{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T05:31:44Z","timestamp":1772343104272,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,1,18]],"date-time":"2017-01-18T00:00:00Z","timestamp":1484697600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100002491","name":"Bristol-Myers Squibb","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002491","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007123","name":"Stanley Medical Research Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007123","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007338","name":"Foundation for Barnes-Jewish Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007338","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bipolar Disorders"],"published-print":{"date-parts":[[2017,2]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>We report on two patients who experienced emergence of full manic symptoms while receiving vagal nerve stimulation (<jats:styled-content style=\"fixed-case\">VNS<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Two patients, both with a well\u2010documented and verified history of longstanding <jats:italic>unipolar<\/jats:italic> depression, were initiated on <jats:styled-content style=\"fixed-case\">VNS<\/jats:styled-content> for treatment of their severe major depressive episodes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The two patients had emergence of full manic symptoms after 8 and 9\u00a0months of <jats:styled-content style=\"fixed-case\">VNS<\/jats:styled-content>, respectively. Manic symptoms were adequately managed with standard treatments (mood stabilizer and electroconvulsive therapy) and <jats:styled-content style=\"fixed-case\">VNS<\/jats:styled-content> was continued in the two subjects for up to 5\u00a0years without any further occurrences of manic\/hypomanic episodes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These cases suggest that some patients with treatment\u2010resistant depression may have a previously unrecognized bipolar disorder, triggered only by <jats:styled-content style=\"fixed-case\">VNS<\/jats:styled-content>. This report also provides evidence that <jats:styled-content style=\"fixed-case\">VNS<\/jats:styled-content>\u2010induced manic switches, however serious and troubling to patients, can be managed safely, and that <jats:styled-content style=\"fixed-case\">VNS<\/jats:styled-content> maintenance can be continued for an extended period of time without manic relapses. Although the mechanism of action of <jats:styled-content style=\"fixed-case\">VNS<\/jats:styled-content> is not known, emerging evidence supports central nervous system dopaminergic and possibly cholinergic system involvement.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.12463","type":"journal-article","created":{"date-parts":[[2017,1,18]],"date-time":"2017-01-18T12:04:32Z","timestamp":1484741072000},"page":"60-64","source":"Crossref","is-referenced-by-count":11,"title":["Emergence of mania in two middle\u2010aged patients with a history of unipolar treatment\u2010refractory depression receiving vagus nerve stimulation"],"prefix":"10.1111","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4634-2797","authenticated-orcid":false,"given":"Naji C","family":"Salloum","sequence":"first","affiliation":[{"name":"Department of Psychiatry Washington University  St. Louis MO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie C","family":"Walker","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Washington University  St. Louis MO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunil","family":"Gangwani","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Washington University  St. Louis MO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles R","family":"Conway","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Washington University  St. Louis MO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,1,18]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1994.tb02482.x"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0920-1211(00)00181-9"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1006\/ebeh.2000.0046"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0006-3223(99)00304-2"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2005.05.025"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2005.05.024"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2008.04.036"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2005.07.028"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0b013e3181db8831"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brs.2012.09.013"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2015.06.019"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1124\/jpet.106.104166"},{"key":"e_1_2_7_14_1","first-page":"272","article-title":"Enhancement of the function of rat serotonin and norepinephrine neurons by sustained vagus nerve stimulation","volume":"34","author":"Manta S","year":"2009","journal-title":"J Psychiatry Neurosci"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1037\/0735-7044.118.1.79"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-4159.2011.07214.x"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brainres.2007.08.045"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(72)93021-8"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.63.10.1121"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brs.2012.01.009"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1461145709000200"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brs.2012.11.006"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1461145706007425"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v66n0902"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.yct.0000174700.79703.56"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.09m05888blu"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2010.11.005"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.164.4.549"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.2009.01514.x"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brs.2015.12.007"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroscience.2011.05.024"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2015.09.004"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2004.06.025"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.09r05259gre"}],"container-title":["Bipolar Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fbdi.12463","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bdi.12463","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T02:52:08Z","timestamp":1696301528000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/bdi.12463"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,1,18]]},"references-count":33,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2017,2]]}},"alternative-id":["10.1111\/bdi.12463"],"URL":"https:\/\/doi.org\/10.1111\/bdi.12463","archive":["Portico"],"relation":{},"ISSN":["1398-5647","1399-5618"],"issn-type":[{"value":"1398-5647","type":"print"},{"value":"1399-5618","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,1,18]]}}}