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Prednisone Psychiatric Symptoms

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Steroid Induced Psychiatric / Mood Effects

Steroids Prescribed to reduce Inflammation can often have Psychiatric Side Effects (PSEs). Steroid Induced Psychiatric effects can occur in Adults or in Children.
Mood / Psychiatric Effects
Aggression
Anxiety
Dementia
Depression
Distractibility
Easily Altered Mood
Euphoria
Hallucinations
Insomnia
Irritability
Mania
Memory Deficits
Psychosis
Tearful

Factors Affecting Steroid Induced Psychiatric Effects

The likelihood and extent of Steroid Induced Psychiatric effects vary and can depend on multiple factors:
Type of Steroid Prescribed
Some types of steroids have a greater or lesser likelihood of inducing Psychiatric Side Effects.
Age / Sex of Patient
Females are more likely to have Steroid - Associated Psychiatric Symptoms than Males. [2]
Age of the patient does not appear to have an effect. [3]
Dosage
Corticosteroids are more likely to affect Mood or cause Psychiatric Disturbance at Higher Doses. [1][3]
- A study looked at how Prednisone dose correlated with Psychiatric Disturbance and found severe Psychiatric Disturbance in:[3]
-- 1.3% of Patients with Prednisone Dosage of 40 mg/day or less;
-- 4.6% of Patients with Prednisone Dosage between 41 - 80 mg/day;
-- 18.4% of Patients with Prednisone Dosage greater than 80 mg/day

High Dose steroid therapy more often causes Manic symptoms (although it can also cause depression). Symptoms of Mania often occur 3-5 days after beginning therapy but can occur any time during the course of treatment. Depressive symptoms can occur during the course of treatment or after the medication is stopped.

Low Dose, Long Term steroid therapy (7.5 mg/day Prednisone for more than 6 months) more often causes Depressive symptoms than Mania. [3]
Stage of Steroid Treatment / Time of Exposure
Psychiatric Side Effects can occur at any dosage of medication, or following Withdrawal.
Psychiatric Side Effects: Acute Phase
Psychiatric Side Effects: Maintainence Phase
Psychiatric Side Effects: Tapering Phase / Withdrawal
Psychiatric Side Effects: Post Medication Withdrawal

Treatment for Steroid Induced Psychiatric Symptoms

Treatment varies depending on the Type and Severity of Psychiatric Disturbance. Often, physicians will suggest no treatment as some symptoms resolve (or severity is reduced) with no intervention or after Steroid treatment is stopped.

If the patient is having difficulty dealing with symptoms sometimes the dosage is reduced slightly as long as the condition being treated allows for dosage reduction without exacerbation of symptoms.

In patients that require continuation of Steroid therapy during Psychiatric Symptoms an additional medication may be prescribed. These medications may include: Lithium, Valproic Acid (Depakote), SSRIs, Tricyclic Antidepressants, Antipsychotics / Neuroleptics.

References

1. Brown ES and Chandler PA. Mood and Cognitive Changes During Systemic Corticosteroid Therapy. Prim Care Companion J Clin Psychiatry. 2001;3(1): 1721. http://www.ncbi.nlm.nih.gov/pmc/arti...03-01-0017.pdf

2. Sirois F. Steroid psychosis: a review. General Hospital Psychiatry. 2003: 2733. http://blog.ecu.edu/sites/penderst/f...-psychosis.pdf

3. Warrington TP. and Bostwick JM. Psychiatric Adverse Effects of Corticosteroids. Mayo Clin Proc. 2006; 81(10):1361-1367. http://www.medicine.wisc.edu/~willia...ch_effects.pdf

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