Effects of Glucocorticoids on Mood, Memory, and the Hippocampus

Abstract

Corticosteroids, such as prednisone and dexamethasone, are commonly prescribed medications that suppress the immune system and decrease inflammation. Common side effects of long-term treatment with corticosteroids include weight gain, osteoporosis, and diabetes mellitus. This paper reviews the literature on psychiatric and cognitive changes during corticosteroid therapy and potential treatment options. Hypomania and mania are the most common mood changes during acute corticosteroid therapy, although depression has also been reported. However, depression is reported to be more common than mania during long-term treatment with corticosteroids. A decline in declarative and working memory is also reported during corticosteroid therapy. Corticosteroids are associated with changes in the temporal lobe, detected by structural, functional, and spectroscopic imaging. The mood and cognitive symptoms are dose dependent and frequently occur during the first few weeks of therapy. Other risk factors are not well characterized. Controlled trials suggest that lithium and phenytoin can prevent mood symptoms associated with corticosteroids. Lamotrigine and memantine also have been shown to reverse, at least partially, the declarative memory effects of corticosteroids. Uncontrolled trials suggest that antipsychotics, anti-seizure medications, and perhaps some antidepressants can also be useful for normalizing mood changes associated with corticosteroids. Thus, both the symptoms and treatment response are similar to those of bipolar disorder. Moreover, corticosteroid-induced mood and cognitive alterations have been shown to be reversible with dose reduction or discontinuation of treatment.

Increased Risks of Developing Anxiety and Depression in Young Patients With Crohn's Disease

“…In our study, 16 % of the patients were treated with glucocorticosteroids, which are known to have implications for mood system ( 40 ). Indeed, in this study, the use of steroids was found to be associated with a signifi cantly increased risk of developing anxiety disorders.…”

Negative illness perceptions are associated with impaired quality of life in patients after long-term remission of Cushing's syndrome

“…Following successful treatment of hypercortisolism, signs and symptoms improve substantially. However, prolonged, excessive exposure to glucocorticoids may have long-lasting adverse effects on behavioral and cognitive functions, due to functional and structural alterations in specific brain target areas (1)(2)(3)(4). Furthermore, these patients do not completely return to their premorbid level of functioning, and quality of life (QoL) is persistently impaired despite long-term cure of CS (5).…”

Interdisciplinary management of central nervous system metastasis and neoplastic meningitis: recent developments and future perspectives

“…[104] The severity of memory impairment is correlated to dose and duration of use. [105] Primary prevention strategies might include the implementation of hippocampal-sparing whole brain radiation therapy, prophylactic use of the N-methyl-Daspartate receptor modulator memantine, or blocking the RAAS cascade. Assessment and treatment of depression is an important strategy, including appropriate pharmaceutical or psychological treatments.…”