Over the course of 5 years, 1 in 5 patients suffering from Bipolar Depression will attempt suicide.2  Estimates indicate that 11% or more of those with Bipolar Disorder succumb to suicide.3


Those with Acute Suicidal Ideation/Behavior, as classified by FDA-recognized scales, have a 33% chance of death within six months of onset. Although only 10% of the 30 million Americans suffering with depressive disorders have bipolar disorder, patients with bipolar depression may account for up to 60% of all depression-related suicides.4


Despite the nature of an acute suicidal crisis, many patients seek medical care or are brought to care by families and physicians. There are currently no approved medicines for this indication. Therefore, for most patients, treatment consists of monitoring and possible sedation, typically in a locked inpatient setting.


The current standard of care, as published by the American Psychiatric Association consists of voluntary or forced admission to a psychiatric hospital and electroconvulsive therapy (ECT).  Although ECT is associated with a decrease in suicide deaths, it requires 6 – 10 sessions of general anesthesia and is known to cause memory loss and confusion.


While there are well-accepted drug therapies for the manic phase of bipolar disease, there is no approved medication for the treatment of Bipolar Depression when Acute Suicidal Ideations & Behaviors are present.

In fact, SSRI/SNRI-based antidepressants can increase the risk of suicide and bear an

FDA-mandated warning label identifying that risk. Furthermore, pharmacological options are not effective for many patients and typically require more than three weeks to show effect. Other treatments, such as electro-convulsive therapy (ECT), are physically and emotionally draining and require extended hospitalization. Scientific findings  indicate that thoughts and impulses for suicide have biological underpinnings.5


Recent scientific breakthroughs indicate that the chemical target for suicidality in bipolar depression may be modulated by the brain’s NMDA receptor, providing a rationale for developing new therapies focused on this target.


In addition to a significant impact on patient health, ASIB in Bipolar Depression takes a dramatic economic toll on the U.S. healthcare system. Given the lack of suitable alternatives, the majority of patients are managed at the inpatient setting, which is costly to payers, patients, families, and employers.


  1. Pompili, M. Gonda, X. Bipolar Disorders 2013; 15: 457-490
  2. Holma, K. Haukka J. Bipolar Disorders 2014; 16: 652-661
  3. Pallaskorpi, et al. Bipolar Disorders 2017; 19: 13-22
  4. Pompili, M. Gonda, X. Bipolar Disorders 2013; 15: 457-490
  5. Johnston et al. American Journal of Psychiatry 2017; 174: 667-675