Am I Going Crazy?

Prednisone affects not just your body, but also your brain. In this article find out what psychiatric side effects to expect and how to cope with them. First a video explains the side effects, and then a second video gives tips for how to cope with mood changes from prednisone.

Many people on prednisone are surprised and feel betrayed when not only they no longer look like themselves because of moon face and weight gain, but they don’t feel like themselves on prednisone.

I know I felt like a stranger in my own body.

Even my brain and moods were no longer trustworthy.

Learn about how prednisone affects your moods and brain.
It’s not you–it’s the drug!

Every week I speak to you Live on Facebook about a prednisone topic that we all struggle with. I teach based not only on my experience as a fellow prednisone patient, but also from evidence-based information gleaned from my research and expertise as a pharmacist.

This blog post is special. Several people approached me directly and asked me to speak on this topic.

Watch Dr. Megan explain this in further detail Live on the Facebook Prednisone Pharmacist Page.

Show Notes:

Psychiatric Side Effects of Prednisone

Incidence & Prevalence of Psychiatric Side Effects of Prednisone

• Prednisone Users make up 0.9% of the population
  • #31 most common drug prescribed in U.S.
  • 23.3 million prescriptions for prednisone in 2018
• Overall, 52.5% of prednisone users report a mood condition
• Lifetime Risk while on prednisone: 60% will have a mood or anxiety disorder
• Incidence: ranges from 1.8% to 57%, or 13-62%, or 27.6%
• Serious Side Effects: 15.7/100 person-years on prednisone
• Hospitalizations: 7% of prednisone users are hospitalized for psychiatric side effects

Types of Psychiatric Side Effects to Prednisone

• Mood Lability: agitation, indifference, tearfulness, irritability
• Anxiety: restlessness, worry, fear, agitation
• Insomnia: restlessness
• Depression: lethargy, suicidality
• Memory: cognitive impairments, distractibility, confusion
• Mania: euphoria, hypomania, pressured speech
• Psychosis: (steroid psychosis) delirium, hallucinations, disorganized thought, delusions

Typical Timing of Psychiatric Side Effects:

• Early: euphoria, mania
  • Insomnia, anxiety
• Longer time: depression, mood lability
• Later: psychosis, memory impairment, suicidality

When can psychiatric side effects happen?

• At any point in the prednisone journey
• Immediately upon taking prednisone
• After stopping prednisone
• Timing Experiment:
  • 39% in 1 week
  • 62% within 2 weeks
  • 83% within 6 weeks
  • Median = 11.5 days

Risk Factors:

• History of mental illness is NOT a risk factor
• Dose does not predict the onset, severity, type or duration of psychiatric side effects
• However, higher dose does predict the prevalence:
  • <40 mg = 1.3%
  • 41-80 mg = 4.6%
  • 80 mg = 18.4%
• Gender: Female > Male
  • Females > depression
  • Males > mania, delirium
• Type of Steroid Drug:
  • Long-acting more likely to cause than short-acting, and more likely to cause depression
• Age:
  • Children
    • Under 6, elderly
      • Cognitive, memory
    • 50% behavior change
  • Adults
    • 18-30: Panic disorder
    • 18-50: suicidal
  • Older Age:
    • > 80 years: Delirium, confusion, disorientation

So who is at risk?

• All patients should be considered at risk and should be monitored:
  • During treatment
  • Withdrawal
  • For some time afterward
• For signs of changes in: mood, memory, thinking, behavior
• Basically, anyone could have psychiatric side effects at any time. It is usually reversible but in the minority of cases, it may not go away for a long time.

How to Cope with Psychiatric Side Effects

• First Line: stop prednisone or decrease the dose of prednisone
• Second Line: non-prescription strategies or prescription

Watch Dr. Megan explain this in further detail Live on the Facebook Prednisone Pharmacist Page.

Non-prescription ways to cope:

• Mood Lability: meditation
• Anxiety: breathing techniques
• Insomnia: bedtime routine
• Depression: exercise
• Memory: keep challenging your brain
• Mania: use this energy to do good things like meal prep
• Psychosis: ECT
• Examples:
  • Meditation: start a practice
    • Resource: Calm app
  • Mood Lability:
    • Online Courses: Parenting, Marriage
    • Marriage Books:
      • John Gottman, The Seven Principles for Making Marriage Work
      • Love Languages

Prescription Treatments for Psychiatric Side Effects to Prednisone

• Mood Lability: talk therapy
• Delirium: haloperidol, atypical antipsychotics
• Anxiety: Zoloft, Xanax
• Insomnia: melatonin, Benadryl (diphenhydramine), Ambien (zolpidem)
• Depression: Zoloft, lithium
• Memory: Namenda, Lamictal, propranolol
• Mania: Lithium, olanzapine (Zyprexa), phenytoin, valproic acid
• Psychosis: (steroid psychosis) atypical antipsychotics, lithium, ECT

Just remember that it is not YOU, it’s the drug. Give yourself grace that you’re not going crazy; you are just suffering from a side effect to a medication. But you do need to get help if these things are happening to you. There is no shame in getting the help that you need.

Sources:

1. Warrington TP, Bostwick JM. Psychiatric Adverse Effects of Corticosteroids. Mayo Clin Proc. 2006;81(10)1361-1367. Link
2. Judd LL, Schettler PJ, Brown ES, et al. Adverse Consequences of Glucocorticoid Medication: Pyschological, Cognitive, Behavioral Effects. Am J Psychiatry. 2014;171(10):1045-51. Link