Contents lists available at ScienceDirect
journal homepage: www.elsevier.com/locate/psychres
Letter to the Editor
Psychotic mania induced by diﬀuse meditation
To the Editor.
Increasing evidence supports the view of meditation and mindfulness as favorable to well-being in the general population and in those suﬀering
from mental illness (Leung et al., 2014;Mehrmann and Karmacharya, 2013). Little is known, however, regarding the role of its potential negative
consequences, such as meditation triggered mania or psychosis. We report an interesting case which suggests meditation may not always be
Ms. D is a 28-year-old white female with a history of multiple episodes of mania with psychosis following meditative practices who presented to
the emergency department in January 2015 for bizarre, aggressive, and hypersexual behavior which began after meditating at a secluded Buddhist
retreat center. Prior to her presentation, she was found meditating in her shrine room at home wearing formal regalia of a Buddhist practitioner and
later attacked her friends, both violently and sexually. Upon examination in the Emergency Department, the patient exhibited waxing and waning
catatonic symptoms, grandiosity, pressured speech, thought blocking, disorganization, inappropriate giggling, and paranoia. She endorsed auditory
and visual hallucinations of her Buddhist teachers and was noted to be responding to internal stimuli. Later she reported decreased need for sleep
during the previous week. She denied regular use of over-the-counter medications, and her only prescription medication was the oral contraceptive
desogestrel-ethinyl estradiol/ethinyl estradiol.
Ms. D reported three previous similar episodes, all while in India and Nepal studying Buddhist meditation in more depth. On one occasion, she
exhibited disorganized and hypersexual behavior which led to hospitalization at a local institution and initiation of a mood stabilizer. However, Ms.
D discontinued the medication after discharge, believing that her altered state was a natural consequence of deep meditation. Noteworthy, the
patient's Buddhist mentor had previously advised her to refrain from any further meditative practices. Further investigation into our patient's
practices revealed engagement in mostly diﬀuse meditation and deity yoga, the latter involving the practitioner self-identifying with a deity.
Ms. D was admitted to our inpatient facility involuntarily, and a diagnosis of bipolar disorder, type 1, was made. Electroencephalogram, head
computerized tomography, and laboratory tests including urine drug screen did not reveal any abnormalities. Lithium and low dose haloperidol
were initiated which resolved her symptoms within two days. Upon discharge, Ms. D displayed excellent insight and willingness to comply with
treatment, including recommendation for refraining from further meditation practices. Of note, she later remembered attempting to show her
friends that she indeed was a Buddhist deity, which led her to engage in the bizarre behaviors she demonstrated.
Previous literature shows sparse information regarding meditation triggering mania and/or psychosis. PubMed was utilized to search for all
previous reports available in English with the following keywords in various combinations: meditation, mindfulness, Buddhism, Buddhist, mania,
bipolar, mood disorder, aﬀective disorder, psychosis, psychotic, and schizophrenia. Fifteen case reports, all identiﬁed in a review article by Kuijpers
et al. (Kuijpers et al., 2007), described diﬀerent types of primary psychotic disorders associated with meditation (Kuijpers et al., 2007), and only two
reported bipolar disorder (Chan-Ob and Bonyanaruthee, 1999; Yorston, 2001).
This case illustrates that despite the growing data of the beneﬁts associated with meditation, it may also trigger mania or psychosis in susceptible
individuals. Because of their intense cognitive demands of prolonged nonreactive monitoring of the ongoing stream of experience from moment to
moment (Lutz et al., 2008) without a speciﬁc object of focus, diﬀuse meditation and deity yoga may be overwhelming to individuals prone to
psychosis or mania who may already have limited sensorimotor gating abilities. Further exploration of the eﬀects of the diﬀerent forms of
meditation on individuals suﬀering from severe mental illness is warranted before considering meditation as an innocuous well-being practice for
Chan-Ob, T., Bonyanaruthee, V., 1999. Meditation is association with psychosis. J. Med. Assoc. Thail. 82, 925–930.
Kuijpers, H.J., van der Heijden, F.M., Tuinier, S., Verhoeven, W.M., 2007. Meditation-induced psychosis. Psychopathology 40, 461–464.
Leung, N.T., Lo, M.M., Lee, T.M., 2014. Potential therapeutic eﬀects of meditation for treating aﬀective dysregulation. Evid.-Based Complement. Altern. Med. 2014, 402718.
Lutz, A., Slagter, H.A., Dunne, J.D., Davidson, R.J., 2008. Attention regulation and monitoring in meditation. Trends Cogn. Sci. 12, 163–169.
Mehrmann, C., Karmacharya, R., 2013. Principles and neurobiological correlates of concentrative, diﬀuse, and insight meditation. Harv. Rev. Psychiatry 4, 205–218.
Yorston, G.A., 2001. Mania precipitated by meditation: a case report and literature review. Ment. Health, Relig., Cult. 4, 209–213.
Holly N. Sherrill, John Sherrill, Ricardo Cáceda
Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 West Markham St., Slot #554, Little Rock, AR 72205, USA
E-mail address: firstname.lastname@example.org
Received 3 June 2016Received in revised form 21 December 2016Accepted 24 December 2016
Psychiatry Research (xxxx) xxxx–xxxx
0165-1781/ © 2017 Elsevier B.V. All rights reserved.