Funding/financial disclosures. The authors have no conflict of interest relevant to the content of this letter. No funding was received for the preparation of this letter.

Innov Clin Neurosci. 2023;20(1–3):8.

Dear Editor:

We would like to discuss the article, “Bipolar I Disorder Exacerbation Following COVID-19 Vaccination,”1 wherein Guina et al1 described the cases of a 60-year-old female patient and a 40-year-old male patient who both reported exacerbations of previously well-controlled bipolar I disorder symptoms after receiving COVID-19 vaccines. The inflammatory response induced by vaccines can potentiate acute mental health exacerbations, necessitating treatment changes, according to Guina et al.1 Despite this, this case series should not be used to support recommendations against vaccination in the absence of larger, carefully planned studies. Before the patient submits clinical information for vaccination, comorbidity is typically eliminated.1 Controlling comorbidities can be challenging if there are issues with COVID-19 vaccination,2 and controlling comorbidities is typically not an option if a clinical problem arises after the immunization. It is also possible that there might be an asymptomatic misunderstanding with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and there are times when a comorbidity is viewed incorrectly as having a detrimental impact.3 Recent studies4 revealed a link between underlying genetic variation and recipient immune response to COVID-19 immunization. The effects of the numerous genetic background elements should be considered in all future studies.


  1. Guina J, Barlow S, Gutierrez D. Bipolar I disorder exacerbation following COVID-19 vaccination. Innov Clin Neurosci. 2022;19(7–9):9–11.
  2. Joob B, Wiwanitkit V.  Letter to the editor: coronavirus disease 2019 (COVID-19), infectivity, and the incubation period. J Prev Med Public Health. 2020;53(2):70. 
  3. Kebayoon A, Wiwanitkit V. Dengue after COVID-19 vaccination: possible and might be missed. Clin Appl Thromb Hemost. 2021;27:10760296211047229.
  4. Čiučiulkaitė I, Möhlendick B, Thümmler L, et al. GNB3 c.825c>T polymorphism influences T-cell but not antibody response following vaccination with the mRNA-1273 vaccine. Front Genet. 2022;13:932043. 

With regards,

Rujittika Mungmunpuntipantip, PhD, and Viroj Wiwanitkit, MD

Dr. Mungmunpuntipantip is a Private Academic Consultant in Bangkok, Thailand. Dr. Wiwanitkit is Adjunct Professor, University Centre for Research and Development Department of Pharmaceutical Sciences, Chandigarh University Gharuan in Mohali, Punjab, India.