Bipolar I Disorder Exacerbation Following COVID-19 Vaccination

We present the cases of a 60-year-old female patient and 40-year-old male patient who experienced exacerbations of previously well-controlled symptoms of bipolar I disorder (BD1) after receiving COVID-19 vaccines, despite being stable for years on the same medications. The first patient experienced worsened depression, mania, and psychosis that improved with an increase in risperidone. The second patient experienced depression, mania, psychosis, and suicidal ideation that resulted in hospitalization. Prior to hospitalization, he took lamotrigine and bupropion, the latter of which was changed to aripiprazole in hospital. We reviewed current literature on inflammation in mental disorders, vaccination-related inflammatory changes, and the type of inflammation induced by COVID-19 vaccines. Inflammation is a component of psychiatric disorders, and the inflammatory response induced by vaccines might potentiate acute mental health exacerbations, necessitating treatment changes. However, this case series should not be used to justify recommendations against vaccination without larger, well-designed studies. At this time, the known benefits of vaccination outweigh these unknown risks, especially because individuals with serious mental illness are more likely to die from COVID-19 than the general population.