One way to know there will be no science at a nutrition conference is to find a yogic flying instructor on the panel roster. Yoga has a variety of mental and physical health benefits, just like all exercise and sports do, but it is not going to cure bipolar disorder or any other disease.

Even taking a few dozen surveys of people with bipolar disorder who do hatha yoga, a questionable methodology, does not find clinical benefits outside the placebo range, according to a paper in the Journal of Psychiatric Practice. 
Hatha yoga is the practice, familiar in the West, in which people move between various poses. It often includes breathing practices and meditation.

Yet collective testimonials gathered online are all there can be, which means anyone who advocates it as a treatment for bipolar disorder really shouldn't be allowed. The questions the 70 people answered were leading: "What impact do you think yoga has on your life?" The majority of responses were positive - not a shock from people who take yoga, they wouldn't take it otherwise - and about one in five respondents characterized yoga as "life changing." One even replied, "Yoga has saved my life. ... I might not be alive today were it not for yoga."  

29 other respondents said yoga decreased anxiety and promoted calm or provided other emotional benefits. Calm also emerged as a specific benefit for 23 survey respondents when asked how yoga affects mania symptoms. Other benefits that were mentioned repeatedly included distraction from depressive thoughts and increased clarity of thought.

"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."

Among the small sample survey answers they also found that yoga could be problematic for some people with bipolar disorder, though it is no surprise fewer people cited problems.

In response to survey questions about whether yoga has had a negative impact, for example, five respondents cited cases in which rapid or energetic breathing made them feel agitated. Another 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."

"There is no scientific literature on hatha yoga for bipolar disorder," said lead author Lisa Uebelacker, staff psychologist at Butler Hospital. "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."

Like some people in general who practice yoga, 11 respondents 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," 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.

Next: A Pilot Clinical Trial

Obviously you can't do a double blind clinical trial of yoga and bipolar disorder, but Uebelacker and colleague Lauren Weinstock now have a grant from the Depressive and Bipolar Disorder Alternative Treatment Foundation to create 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, Uebelacker said.

For many bipolar patients, symptoms persist for decades despite multiple medications. The current studies of yoga, 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.

"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" Uebelacker said.