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Major Prednisone Psych Reactions

58 posts in this topic

Posted

After battling a respiratory infection that wouldn't go away, my doctor put me on a 3-day course of predisone. Only three days, no tapering. I can't believe the reaction I've had after only a three-day course: I felt like I was going to turn green and start crashing through walls. I was filled with such rage, and then the hypersensitivity and crying jags would start. My whole body ached. I was a mess. It's been about a week and a half since going off it and I still feel weird. After one particularly scary episode, I saw my psychiatrist, who confirmed that it was probably prednisone-induced mania, and told me that even though the drug had probably left my system, it was most likely still present in my brain. He gave me some Zyprexa to get me through the rough bits (makes me feel uber-stoned, though, so try not to take it.)

I've done some research into prednisone's psych side effects, and have only seen its effects bipolar people; for the record, my diagnosis is depression and anxiety and prednisone effected me horribly. So basically, this is a warning to anyone with any kind of mood disorder to avoid prednisone if you can possibly help it. It's disrupting my life in ways that in the end, just aren't worth any benefits it may have provided.

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Posted

Prednisone can cause mood and personality changes in all people not just those of us with a mood disorder. I had my first psychotic break while taking Prednisone. So for me at least it is a drug to avoid and No Prednisone is engraved on my medic alert necklace.

But a doc who Rx's Prednisone with no taper, well I have never heard of not tapering off Prednisone after an allergic reaction or respitory infection, etc. Must have sucked.

Erika

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Posted

I'll second that response. A friend of mine had to take prednisone for an allergic reaction. She ended up in the Emergency ward with extreme anxiety, depression, paranoia and mild hallucinations.  She has no mood problems ordinarily.

prednisone = bad

I wonder what the percentage of people affected is...

Greeny

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Posted

Steroid Psychosis is a well known effect and can happen to anyone.

Taking a steroid pulse without tapering is typical for moderate dosages for less than 5 - 7 days. The only reason downward tapering is used is to prevent suppression of cortisone production by the adrenal glands, not for anything related to steroid psychosis. Studies have shown that steroid psychosis is more common at dosages above 60mg per day, but have been reported at all dosages.

Now you know how your body reacts to cortical steroids, be careful. Be aware that there are other types of steroids your doctor may prescribe for other reasons, which won't have the same effect.

A.M. (I've played this tune as well)

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Posted (edited)

Here's an excellent study, high points below.

This study suggested that patients receiving daily doses of greater than 40mg of Prednisone or its equivalent were at greatest risk for developing a steroid psychosis.

No characteristic stable presentation was observed in these 14 patients, but the most prominent symptom constellation to appear during the course of the illness consisted of emotional lability, anxiety, distractibility, pressured speech, sensory flooding, insomnia, depression, perplexity, agitation, auditory and visual hallucinations, intermittent memory impairment, mutism, disturbances of body image, delusions, apathy and hypomania.

The incidence of steroid psychosis varies widely in the literature ranging from 13 to 62%, with a weighted average of 27.6% for some steroid induced mental change, the vast majority of which are mild to moderate and do not herald the development of a full-blown psychosis or affective syndrome.

Overall, approximately 40% of patients present predominantly with a depressive disorder, 25% with mania, 5% with a bipolar disorder-cyclical form; 15% with an agitated schizophreniform or paranoid psychosis and 10% as an acute progressive delirium. Three-quarters of all patients with steroid psychosis evidence affective symptoms some time during the course of their illness. A frank psychotic state without mood disturbance occurs in 10 to 15% of patients while some psychotic features, (i.e., a marked impairment of reality testing) associated with affective symptoms occurs in 70% of patients.

In conclusion, steroid induced mental changes are common. The overall incidence of steroid psychosis when steroids are used to control systemic medical disorders varies between 3 and 6%. The clinician usually has a window of from 24 to 96 hours to initiate treatment and abort the full-blown picture of steroid psychosis.

Edited by Greenyflower

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Posted

The link to the study didn't work...could you post it again?

Here's an excellent study, high points below.

This study suggested that patients receiving daily doses of greater than 40mg of Prednisone or its equivalent were at greatest risk for developing a steroid psychosis.

No characteristic stable presentation was observed in these 14 patients, but the most prominent symptom constellation to appear during the course of the illness consisted of emotional lability, anxiety, distractibility, pressured speech, sensory flooding, insomnia, depression, perplexity, agitation, auditory and visual hallucinations, intermittent memory impairment, mutism, disturbances of body image, delusions, apathy and hypomania.

The incidence of steroid psychosis varies widely in the literature ranging from 13 to 62%, with a weighted average of 27.6% for some steroid induced mental change, the vast majority of which are mild to moderate and do not herald the development of a full-blown psychosis or affective syndrome.

Overall, approximately 40% of patients present predominantly with a depressive disorder, 25% with mania, 5% with a bipolar disorder-cyclical form; 15% with an agitated schizophreniform or paranoid psychosis and 10% as an acute progressive delirium. Three-quarters of all patients with steroid psychosis evidence affective symptoms some time during the course of their illness. A frank psychotic state without mood disturbance occurs in 10 to 15% of patients while some psychotic features, (i.e., a marked impairment of reality testing) associated with affective symptoms occurs in 70% of patients.

In conclusion, steroid induced mental changes are common. The overall incidence of steroid psychosis when steroids are used to control systemic medical disorders varies between 3 and 6%. The clinician usually has a window of from 24 to 96 hours to initiate treatment and abort the full-blown picture of steroid psychosis.

<{POST_SNAPBACK}>

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Posted

Hehe when I mouse over the link it says it's "http:///".  I didn't know / was a website! ;)

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Posted (edited)

Nevermind

Edited by number_6

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Posted

HOWEVER.... since I have no choice but to use steroids to keep breathing when on the down hill slide into pneumonia, my doc tried an alternative: Prednisolone (marketed as Medrol).

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Posted

Sorry.

I edited the URL. It's an actual link now.

Greeny

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Posted

I frequently take prednisone to break my migraine cycles.  In fact I am coming off it right now.  This med really screws me up.  I get so disoriented and can barely function.  I also just started Effexor, so I am really feeling icky even more so than I have previously on prednisone.

The first time my neuro prescribed it, it was with no taper for 7 days - 20mgx3 times a day.  My system was so screwed up.  I don't think I slept that entire week.  Since then, he always does a taper.

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Posted

I took prednisone the first time I ended up in the hospital with asthma/pnemonia/bronchitis back in '96.  They did not know I was bi polar, and I wasn't under a pdoc's care at the time.  Back then, I only acknowledged my manic depression as "Oh yeah, I have really bad mood swings sometimes."  Can we say "denial" anyone?

Anyway, I found out the hard way that prednisone and BP don't mix, but since they pumped so much of it into me during the two weeks I was in the hospital, I *had* to taper off of it, and it took me a month (I think... could have been six weeks - it was eleven years ago) to do that.  I still feel sorry for my roommates who had to put up with the psycho bitch from hell for so long.  Luckily, it didn't get *too* bad, and they were able to keep me out of trouble.

Not only did it give me wicked mood swings, but man, I still remember the horrible heartburn.  I had to sleep sitting up most of the time.  It sucked rocks.

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Posted

I just found this board and subject and wanted to add my experience to the thread. If you are having a steroid psychosis reaction you are not alone and you need info for self-defense. Check out the article link listed in Greeyflower's thread and print it out - you may need to give a copy to your GP or Pdoc or other specialist so they treat your condition correctly. Don't let them dx you based on this psychosis - it could really make your life worse.

My story: I experienced a severe rx to 20 mg prednisone used to treat my inflammatory arthritis symptoms (I had changed HMO plans earlier in the year and had a new crop of docs). Ended up in Intensive Outpatient program with full blown manic-depressive episode - my first ever. Had a hx of MDD and PTSD, no BP. Anyway, the Pdocs wanted to label me BP while I was still flipped out then the Tdoc wanted to label me BPD while I was still coming down and I objected to both based on my hx. The Tdoc used my objections to further justify the BPD dx and put it in my file without disclosing it to me - just found that out this week. Anyway 3 months after the height of my psychotic break, I was still having MDD symptoms so the Pdoc put me on Impipramine, slow titration to 75 mg. 3 weeks after reaching 75 mg I developed palpitations and at 4 weeks began to experience episodes of severe emotional lability, suicidal ideation, si impulses, etc. When I tried to talk the Pdoc about it he said it wasn't the Imipramine, that I was BPD and needed to go to DBT to learn to handle these feelings. 1 week later I was hospitalized with a severe cellulitis infection and got morphine 6 mg every 2 hours for 3 days while also receiving the Imipramine. The day after I got out of the hospital (still on IV antibiotics with a PICC line) I flipped out completely - spent 3 hours walking 5 miles home from the ER at 1 am raging, screaming and hitting everything in my path. Went to see a different Pdoc yesterday and said I think I'm having a rx to the Imipramine and I'm going to stop it. She agreed - said I should stop the Imipramine w/no weaning and should recover from psychotic symptoms within one week. If I'd found that article I'd have known to tell the first Pdoc to shove it when he wanted to prescribe Impramine (a tricyclic). It clearly states Tricyclics make steroid psychosis worse. It is so validating to see this information and know that all of this has been medication induced.

Anyway, I also talked to this Pdoc about my frustration with the BPD dx and she agreed I'd never had a proper diagnostic eval and she'd help me get one once I was better. So I'm hopeful of getting somewhere with that.

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Posted (edited)

I was just on prednisone for five days, 40mg, no taper. My last day was two days ago, my heart is about to burst out of my chest right now, and Klonopin is barely touching the anxiety. At least I know now it's not just me losing it, but a side effect of the prednisone.

I'm also ten days into Buspar for GAD (5mg tid) and it seemed like it was just beginning to work. Who knows, now.

I'm glad I took the prednisone, really; I just wish I'd had a little more info. My primary doc is a good person, so I'll talk to her about it when I see her in two weeks.

Edited by folder1

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Posted

I was supposed to be on Prednisone for a bad knee thing...the urgent care specialist recommended it, but I don't do anything with meds without talking to my PCP first. She said ABSOLUTELY not, not with bipolar, and that it'd make the time I went nuts on Zoloft look like child's play. Not in everybody, apparently, but if you have a history of not doing so well on meds because they screw with your head, it could be very bad. However, you shouldn't do anything without talking to a doctor first :> If they still say yes, even knowing the whole story, it seems like they're the ones you should listen to. But they have to know the whole story; probably, a pdoc would be a good person to talk to, too, if your PCP doesn't know so much about the psych meds or reactions.

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Posted

I had asthma since child, and so many severe allergic reactions to so many things, sort of like new thing of week for while.

Still can go out hiking and plant scratch and that happen, full blown hives, throat swelling up.

So, I have had so many injections, plus packets of prednisone, and times where thought packets not be enough, since past history had to piggyback them. I would have 60 mg a day after injection day for 4 plus days then 40mg 4 days and so on...

What is odd all the talk here, maybe since so much use of it I kind of built of immunity, because I like the extra just buzz, nothing remotely close to agitation I felt from couple days of just starting Wellabutrin, that I could not bear!

Aly

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Posted

Interesting about the "buzz" -- the first couple of days on prednisone, I had some extra energy, but that may have been the joy of being able to breathe easily for the first time in over a month. It was only after I stopped the prednisone that I experienced anxiety (and nightmares last night).

I like the extra just buzz, nothing remotely close to agitation I felt from couple days of just starting Wellabutrin, that I could not bear!

Aly

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Posted

Interesting about the "buzz" -- the first couple of days on prednisone, I had some extra energy, but that may have been the joy of being able to breathe easily for the first time in over a month. It was only after I stopped the prednisone that I experienced anxiety (and nightmares last night).

I like the extra just buzz, nothing remotely close to agitation I felt from couple days of just starting Wellabutrin, that I could not bear!

Aly

<{POST_SNAPBACK}>

<{POST_SNAPBACK}>

True the whole breathing thing can do that for ya  ;)   And not scratching all night at hives!

Were you titrated down slowly? I would be on for quite a while and really titrated down slowly and to just 1 pill for few days too.

I never had anxiety afterwards or nightmares, just missed my friendly beginning buzz got to admit, but glad to be getting healthy!

Aly

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Posted

Here's the article on Steroid Psychosis in case the link doesn't work:

Psychiatric Adverse Drug Reactions: Steroid Psychosis

by Richard C.W. Hall, M.D.

Medical Director, Psychiatric Programs

Clinical Professor of Psychiatry

University of Florida, Gainesville

It's excellent!

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Posted

Injected cortisone (or whatever it is) doesn't cause a problem for me (several times in wrists, couple times in shoulder, once in back). Briefly used a prednisone inhaler for newly-diagnosed asthma, no longer need it now that the GERD is finally controlled.

I had one course of oral prednisone for horrific tendinitis. Yikes. It did nothing for the tendons, but cleared up my asthma brilliantly, and made me totally nuts until I'd tapered all the way off.

I hope never to have to take oral prednisone again. I'm crazy enough when I'm "normal", sure don't need to be that crazy.

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Posted

interesting. Been on LOTS of predinsone a little while ago... just turns me into an asshole...not that that takes a whole lot of turning.

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Posted

I'm really glad I found this website. I was diagnosed with Refractory ITP (Wikipedia Article) on Sept 5th 2009. Since day one they have been pumping me full of every variation of prednisone known to man, along with decadron. We're talking 160mg/day for about 5 weeks straight, and then I've been tapering over the last several weeks and am now finally down to 30mg/day, which is still relatively high. I can't wait until I'm completely off. The phrase I prefer to use for myself is 'batshit crazy'. Although I don't think that really does it justice, and I really don't think anyone truly understands how strongly it is affecting me. I'm also in the middle of a divorce, and have lashed out at my estranged wife in ways that I am truly ashamed of. I make threats, I argue over anything, I cry constantly, I scream at the top of my lungs, and can barely keep myself from physically damaging things when they frustrate me. I am so miserable and want off the prednisone so bad, but I have to go through the titration process (tapering), which has it's own set of miserable side effects. I still have all the anxiety, but now I am noticing I am extremely fatigued most of the day. I'm also coming off a very heavy opiate regimen for the pain mgmt for the splenectomy I had to have for the ITP. So anyway, I'm a stinkin mess and am taking a little comfort in the fact that I'm not alone. I've also talked to my hematologist and psychologist about it and they agree that I have steroid psychosis and opiate withdrawal sickness (runny nose, mania, perplexity, etc..). I can't wait for this to all seem like a dream, but I regret the damage that has been done to those who don't understand the severity of this issue. It's even more confusing to those around me when I act completely fine for a while. I also have clinical depression and generalized anxiety prior to being thrown into the emergency room by the symptoms of ITP, which were pretty severe and scary. So they took me off Effexor cold turkey when I got diagnosed with ITP because they thought it might have triggered the ITP. So now I take a $hitload of klonopin, but it doesn't even put a dent in the steroid psychosis, although my psychologist shudders at the thought of what I would look like without the klonopin. Ok, I think I've said enough and I could keep typing for hours so I will end it here. I will leave you all with one last note that might be of some use. Get a cannabis card (if you can in your state) and get some edible THC products from the dispensary. They have been my only silver lining. I am able to relax a little, and even nap sometimes if I eat a brownie or whatever treats they have available. Everyone tells me "Boy, you sound great today" when I've eaten one of those, so that's a testament to the efficacy. I hope this information helps someone. Good night.

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Posted

i had kidney failure, got a transplant and one of my post transplant drugs is prednisone. This drug put me on a real good energetic happy buzz when i first started it. After three and half yrs i started to get chronic tension headaches, developed moon face, loads fluid retention. Then along with the headaches i started to find it hard to breathe at night, heart beating way too fast. I knew it was the prednisone as when i took it all my bad symptoms went away for few hours. I said to my doc that my health ws better when i ws on dialysis because at least then i ws just nautious after food, now im nearly always in pain and have sleep problems. I tapered slowly off the drug suffering really bad with anxiety, joint pain, chronic headaches and bad nightmares every night. this drug gave me the worst health of my life. I am finished tapering now and am in my best health in years ;)

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Posted

All I've been hearing is bad things about prednisone on this site.. for me, prednisone is the greatest drug.. it made me feel alive again.. it took away my depression and made me feel veryyyy happy, energetic, confident, charismatic, motivated, creative, it inflated my self esteem, it gave me hope that my depression could be relieved.. i know this is a hypomanic side effect, but i dont care, it was awesome !!.. i was on 50mg for 4 days (wish it was longer) for bronchitis.. i didnt have any rage, agitation, psychotic sypmtoms and i wasn't irritable.. I just had the best time of my life !.. The only down side about prednisone is it increased my anxiety and OCD symptoms, but I didnt really mind because I was soo joyful. And the big downfall is when i went off of prednisone, i got reallyyyy depressed for a couple of days, this is to be expected though, when your at a big high and go off then your bound to hit a low.. Apparently prednisone mania/hypomania wears off after a few weeks... Anyway to sum things up, if someone offered me prednisone, I would take it in a heart beat.. Even if it has bad long term side effects..

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Posted (edited)

Stop Prednisone Negligence Now!

Doctors, nurses, and hospitals worldwide are prescribing this drug in record numbers, without any thought or concern for their patients personal safety. This drug was originally created IN THE 1930'S to help infertile men due to hypergonadism. It is in essence synthetic testosterone. If this drug is given to someone with high testosterone and low serotonin (the combo for serial killers!) then YOU WILL HAVE EMOTIONAL INSTABILITY, even PSYCHOSIS. This IS PREDNISONE TOXICITY! Hair loss/baldness, obesity/insatiable appetite, ostheoporosis, heart failure, renal failure, IMMUNE SYSTEM CRASH/adrenal gland atrophy--ALL COMMON "ADVERSE REACTIONS"--aka.....Prednisone Toxicity.

Patients are rarely told about the serious and life threatening "Adverse Reactions" that often accompany the use of this drug. The pharmacies handing out this medication often give charts and "warning pamphlets" with such small print, most people could never read them, let alone understand them. This is not good enough! Prednisone is far too dangerous a drug to leave to fine print--or political and legal loopholes. Please see the website below for a list of Adverse Reactions/side effects, Indications, and dosage charts.

http://noairtogo.tripod.com/prednisone.htm

Even with the "knowledge" of severe reactions, many patients are left permanently disabled with no help from their physicians from the disabling effects of this drug. This universal misuse of Prednisone needs to stop now. Your tax dollars are spent by the millions supporting people that are permanently disabled by this drug. Do not allow this to continue. With enough signatures, we will be able to get our Representatives to hear us. If you do nothing....then nothing will change.

Stand up and be counted, stop Doctors from over-prescribing this deadly drug today before someone in your family is injured, becomes disabled, or dies because of Prednisone. Sing the petition today to vote for strict regulation of this awful drug, and demand compensation for pain and suffering doctors so willingly refuse to acknowledge.

[REDACTED LINK]

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Edited by Aurochs
rm petition link

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