People with bipolar disorder who do yoga believe their yoga practice has significant mental health benefits, reports a survey study in the September Journal of Psychiatric Practice.

"Some individuals with bipolar disorder believe that yoga has had a significant positive impact on their life." according to the study by Dr. Lisa A. Uebelacker of Butler Hospital and Brown University, Providence, R.I., and colleagues. But they note their survey shows that yoga is "not without risks"—including potential worsening of symptoms related to bipolar disorder.

The researchers recruited 109 individuals who identified themselves as having bipolar disorder and as being yoga practitioners. Participants were asked to complete an online survey concerning their yoga practice and its impact on their mood disorder symptoms. Of 86 individuals with usable responses, 70 had positive results on a screening questionnaire for manic, or less-severe hypomanic symptoms.

Participants reported practicing yoga for an average of six years; they attended a yoga class twice a week and practicing yoga at home three times per week, on average. Two-thirds of respondents said they practiced yoga for exercise/to improve flexibility and to reduce stress and anxiety.

Most participants believed that yoga had benefits for their mental health. Two-thirds said that yoga positively affected their depressive, manic, or hypomanic symptoms at least some of the time.

They also reported positive emotional effects of yoga, such as reduced anxiety and worry; positive cognitive effects, especially in terms of increased mindfulness; and positive physical effects, such as weight loss, increased energy, and improved sleep. Fifteen respondents said that yoga had been "significantly life-changing."

But about one-fourth of respondents reported some type of negative effects related to yoga. The most common negative effects were physical pain or injury. In addition, nine percent of respondents reported that yoga had negatively affected their bipolar disorder symptoms at some time.

Some gave examples of yoga practices that they believed increased agitation or manic symptoms, such as rapid/energetic breathing or heated yoga. Others said that yoga had at times led to increased depression or lethargy—for example, after very slow and meditative practice. At least one report raised concerns about possible heat intolerance during hot yoga in patients taking antipsychotic medications or lithium.

Dr. Uebelacker and coauthors note important limitations of their Internet survey study—particularly in that it was limited to people who identified themselves as having bipolar disorder, and relied on participant-reported effects of yoga. The researchers write, "Our results suggest that hatha yoga may be a powerful positive practice for some people with bipolar disorder but that it is not without risks and, like many treatments for bipolar disorder, should be used with care."

The next step is to undertake a pilot study of yoga as an adjunctive intervention for bipolar disorder. In the meantime, Dr. Uebelacker and colleagues add, "We hope that 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."