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Guest Cheri Crist

Major Prednisone Psych Reactions

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Guest Cheri Crist

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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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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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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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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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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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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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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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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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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Guest Guest_rlsnights_*

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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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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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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Guest FrannyNZooey

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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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}>

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Guest FrannyNZooey

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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Guest Guest

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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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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