Yoga for Bipolar Disorder? The Upsides and the Risks

Say "yoga" to most people and the thing they're picturing is Hatha Yoga, even if they don't know the name. It traces back to a 15th-century Indian sage, Yogi Swatmarama, and it has become the root system that most other styles branched off from. The aim is a kind of equilibrium between body and mind, with a further reach toward the quieter spiritual layers of the mind. Three tools do the work: Asanas, or poses; controlled breathing; and meditation.

Asanas are body positions meant to keep you healthy and clear out physical ailments. Originally they existed to support meditation, since holding a posture can leave you settled and relaxed for a long stretch. People who practice them regularly report steadier flexibility and stronger bones, along with gains that aren't physical at all: firmer will, sharper concentration, a capacity to withdraw inward.

Then there's Pranayama, the discipline of breath control. Hatha yogis treated it as central, on the theory that whoever masters the breath has found the lever for mastering the mind. It's also said to wake up energies that sit dormant in the body otherwise.

Certain poses are described as massaging and toning the internal organs, which believers connect to warding off diabetes, arthritis, and hypertension, and to steadying glandular and internal functions. Pranayama gets credited with easing asthma and bronchitis. Beyond any of that, Hatha Yoga is pitched as a way to handle stress, loosen tension, and work through anxiety and depression. And there's a case, as it turns out, for people living with bipolar disorder.

A paper in the Journal of Psychiatric Practice collected survey responses from a good number of people who have bipolar disorder and practice yoga. Read together, their accounts point in two directions at once: yoga can help a great deal, and it can also carry hazards.

Lisa Uebelacker led the study. She's an associate research professor of psychiatry and human behavior at Brown University's Alpert Medical School and a staff psychologist at Butler Hospital. As she put it, there is no scientific literature on hatha yoga for bipolar disorder, and there is reason to suspect it could be wonderful in some ways and unsafe in others. What she and her colleagues want to investigate is hatha yoga as something added alongside medication, not a replacement for it.

More than 70 people filled out the online survey, and most of them figured yoga was good for people with bipolar disorder. Asked what impact yoga had on their lives, the answers skewed positive far more often than not. Roughly one in five called it "life changing." One went further: "Yoga has saved my life. ... I might not be alive today were it not for yoga."

Twenty-nine respondents said yoga cut their anxiety, brought on calm, or delivered some other emotional benefit. On the question of mania specifically, 23 named calm as what yoga gave them. Other recurring themes were a break from depressive thinking and a clearer head. The researchers wrote that yoga plainly seems to be a powerful practice for some individuals with the disorder, and that they found it striking how many respondents credited it with a major positive change in their lives.

The picture wasn't uniform, though. Five people said rapid or forceful breathing left them agitated. One slipped the opposite way after a slow, meditative session: "I fell into a relaxed state ... near catatonic as my mind was depressed already. I was in bed for three days afterward." Eleven flagged the chance of physical injury or pain. Four admitted they sometimes turned self-critical or frustrated with how they were performing.

Uebelacker's reading is that the extreme practices may be the ones to steer clear of, long stretches of rapid breathing among them. The point she keeps returning to is matching: the right style of yoga for the right person. Overdoing it seems to be where the trouble starts.

This survey is only the opening move. Uebelacker has spent years looking at yoga for unipolar depression, and together with Lauren Weinstock, who specializes in bipolar disorder, she plans a pilot clinical trial. That trial would set yoga against a respected bipolar workbook and compare how patients fare. Strong results there could justify a larger, better-powered trial capable of pinning down the real benefits and real risks.

All of this sits inside a wider effort aimed at people who are already in conventional treatment. Bipolar symptoms can drag on for decades even with several medications in rotation, and the question the team keeps circling is what place, if any, hatha yoga might hold in that long haul. As Uebelacker described it, they're hunting for additional ways to cope with the suffering that fills people's ordinary days, so that medication and psychotherapy aren't the only cards on the table.

The short version: for some people with bipolar disorder yoga may genuinely help, and for others it may run too hot to be safe.