Meditation, Psychosis and Mania: Who Should Check With a Clinician First

Urgent help first. If you or someone else is seeing or hearing things that others cannot, has strong beliefs that are not shared by others, has not slept for days and feels unusually driven or confused, or is at risk of harm, get medical help now. In the US, call 911 in an emergency, or call, text or chat 988 for crisis support (free, confidential, 24/7). [1] The NHS advises seeing a doctor immediately for symptoms of psychosis, because early treatment can be more effective. [2]

This page is general information. It is not a reason to stop any medicine or treatment you take.

What psychosis and mania are

The NHS describes psychosis as losing some contact with reality, which may involve hallucinations and delusions. [2] Mania is a high mood phase of bipolar disorder, with signs such as feeling restless or not needing much sleep. [3]

What the case reports show

There are published cases of psychotic or manic episodes beginning around meditation. A 2022 review gathered 28 cases from 19 studies; the types of meditation included mindfulness, transcendental and Buddhist practices among others. [4] In 14 of those cases there were precipitating factors such as insomnia, lack of food, a history of mental illness, stress or psychoactive substance use. [4] The authors say it is difficult to attribute a causal relationship between meditation and psychosis. [4]

A 2007 case report and literature search concluded that meditation can act as a stressor in vulnerable patients, who may develop a transient psychosis. [5] Other cases it found involved relapse of an existing psychotic disorder or a brief reaction in someone with no psychiatric history. [5]

Evidence label: insufficient evidence about how often this happens, and evidence of harm for some vulnerable people from case reports. Case reports cannot give a rate, and people who have a reaction are more likely to be written about. Proper evidence not found for a trial that measured psychosis risk from ordinary meditation in people without a psychotic illness.

What trials of structured programs show

Structured programs delivered by trained clinicians for people who already have psychosis are a different situation from meditating alone.

• A 2024 systematic review of 39 studies (2,684 participants) found no significant difference from control groups in adverse events, death, symptom deterioration or dropout, and a lower risk of hospitalisation and crisis service use in the mindfulness groups. [6]
• The same authors note that none of the studies reported side effects of the interventions, so the absence of thorough harm reporting prevents a balanced analysis. [6]
• A 2022 meta-analysis of 31 studies in non-affective psychosis said short-term programs can be helpful, with high heterogeneity, and called for research on efficacy and safety over longer periods. [7]
• An earlier review of eight trials (434 patients) found no serious adverse events reported. [8]

For bipolar disorder, a review of ten studies of mindfulness-based cognitive therapy found mania symptoms were not alleviated, with only three controlled studies. [9] Another review of 13 studies (429 participants) called the approach promising alongside medication. [10] See mindfulness for OCD, bipolar disorder and psychosis.