Why Bipolar Disorder Shortens Lifespan by Up to 20 Years and What You Can Do

Living with bipolar disorder means more than weathering mood highs and lows; it also takes a silent toll on your lifespan. Research shows people with bipolar die 11–20 years earlier than those without the condition, driven by everything from suicide and heart disease to sleep disruption, inflammation, and even the side effects of our medications. In this article, I’ll unpack every factor contributing to the bipolar life-expectancy gap — natural causes like cardiovascular and respiratory illness, lifestyle issues such as poor diet, inactivity, and disrupted sleep, social challenges like stigma and housing instability, biological factors including inflammation and accelerated aging, plus the impact of untreated illness and medication-related risks. Armed with peer-reviewed insights and actionable strategies, you’ll learn how to reclaim those lost years and build a healthier, longer life.

Note: All sources are linked directly within the text.

Table of Contents

Use these links to jump to the section in which you are interested. (Check out the table in #9 for an overview.)

1. Bipolar Disorder Cuts Average Lifespan by 13 Years
2. Suicide, Accidental Deaths, and Violence: Leading Causes of Early Mortality
3. Cardiovascular and Metabolic Disease Drive 40% of Excess Deaths
4. How Poor Diet and Inactivity Worsen Lifespan
5. Stigma, Homelessness, and Insurance Gaps Fuel Mortality
6. Cognitive Deficits and Cellular Aging: Hidden Mortality Risks
7. Antipsychotic Metabolic Risks: How Meds Shorten Life
8. Untreated Bipolar Disorder: Losing Up to 20 Years of Life
9. Putting Bipolar Mortality Stats into Years: Your Risk Breakdown (a table)
10. Strategies to Narrow the Mortality Gap

Bipolar Disorder Cuts Average Lifespan by 13 Years

I know we’ve all heard the scary numbers about how bipolar disorder costs us years of life. Let’s start by acknowledging those numbers:

• There is an average reduction of 13 years of life expectancy for those with bipolar disorder. (While most studies have been done on those with bipolar I, it appears that this holds true for other types of bipolar as well.)
• Individual studies report 11-20 years lost, depending on multiple factors like care access and comorbidities (co-occurring disorders).

I know some people have a reflex at this point to say it’s all the fault of antipsychotics (antipsychiatrists are all over that), but it’s much more complicated and multi-storied than that.

Suicide, Accidental Deaths, and Violence: Leading Causes of Early Mortality in Bipolar Disorder

As I’ve written about, most people with bipolar disorder attempt suicide, and a significant number die by suicide. The numbers are slippery, however. We used to think that about 20% of people with bipolar disorder died of suicide, and then it was 12%. Now, it seems we recognize that we just don’t know, as numbers from 15-20% are commonly cited. It seems like most research indicates it’s around 15%.

Violent and unintentional deaths are also four times more common for those with bipolar than in the general population. (This is mostly driven by impulsivity and substance use activities.)

Cardiovascular and Metabolic Disease Drive 40% of Excess Deaths in Bipolar Disorder

When it comes to disease-based deaths in bipolar disorder, things get a bit messy. It’s clear that disease accounts for a large number of bipolar disorder deaths and a large amount of the decreased life expectancy, but these get tangled with lifestyle and medication side effect risks. (I attempt to untangle this as we go.)

• Cardiovascular disease (CVD) accounts for 35-40% of excess deaths in bipolar disorder. It was shown that the mortality rates for cerebrovascular disease, coronary heart disease, and acute myocardial infarction were twice as high in persons with bipolar disorder compared to the general population.
• About 37% of people with bipolar disorder have metabolic syndrome, and there is around a two times increased risk of diabetes and obesity when compared to the general population, compounding the risks of cardiovascular disease.
• Early deaths from respiratory disease, which includes pneumonia, chronic obstructive pulmonary disease (COPD), and others, are three times more common in those with bipolar disorder.
• Substance use disorder affects at least 40% of those with bipolar disorder (and some research suggests the number is higher than that) and contributes to disease in many ways, including overdose and organ damage.
• Smoking is also very common in those with bipolar disorder. About 37% of those with bipolar smoke cigarettes (as opposed to 17% of those without a psychiatric illness), and this contributes to both cardiovascular disorder and respiratory mortality.
• There is early data that bipolar disorder negatively impacts the immune system, even when a person is euthymic (not in a bipolar mood episode). A meta-analysis showed that key immune messengers remain high in euthymic patients. This matters because an individual participant meta-analysis in adults found that each doubling of C-reactive protein (CRP) levels boosts the risk of heart attack by 60%, stroke by 32%, and overall cardiovascular death by 75%, and also predicts greater all-cause mortality.

How Poor Diet and Inactivity Worsen Lifespan in Bipolar Disorder

While the medical factors contribute greatly to early death in bipolar, lifestyle factors also come into play. For example:

• Those with bipolar disorder tend to consume a less healthy diet, including higher-glycemic, lower-nutrient foods, worsening obesity, inflammation, and metabolic risks.
• People with bipolar disorder spend 615 minutes per day sedentary, while 84.2 minutes are engaged in moderate or vigorous physical activity (I suspect that mania/hypomania skews physical activity numbers.). Only 31.4% of people with bipolar meet physical activity guidelines. This is compared to 492 minutes per day of sedentary minutes in the average person in the United States.
• Sleep problems are rife in those with bipolar disorder, with basically 100% reporting insomnia, hypersomnia, or irregular sleep rhythms during an episode, while 70% report it even in remission. And it’s important to remember that sleep disturbance is implicated in suicidal ideation, suicide attempts, obesity, poor diet, inadequate exercise, and other negative health effects, thus contributing to poor health and early death. (I will also mention that controlling your sleep schedule is a huge step towards mood stabilization.)

Stigma, Homelessness, and Insurance Gaps Fuel Mortality in Bipolar Disorder

It can’t be ignored that those with bipolar disorder also suffer from systemic societal issues that affect our health.

• Homelessness affects those with bipolar disproportionately. Fifteen percent of those with serious mental illness report being homeless at some point over the last year, and in a Veterans Affairs (VA) bipolar population, 12% report being homeless in the last month. Homelessness exacerbates stress and disrupts care, both worsening symptoms and outcomes.
• Stigmatizing attitudes and attribution of physical complaints to a patient’s psychiatric diagnosis lead to misdiagnoses or delays in treating serious medical conditions.
• Most people with mental illness in the United States remain either untreated or poorly treated. Only 31% of adults with no insurance received any outpatient mental health care in a year, compared with over 60% of those with private coverage. (And we know that those who are treated have a greater life expectancy than those who don’t [see below]).

Cognitive Deficits and Cellular Aging: Hidden Mortality Risks in Bipolar

This gets into the nitty-gritty of the brain. I’m offering an overview here, but you can click on the links for details.

• Even when a mood is stable, people with bipolar disorder often struggle with planning, organizing, and staying focused, which are core executive skills needed to keep up with doctor visits, remember prescriptions, and follow treatment plans. Those very deficits have real-world consequences: it has been found that poorer response-inhibition performance is an independent predictor of low medication adherence, helping explain why hypertension, diabetes, and other chronic conditions so often go under-treated in those with bipolar disorder (creating risks for earlier death).
• It’s a bit technical, but even during remission, bipolar disorder is marked by cellular aging: shorter telomeres and epigenetic clocks running faster, mechanisms linked to earlier onset of cardiovascular disease, neurodegeneration, and other age-related illnesses.

Antipsychotic Metabolic Risks: How Meds Shorten Life in Bipolar Disorder

I know that people really want to blame all the risks of early death in bipolar disorder on medication, specifically, antipsychotics, but this just isn’t true. If you’ve been paying attention to everything I’ve mentioned so far, you can see that many things affect our overall lifespan.

• Second-generation antipsychotics commonly induce weight gain, dyslipidemia, hyperglycemia, and full metabolic syndrome in up to 45.3% of treated patients. (Which is not to say that those not treated with antipsychotics do not also get metabolic syndrome; they do, at alarming rates, due to the factors mentioned above.)
• To drill down: In bipolar disorder, one study found that 38% of all deaths are due to cardiovascular disease (in the range mentioned earlier). If roughly 45% of treated patients develop medication-induced metabolic syndrome, and metabolic syndrome approximately doubles CVD risk, the attributable fraction of excess deaths from medication side effects works out to about 11% of total excess mortality, translating to about 1.5 years lost.

As I said, while antipsychotics can cause harm, it’s not as much as people tend to think. Moreover, this harm is dose-dependent, meaning that the higher a dose of antipsychotics you are on, the more harm they are likely to cause.

Untreated Bipolar Disorder: Losing Up to 20 Years of Life

While I said studies report 11-20 years lost to bipolar disorder, some of that variance has to do with whether the people in the study were treated or not.

• Treated people with bipolar disorder lose around 13 years
• Untreated/inconsistently treated people with bipolar disorder are thought to lose more on the order of 20 years.

Putting Bipolar Mortality Stats into Years: Your Risk Breakdown

This table gives a general idea about how much each risk category affects your life expectancy. (All numbers are approximate, and use an average years lost of ~13, but they are the best I could find.)

Risk Factor	% of Excess Mortality	Years Lost¹
Suicide and Accidents	~30%	~4
Cardiovascular and Metabolic Disease	~35-40%	~4.5-5
Poor Diet and Inactivity	~10%	~1.3
Sleep/Circadian and Inflammation	~10%	~1.3
Social Determinants	~5%	~0.7
Medication Side Effects	~11.8%	~1.5
Overall Gap		11-20

So, while our lives may be negatively impacted by bipolar disorder in myriad ways, it looks like cardiovascular and metabolic diseases are the biggest offenders. The good news about that risk is that we can actively modify it.

Strategies to Narrow the Mortality Gap in Bipolar Disorder

1. Collaborate on Medication Choices and Monitoring
   • Prioritize lower-metabolic-risk agents (e.g., aripiprazole, lurasidone). Talk to your doctor about the risks of your particular medication and what alternative might work if you need it.
   • Try to stay on the smallest dose possible.
   • Make sure you get quarterly metabolic labs, weight, lipids, and glucose, so you see any problems coming as soon as possible.
2. Embrace a Whole Food, Anti-Inflammatory Diet
   • Focus on fruits, vegetables, nuts, beans, legumes, lean protein, whole grains, and omega-3s in your diet. (See this post on a brain health diet.)
   • Minimize processed, high-glycemic foods.
   • Check out this brain health diet.
3. Boost Physical Activity
   • Aim for more than 150 minutes per week of moderate exercise.
   • Break up sitting time hourly.
   • You can start small with exercise. Even 15 minutes of walking can be a win.
4. Prioritize Sleep and Circadian Health
   • Always maintain a consistent sleep-wake schedule.
   • Try cognitive behavioral therapy for insomnia (CBT-I) when needed. (Yes, it really works.)
5. Address Inflammation
   • Consider adjunctive omega-3 supplementation and anti-inflammatory lifestyle choices.
   • Your best choice for omega-3 supplementation is a prescription medication, if you can afford it or have coverage. This is because supplements in the US are unregulated, and you never really know what you’re taking.
   • Learn about the right way to use fish oil and omega-3s here.
6. Tackle Social Barriers
   • Seek case management for housing or financial support.
   • Advocate for integrated behavioral-physical health services if possible.
   • Don’t take no for an answer and be prepared to use the formal objection process if you are denied what you believe you are owed.
   • Get help from a non-profit or loved one if you can’t advocate for yourself adequately.
7. Enhance Cognitive and Self-Care Skills
   • Cognitive remediation and executive function training aren’t common but do exist. Ask your psychiatrist or psychologist how you can access them.
   • Use reminders, pillboxes, or digital apps to make sure you take your medication as prescribed.
8. Engage Consistently in Evidence-Based Care
   • Always get regular psychiatric and primary-care follow-ups.
   • Participate in peer support groups or get out and socialize in other ways to reduce isolation and suicide risk.
9. Screen and Treat Comorbidities Early
   • Get annual checks for diabetes, hypertension, and dyslipidemia.
   • Ensure you get specialist referrals as indicated.

Reclaim Your Years: Use Actionable Steps to Extend Life with Bipolar Disorder

Bipolar disorder may try to tacitly shave more than a decade off your life, but that number isn’t destiny — it’s a call to action. From tackling the high risk of suicide and accidents to battling cardiovascular disease, inflammation, and the metabolic toll of medications, so many pieces of the puzzle are things you can influence.

Yes, the statistics are sobering. But armed with evidence and actionable strategies, you can take your power back from the numbers. Start small by scheduling that lab work, joining a peer support group, setting a consistent sleep-wake time, and build momentum. Many of the necessary habits aren’t easy to develop, but over time, they add up to a healthier heart, sharper mind, more resilient body, and ultimately, the longer, fuller life you deserve.