By Anita Kablinger, MD, CPI, DFAAP, DLFAPA, FACRP, FASCP
This presentation explored the complex interplay between neuromodulation treatments and mood disorder diagnosis through a detailed clinical case. A 46-year-old man with long-standing treatment resistant depression experienced significant improvement following vagus nerve stimulation (VNS), only to later develop a first-ever manic episode several months into treatment. The episode prompted hospitalization, adjustment of stimulation parameters, and initiation of mood stabilizers, ultimately leading to a revised diagnosis of Bipolar I Disorder. With careful management, the patient was able to safely continue VNS and demonstrated sustained improvement in depressive symptoms over long-term followup.
The case highlights both the therapeutic potential and diagnostic implications of neuromodulation in mood disorders. While treatments such as ECT, rTMS, and VNS offer meaningful benefits for patients with refractory depression, they can occasionally unmask underlying bipolarity, particularly in individuals with risk factors such as family history or substance use disorders. The key message emphasized the importance of thorough screening, vigilant monitoring for emergent manic symptoms, and timely intervention. When managed appropriately, neuromodulation remains a safe and effective option—even after treatment-emergent mania—underscoring its valuable role in contemporary psychiatric care.
