Emergence of mania in two middle-aged patients with a history of unipolar treatment-refractory depression receiving vagus nerve stimulation.
Naji C SalloumMarie C WalkerSunil GangwaniCharles R ConwayPublished in: Bipolar disorders (2017)
These cases suggest that some patients with treatment-resistant depression may have a previously unrecognized bipolar disorder, triggered only by VNS. This report also provides evidence that VNS-induced manic switches, however serious and troubling to patients, can be managed safely, and that VNS maintenance can be continued for an extended period of time without manic relapses. Although the mechanism of action of VNS is not known, emerging evidence supports central nervous system dopaminergic and possibly cholinergic system involvement.
Keyphrases
- bipolar disorder
- major depressive disorder
- middle aged
- end stage renal disease
- depressive symptoms
- newly diagnosed
- ejection fraction
- chronic kidney disease
- sleep quality
- prognostic factors
- patient reported outcomes
- drug induced
- cerebrospinal fluid
- oxidative stress
- patient reported
- endothelial cells
- replacement therapy
- smoking cessation