Yoga for bipolar disorder: a steady routine, highs and lows, slow breathing not fast, lithium and heat, and a class

Get help straight away

The NHS says a mental health emergency should be taken as seriously as a physical one, and that you will not be wasting anyone's time.

• Call 999 or go to A&E if your life is at risk: for example, you have seriously harmed yourself or taken an overdose, or you feel you can't keep yourself safe.
• For urgent help in England, call 111 and select the mental health option, or use 111 online.
• Call Samaritans on 116 123. It is free, any time, day or night.
• In the US, call or text 988, the 988 Suicide and Crisis Lifeline, any time.

Sources 1, 2

Use your crisis plan

NICE asks that your care includes a crisis plan with your early warning signs and triggers for highs and lows, and what to do. If you have one, follow it, and contact your mental health crisis team.

Source 3

Yoga doesn't treat bipolar disorder

NICE (the National Institute for Health and Care Excellence) says to "explain that lithium is the most effective long-term treatment for bipolar disorder", and the NHS (National Health Service): "Do not stop taking your bipolar disorder medicine unless you are told to by a doctor, even if you feel better." Yoga goes alongside the routine, sleep and activity the NHS suggests, never instead of treatment.

Sources 3, 4

The evidence is thin

No adequately powered trial has tested yoga in bipolar disorder. There is a survey of 86 people who practised yoga, one trial in which only 5 people with bipolar disorder finished, and small reviews whose authors say the results "should be approached with caution".

Sources 5, 6, 7, 8

A steady routine matters more than any pose

The NHS says high and low moods can be triggered by "feeling stressed, not getting enough sleep or being too busy". Practise at about the same time each day, in the morning or early afternoon: Bipolar UK advises not exercising "in the late afternoon or evening", because it can make it harder to fall asleep.

Sources 4, 9

Keep the breathing slow

In the survey, 5 of 86 people described a practice they believed increased agitation or manic symptoms. The survey didn't show what caused it, but a review says people with bipolar disorder "may be particularly affected by extreme activities, such as fast breathing, warm surroundings, or very slow and contemplative techniques". Our suggestion: keep to slow breathing with a longer out-breath and no holds, and leave out fast, forceful breathing.

Sources 7, 8

When a high may be starting, don't add more

In trials, gentle exercise including yoga didn't make manic symptoms worse, but people who were high weren't included. A sudden urge to practise much more, later at night or on less sleep, can be an early warning sign: keep your usual routine and follow your crisis plan.

Sources 3, 10, 11

On lithium, drink more when you sweat, and ask before hot yoga

NICE advises people taking lithium to keep up their fluids, "particularly after sweating (for example, after exercise, in hot climates or if they have a fever)". Some antipsychotics make it easier to overheat.

Sources 3, 12, 13

What bipolar disorder is

The NHS: "Bipolar disorder is a mental health condition where you have extreme mood changes. Medicines and talking therapy can help manage it." and "These moods usually last a few days or weeks at a time." Bipolar UK: "Bipolar disorder is a lifelong condition. But if someone gets the right treatment and support, their mood swings can be managed, and they can live and function well." Our exercise and bipolar disorder guide gives the types and how common it is.

Sources 4, 16

Highs

The NHS lists "having a lot of energy, feeling restless or not needing much sleep" and "feeling overly confident or adventurous". Bipolar UK: "When someone is having symptoms of mania, this is a psychiatric emergency." and "Noticing and managing the symptoms of hypomania before they get worse and turn into mania is one of the main challenges for people living with bipolar." So extra classes, or practising late into the night, can be a sign of a high rather than of health.

Sources 4, 17

TreatmentStrong evidence

NICE: "Offer lithium as a first-line, long-term pharmacological treatment for bipolar disorder." Recommended talking therapy should "include self-monitoring of mood, thoughts and behaviour". The NHS: "Bipolar disorder cannot be cured, but there are treatments that can help manage it."

Sources 3, 4

The heartStrong evidence

"Individuals with BD face a 76% higher risk of cardiovascular morbidity and mortality compared to the general population" (an international task force on exercise in bipolar disorder). Across 37 publications, "The overall metabolic syndrome rate was 37.3%", a cluster of risks for heart disease and diabetes. NICE's yearly check includes "weight or BMI, diet, nutritional status and level of physical activity".

Sources 11, 14, 15, 3

Where a class meets the triggers

Most classes mix poses, breathing and relaxation. Some add fast breathing (kapalabhati, bhastrika or breath of fire), long silent meditation, a hot room or a late-evening slot. Those are the parts that meet the triggers: fast breathing and long meditation because of the reports below, heat because of lithium and some antipsychotics, and evening classes because of sleep. A daytime gentle or hatha class with slow breathing avoids all of them (our reading).

Sources 4, 9, 8

No good trial of yoga in bipolar disorderStrong evidence

A search of PubMed found 36 records and no adequately powered yoga trial in bipolar disorder. A 2026 review that pooled the two small yoga trials found no clear effect on depression in bipolar disorder, and a 2026 review of yoga for mood disorders found no newer bipolar trial: "Rigorous studies are needed to establish yoga's effects on mood disorders."

Sources 5, 6, 22, 23

The one trial that included people with bipolar disorderMixed evidence

In Toronto, 72 adults with ongoing depression on medicines, 17 of them with bipolar disorder, had breathing-focused yoga or education classes twice a week for 8 weeks. Depression fell after yoga, "However, there was no significant difference in MADRS ratings between intervention groups." Only 5 people with bipolar disorder finished, too few to analyse, and about 4 in 10 people dropped out. The yoga included fast breathing, building to "80 to 100 breaths per minute"; side effects were "mild and temporary", but with 5 bipolar completers the trial can't show that fast breathing is safe in bipolar disorder (our reading).

Source 6

What practitioners reportEmerging evidence

In an internet survey, "86 respondents provided sufficient information for analysis". Most described benefits, such as less anxiety and more focus. "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." The survey can't say how often this happens, or which practices caused it.

Sources 7, 8

One online class

In 56 people with mood disorders, one 30-minute online class lowered negative feelings straight afterwards; results for bipolar disorder weren't reported separately, and there was no comparison group.

Source 24

Exercise and mood: low certaintyMixed evidence

A 2025 review of 7 exercise trials (576 people) found exercise eased depressive and anxious symptoms, but "GRADEPro analysis rated evidence quality as low for anxiety and very low for depression and mania". A 2026 review limited to English-language trials found no effect on depression. Our exercise and bipolar disorder guide covers the exercise trials.

Sources 10, 22

Does exercise push mood up?Emerging evidence

In trials: "Low-intensity exercise regimens (e.g., yoga, qigong, walking) in this study did not exacerbate manic symptoms.", but "The effectiveness and safety of exercise during the manic phase remains unclear." The 2026 task force says supervised exercise programmes "appear safe with regard to mania risk in clinical trial contexts". In people whose mood was stable, exercise "was not associated with subsequent changes in sad, activated, or energetic feelings" over the next few hours.

Sources 10, 11, 25

Everyday life tells a less tidy storyMixed evidence

More frequent exercise went with more manic symptoms in one large study, but "Directionality and predictive validity cannot be determined." People describe exercise as helpful but able to push a high further, and "forms of exercise with an inherent rhythm may provide a somewhat calming effect". A Cochrane synthesis of 12 studies: "Over- or under-exercising could be counterproductive and accelerate depressive or manic moods."

Sources 26, 27, 28, 21

Intensive meditation and breathing: case reports onlyMixed evidence

A review of 28 published cases of psychosis linked with meditation included 3 of mania; half the people had triggers such as poor sleep, not eating or past mental illness, and "it is difficult to attribute a causal relationship between the two". One man, stable on treatment after one manic episode, became manic again after "a 10-day residential course in which the person was involved in meditation for 11 hours per day". A case series lists late-night practice, fasting, lost sleep and unsupervised practice as possible risks. These are single cases, not a measure of risk.

Sources 29, 31, 30

Sleep loss can trigger a highStrong evidence

In 3,140 people with bipolar disorder, 20% said sleep loss had triggered mania or hypomania, more often with bipolar I (24.7%) than bipolar II (10.8%). Bipolar UK: "Sleep and bipolar are closely connected. If you live with bipolar, getting good quality sleep is one of your key protective factors."

Sources 18, 9

Regular days helpEmerging evidence

In a trial of a talking therapy that steadies daily routines, people who made their days more regular were less likely to relapse. In a cohort of 189 people, a later daily activity rhythm went with more depressive relapses. People with bipolar disorder say "Achieving balance, rhythm, and routine helped to support mood management."

Sources 19, 20, 21

Plan your practice time

Bipolar UK: "Planning your exercise times will help to get your circadian rhythms into a routine to help support your sleep pattern." Our suggestion: the same time on most days, in the morning or early afternoon, and no classes, retreats or practice that cut into sleep.

Source 9

When a high may be starting

Don't add extra training. Keep to your usual routine, protect your sleep, avoid late-night sessions, and contact your team as your plan says.

NICE asks that people with mania or hypomania "have access to calming environments and reduced stimulation". Our suggestion: no fast breathing, no hot rooms and no evening classes; a short, slow daytime practice or a walk instead.

Source 3

In a low

Start small: 10 minutes counts. A long, still final rest can drag your mood down for some people, so keep it short, with your eyes open if you prefer, or sit up and finish with breathing (our suggestion, from the survey's reports of yoga increasing lethargy and the review's line on very slow practices).

Sources 8, 7

Retreats, intensive courses and long meditation

Talk to your mental health team before intensive breathing or meditation practice. Warning signs in published cases included hearing voices, believing others were talking about you, not sleeping, not eating and long practice through the night.

Long silent retreats cut sleep and food and remove your usual routine, the factors named in the case reports.

Sources 30, 31

If exercise is becoming about weight

Exercise is becoming compulsive, or a way to control your weight: exercising too much can be a sign of an eating disorder.

Slow breathing is the default

Breathe in for about 4 and out for about 6, with no holds, or do slow rounds of alternate nostril breathing. Slow breathing is calming for most people; it's a way to settle, not a treatment for mood.

Source 8

Leave out fast, forceful breathing (our suggestion)Emerging evidence

Bhastrika, kapalbhati and the fast parts of Sudarshan Kriya are, in one trial's words, "rhythmic hyperventilation". Leave them out with panic attacks, bipolar disorder, pregnancy or uncontrolled high blood pressure, or if they make you dizzy (our suggestion, as in our yoga for anxiety and sleep guide).

That line covers kapalabhati, bhastrika, breath of fire and the fast cycles of breathing used in some courses. It comes from survey reports, case reports and expert caution: the survey didn't show that breathing caused the agitation people described, and no trial has compared slow and fast breathing in bipolar disorder.

Sources 7, 8, 6, 29

Breath holds

Box breathing and 4-7-8 breathing hold the breath. No harm has been shown in bipolar disorder, but they aren't needed, and our classes leave them out (our suggestion).

Source 6

Drink more when you sweatStrong evidence

NICE: "ensure they maintain their fluid intake, particularly after sweating (for example, after exercise, in hot climates or if they have a fever)". The NHS: "Drink plenty of fluids, especially if you're doing intense exercise or in hot weather when you'll sweat more." The medicine's product information says keeping food and fluids normal "may be of special importance in very hot weather or work environment". Take water to every class.

Sources 3, 12, 34

Keep salt steady, and check painkillers

The NHS: "It's important not to reduce your salt intake suddenly. Talk to your doctor if you want to reduce the amount of salt in your diet." NICE warns people taking lithium "not to take over-the-counter non-steroidal anti-inflammatory drugs", such as ibuprofen; ask a pharmacist what to use for sore muscles.

Sources 12, 3

Starting or changing lithium

"If you have just started taking lithium, or your dose has recently been changed, it may make you feel tired, dizzy, sleepy and make your hands shake." (the NHS) Keep balance poses beside a wall for those days (our suggestion).

Source 33

Hot yoga

If you take lithium or an antipsychotic, ask your doctor before trying hot yoga (our suggestion). Our hot yoga guide lists who else should avoid it.

The MHRA: "Some antidepressants and antipsychotics can affect the body's ability to regulate temperature", and antipsychotics such as olanzapine or quetiapine "can increase your body temperature, making you overheat more easily". "Do not stop taking prescribed medicines during hot weather without advice."

Sources 35, 13

Yoga is light activity

NICE: "People with bipolar disorder, especially those taking antipsychotics and long-term medication, should be offered a combined healthy eating and physical activity programme by their mental healthcare provider." For the heart, brisk walking, cycling or swimming and strength work do more than gentle yoga, so use yoga as one or two sessions in a steady week (our reading). Our exercise and bipolar disorder guide sets out the week.

Sources 3, 11

Call 999 or go to A&E

Call 999 or go to A&E if your life is at risk: for example, you have seriously harmed yourself or taken an overdose, or you feel you can't keep yourself safe.

Source 1

Signs of lithium toxicity: call 999 or go to A&E

If you take lithium and have any of these, the NHS says: "These are signs of lithium toxicity, which is an emergency. Stop taking lithium straight away." Don't drive yourself to A&E, and take the lithium packet or leaflet and any other medicines with you.

• Stomach ache, feeling sick and having diarrhoea.
• Problems with your eyesight (blurred vision).
• Feeling very thirsty, needing to pee more than normal, and lack of control over pee or poo.
• Feeling lightheaded or drowsy.
• Confusion and blackouts.
• Shaking, muscle weakness, muscle twitches, jerks or spasms affecting the face, tongue, eyes or neck.
• Difficulty speaking.

Source 12

Get urgent help today

Bipolar UK says "we do not offer crisis support", so use these:

• In England, call 111 and select the mental health option, use 111 online, or ask for an urgent GP appointment.
• Call Samaritans free on 116 123, any time, day or night (UK and Ireland). If you're under 19, you can also call Childline on 0800 1111.
• Text SHOUT to 85258, any time.
• Contact your mental health crisis team if you have one.
• In the US, call or text 988, the 988 Suicide and Crisis Lifeline, any time.
• If you take lithium, call 111 now if you have an illness that causes severe diarrhoea, vomiting, a high temperature or sweating, a urine infection, or you're not eating and drinking much.

Sources 1, 32, 2, 36

Contact your mental health team or GP promptly

If you notice signs of a high starting, as your plan describes, such as feeling very energetic or restless, not needing much sleep, racing thoughts, speaking fast or talking a lot, impulsive spending or feeling overly confident, or if low mood is deepening. A sudden urge to exercise much more, later at night or on little sleep, can be one of these signs (our suggestion).

Wanting extra classes, longer or faster breathing practice, or practising late at night or through the night can be one of these signs too (our suggestion, from the case reports and our kundalini guide).

Sources 3, 4

See a GP

You have extreme changes in your moods that last a long time or affect your everyday life, or treatment isn't helping.

Source 4

Call 999 for chest pain or collapse

Call 999 if:

• You get sudden pain or discomfort in your chest that doesn't go away; it can feel like squeezing or pressure, burning or indigestion.
• The pain spreads to your left or right arm, or your neck, jaw, stomach or back.
• You have chest pain and feel sweaty, sick, light-headed or short of breath.
• Someone faints while exercising, can't be woken within 1 minute, or has chest pain or a pounding, fluttering or irregular heartbeat.

Sources 37, 38

Breathlessness

Call 999 or go to A&E (accident and emergency) straight away for severe difficulty breathing (gasping, choking or not able to get words out), a chest that feels tight or heavy, pain that spreads to your arms, back, neck and jaw, lips or skin turning very pale, blue or grey, or sudden confusion. If you're more short of breath than usual, or your heart is racing, fluttering or skipping beats, contact NHS 111.

Source 39

Before you start, and during a class

The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.

A joint pain that is sharp, gets worse during a session, lingers into the next day or changes how you move is a reason to use an easier version, and to see a GP or physiotherapist if it keeps happening (the rule in our plans). Muscle soreness for a day or two after something new is normal. In a hot class, stop if you feel dizzy, sick or unwell; our hot yoga guide lists the signs of heat illness.

You can say no to any hands-on adjustment, and a teacher registered with Yoga Alliance must get your explicit consent each time.

With glaucoma, or high blood pressure that isn't under control, skip headstands, shoulder stands and long head-down holds. With osteoporosis, swap deep forward folds for a flat-back hinge from the hips, and twist smoothly. In pregnancy, our yoga in pregnancy guide covers the changes. NCCIH advises beginners to avoid headstands, shoulder stands, the lotus position and forceful breathing.

"Yoga can replace mood stabilisers"Strong evidence

No trial supports it, and the one trial that included people with bipolar disorder didn't beat education classes on its main measure. NICE calls lithium the most effective long-term treatment, and the NHS says not to stop your medicine unless a doctor tells you to.

Sources 3, 4, 6

"People with bipolar disorder shouldn't do yoga"Emerging evidence

Gentle exercise including yoga didn't make manic symptoms worse in trials, and most practitioners in the survey described benefits. The care is in the choice: slow breathing, daytime classes and no heat.

Sources 10, 7

"Powerful breathing is the best part for mood"Mixed evidence

Breathing-focused yoga with fast breathing didn't beat education classes on its main measure, and too few people with bipolar disorder finished to judge its safety. Fast breathing is the practice most often mentioned in the warnings.

Sources 6, 8

"More practice is always better"

A sudden increase in activity, or practice through the night, can be a sign of a high. Bipolar UK lists "Not sleep much" among the signs of hypomania.

Sources 17, 4

"Inversions calm mania"

No evidence supports it. NICE's advice for a high is "calming environments and reduced stimulation", not a particular pose.

Source 3

"Yoga is only for flexible people"

The trial classes were for beginners, and every pose in our class has an easier version.

Source 6