Psychiatric complications of treatment with corticosteroids: Review with case report

Abstract

Corticosteroids are widely used in modern medicine but can result in troubling psychiatric side-effects. Physicians and other medical professionals should be aware of the potential for these side-effects, possible means of prevention, and efficacious treatments. Herein, we review adult case report data published during the past quarter-century on adverse corticosteroid-induced psychiatric effects, and present a case of corticosteroid-induced psychotic depression. PubMed and PsychLit databases were searched using the terms 'corticosteroids', 'steroids', and the generic names of corticosteroid medications with terms for psychiatric symptoms or syndromes, including psychosis, mania, hypomania, depression, apathy, anxiety, panic, depersonalization, delirium, confusion, hallucinations, delusions, paranoia, cognitive impairment and dementia. Fiftyfive cases and a number of clinical trials investigating the incidence and treatment of these psychiatric symptoms and syndromes were identified. Data on incidence, drug dose, risk factors, course of illness and treatment (when present) were tabulated. We conclude that the cumulative data indicate that psychiatric complications of corticosteroid treatment are not rare and range from clinically significant anxiety and insomnia, to severe mood and psychotic disorders, delirium and dementia. While tapering or discontinuation of the corticosteroid treatment may remedy these adverse side-effects, psychotropic medications are often required because of the medical necessity of the corticosteroid or the severity of the psychiatric symptom. Further studies are needed to better understand the deleterious psychiatric effects associated with corticosteroids.

Steroid Psychosis: A Case Series of Three Patients

“…However, they found 100% effectiveness in cases where neuroleptics and steroid taper, or treatment with lithium alone, or treatment with ECT alone was initiated. 5,12 In two of our patients, the psychotic symptoms resolved soon after drug tapering and withdrawal, without initiation of any psychotropic medications. However, one patient received treatment with antipsychotics like risperidone and olanzapine.…”

“…However, many publications on this topic appear to support the symptoms of depressive disorder (40%) in majority of patients followed by mania (25%). 4,5 Interestingly, all our patients presented with symptoms of psychosis without any mood disturbance.…”

“…Corticosteroids dexamethasone and methylprednisolone have half-life of 36-54 h and 18-36 h respectively. 5 This may have led to persistence of symptoms even after drug withdrawal.…”

“…Other risk factors to develop steroid psychosis include hypoalbuminuria and use of drugs which can increase circulating levels of corticosteroid like cytochrome P450 enzyme inhibitor. 2,5 In the first two cases use of cytochrome P450 enzyme inhibitors like doxycycline, hydroxychloroquine, pantoprazole and esomeprazole could have also contributed to the development of psychosis. 8,9,10,11 Various treatment approaches are available for steroid induced psychosis.…”

Immunotherapies for Neurological Manifestations in the Context of Systemic Autoimmunity

“…Steroid-induced psychosis is arguably rare and usually resolves after steroid discontinuation, but adjunctive antipsychotic treatment may be required in those cases that steroids seem to be the main culprit [163].…”