Corticosteroid therapy may be associated with a number of adverse psychiatric effects, which can be quite severe.


Psychiatric disorders associated with corticosteroid therapy:

(1) elevated mood, euphoria

(2) mania or hypomania

(3) anxiety

(4) depression

(5) psychosis

(6) bipolar (mixed mania and depression)

(7) delirium

(8) insomnia or restlessness


Psychiatric symptoms usually appear within the first few (2-3) weeks of starting therapy (or after an increase in dosage). Depression and other symptoms also may appear on discontinuation of therapy.


Risk factors for an adverse psychiatric effect:

(1) pre-existing psychiatric disorder

(2) high dose therapy (dose-dependent)

(3) history of drug-induced mood changes

(4) significant stressor


Unfortunately many cases are unpredictable.


Differential diagnosis:

(1) neuropsychiatric complications of comorbid disease (SLE, other)

(2) adverse effects of other medications


Management options:

(1) discontinuation of therapy

(2) dose reduction

(3) treatment with lithium, antidepressant, antipsychotic or other agent


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