Kratom May Exacerbate Psychiatric Conditions Including Psychosis and Mania

Why it matters

Kratom's mood-altering alkaloids interact with dopamine, serotonin, and opioid receptors in ways that can exacerbate pre-existing psychiatric conditions — a major clinical concern given that kratom's metabolites are undetectable on standard urine toxicology screens.

The big picture

As kratom is increasingly marketed as a natural supplement for mood and anxiety, this research highlights a dangerous paradox: kratom could worsen the very mental health conditions it is often sought to treat, particularly in vulnerable populations without access to formal psychiatric care.

Key findings

• • Case report: A patient with bipolar disorder developed acute mania with psychotic features after replacing benzodiazepines with increased kratom consumption
• • Kratom's alkaloids interact with D2 dopamine, 5-HT2A, 5-HT2C, alpha-2 adrenergic, and mu-opioid receptors — all implicated in psychiatric disorders
• • Kratom metabolites are not detected on routine urine toxicology screens, creating a diagnostic obstacle in emergency and psychiatric settings
• • At least 54 alkaloids extracted from kratom leaves, with mitragynine and 7-hydroxymitragynine showing 10-20x greater mu-opioid potency than morphine in animal studies

What they say

Case report with literature review; Bergen Newbridge Medical Center, NJ; published in Psychiatry Research Case Reports 2022.

Bottom line

Kratom can exacerbate psychiatric conditions like mania and psychosis in predisposed individuals, and its metabolites go undetected on standard drug screens — clinicians must specifically ask about kratom use in psychiatric evaluations.