Yoga benefits mental health but does carry some risks
Although hatha yoga has frequently been recommended for patients with bipolar disorder (BD) and there is preliminary evidence that it alleviates depression, there are no published data on the benefits and potential risks of yoga for patients with bipolar disorder.
“There is no scientific literature on hatha yoga for bipolar disorder,” said lead author Dr. Lisa Uebelacker, PhD, associate professor (research) of psychiatry and human behavior in the Alpert Medical School of Brown University and a staff psychologist at Butler Hospital. Hatha yoga is the practice, familiar in the West, in which people move between various poses. It often includes breathing practices and meditation. “There is reason to think that there are ways in which it might be wonderful and ways in which it might not be safe. We are interested in studying hatha yoga for bipolar as an adjunctive treatment to pharmacotherapy.”
In this new study Dr. Uebelacker, and colleagues examined the risks and benefits of yoga in individuals with bipolar disorder.
Bipolar disorder causes dramatic mood swings, from feeling overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these episodes. The periods of highs and lows are called episodes of mania and depression. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Approximately 2.6 percent of American adults live with bipolar disorder.
For the study researchers recruited 109 yoga practitioners to complete an Internet survey that included measures of demographic and clinical information and open-ended questions about yoga practice and the impact of yoga
Eighty-six respondents had provided sufficient information for analysis and 70 met positive screening criteria for a lifetime history of mania or hypomania. The most common styles of yoga preferred were hatha and vinyasa.
When asked, “What impact do you think yoga has on your life?” the vast majority of responses were positive, particularly reduced anxiety, positive cognitive effects (e.g., acceptance, focus, or “a break from my thoughts”), or positive physical effects (e.g., weight loss, increased energy). Around one in five respondents characterized yoga as “life changing.” One even said, “Yoga has saved my life. … I might not be alive today were it not for yoga.”
“There is clearly evidence that yoga seems to be a powerful practice for some individuals with BD,” the researchers wrote in the paper. “It was striking that some of our respondents clearly believed that yoga had a major positive impact on their lives.”
The most common negative effect of yoga was physical injury or pain. Five respondents gave examples of specific instances or a yoga practice that they believed increased agitation or manic symptoms; five respondents gave examples of times that yoga increased depression or lethargy. One respondent became too relaxed after a slow, meditative practice: “I fell into a relaxed state … near catatonic as my mind was depressed already. I was in bed for three days afterward.”
Among respondents 11 warned that there is the potential for physical injury or pain. Another four said they became self-critical or frustrated with their performance sometimes during yoga.
“It’s possible that you want to avoid any extreme practice, such as extended periods of rapid breathing,” Dr. Uebelacker said. The survey also raised some concerns about heated yoga, which is consistent with evidence that the use of certain medications for bipolar disorder, including lithium and antipsychotic medications, are associated with possible heat intolerance and resulting symptoms of physical illness.
The researchers write “Our results suggest two overarching themes: hatha yoga may be a powerful positive practice for some people with bipolar disorder; and hatha yoga is not without risks, and, like many treatments for bipolar disorder, should be used with care.”
This study did have limitations including the lack of structured interview to confirm bipolar diagnosis in participants.
The researchers noted “From a clinical perspective, patients (and their clinicians) may use the information we collected to decide whether to try community yoga for themselves, and, if so, what potential risks to watch for.”
This online survey is the first stage in a research program that Uebelacker, who has spent several years studying yoga for unipolar depression, and colleague Dr. Lauren Weinstock, PhD, assistant professor of psychology and human behavior and an expert in bipolar disorder, are developing to examine yoga for bipolar disorder. They now have a grant from the Depressive and Bipolar Disorder Alternative Treatment Foundation to run a pilot clinical trial in which they will compare outcomes from yoga to outcomes from using a well-regarded workbook for bipolar disorder.
Those results could set the stage for a larger trial with enough statistical power to rigorously identify benefits and risks, Dr. Uebelacker said.
For many bipolar patients, symptoms persist for decades despite multiple medications. The current studies of yoga, Dr. Uebelacker said, are part of a broader program at Butler and Brown to determine what else can help people who are already undergoing conventional therapies.
According to Dr. Uebelacker “We’re looking at alternative ways to cope with suffering that is part of people’s everyday lives so that there are other options in addition to ongoing medication and psychotherapy.”
As their research continues, they will learn what role hatha yoga might play.
In addition to Dr.’s Uebelacker and Weinstock, another author on the paper is Morganne Kraines, graduate student, Oklahoma State University.
Journal of Psychiatric Practice