Cold Plunge and Mental Health

By the clinical team at Next Step Psychiatry • Lilburn, GA

The Cold Plunge Craze

Cold water immersion has exploded in popularity thanks to influencers, podcasters, and wellness advocates promoting its benefits for mental health, energy, and resilience. From dedicated cold plunge tubs to ice baths and cold showers, millions of people are incorporating cold exposure into their routines. But how much of this is supported by science and how much is hype? As psychiatrists, we owe our patients an honest assessment of the evidence.

How Cold Exposure Affects the Brain

Cold water immersion triggers a powerful physiological stress response. When your body encounters cold water, it releases norepinephrine, a neurotransmitter involved in attention, focus, and mood regulation. Studies show that cold exposure can increase norepinephrine levels by 200 to 300 percent. It also activates the sympathetic nervous system, releases endorphins, and may increase dopamine levels. A 2023 study in Biology found that cold water immersion increased plasma dopamine concentrations by 250 percent, which could explain the mood-boosting effects many people report.

Evidence for Depression and Anxiety

A frequently cited 2008 case study in Medical Hypotheses proposed that cold showers could help treat depression through the dense network of cold receptors in the skin sending electrical impulses to the brain. However, this was a hypothesis paper, not a clinical trial. More recently, a 2022 study in Lifestyle Medicine found that participants who took cold showers for 30 days reported reduced anxiety and improved mood. A 2020 study in the British Medical Journal documented the case of a young woman whose treatment-resistant depression remitted after starting weekly cold water swimming. While these results are intriguing, we lack large randomized controlled trials, and most evidence comes from small studies, case reports, and observational data.

Risks and Who Should Avoid It

Cold water immersion is not without risks. The initial cold shock response can cause dangerous cardiac arrhythmias in people with underlying heart conditions. Hyperventilation during cold exposure can lead to aspiration if the face is submerged. Hypothermia is a real risk with prolonged exposure. People with Raynaud disease, uncontrolled hypertension, heart disease, or cold urticaria should avoid cold plunging. If you are taking beta-blockers or other cardiac medications, consult your doctor first. The safest way to start is with cold showers rather than full immersion, gradually increasing duration over weeks.

Our Clinical Take

At Next Step Psychiatry, we view cold exposure as a potentially helpful wellness practice for some patients but not a replacement for evidence-based psychiatric treatment. If a patient finds that cold showers improve their mood and energy, we support that. However, we would never recommend cold plunging as a standalone treatment for clinical depression, anxiety disorders, or any other psychiatric diagnosis. The best outcomes come from combining healthy lifestyle practices with proven treatments like therapy and medication when indicated. If you are interested in incorporating cold exposure into your routine, discuss it with your psychiatrist to ensure it is safe for you.

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider. If you or someone you know is in crisis, call 911 or the 988 Suicide & Crisis Lifeline.