Psychiatric Side Effects of Prednisone

Prednisone not only affects your body, but it also affects your mind. Based on scientific sources, this article will discuss the psychiatric effects of this nightmare drug and how you can cope with its effects.

First, a video explains the side effects. You’ll find out who is most likely to get psychiatric side effects plus when they are most likely to happen. Finally, another video gives tips on how to cope with mood changes from prednisone.

Am I Going Crazy?

While you may feel like you’re going insane, due to the psychiatric effects of prednisone, you are not going crazy. Many people who take prednisone feel frustrated with themselves, not only because of the mental effects of this drug but also the physical impact prednisone has on their bodies (weight gain, “moon face”, acne, etc.).  Naturally, this leaves people feeling confused and like a stranger in their own body. Trust me. It’s not you–it’s the drug!

It’s not you–it’s the drug!

I have been asked several times to do a video on the psychiatric effects of this “nightmare drug.”

Below is a video highlighting the psychiatric side effects of prednisone.

Watch Now

https://youtube.com/watch?v=09WyyjfZboM%3Ffeature%3Doembed

Example Of How Prednisone Affects Your Brain

One patient shared her story about her experience with taking prednisone. She stated that three days after starting a high dosage of prednisone, she began experiencing depression, intense fatigue, malaise, weight gain, and swelling of her lower extremities. She felt impaired and had difficulty falling asleep. This patient also experienced impulsivity, which caused her to be inappropriate in professional settings.

Her mind was flooded with racing thoughts, and she suffered from memory problems and required multiple reminders, including pinning it to her clothes so that she wouldn’t forget her responsibilities and appointments (yikes).

While her doctor told her that she might become hyperactive, she was not prepared for the extent of the changes she would face while taking prednisone.

During other prednisone treatment cycles, her depression became so bad, she sought help from a psychiatrist. Even after stopping prednisone, she continues to report memory problems, loss of cognitive clarity, and vulnerability to overreactive distress.

Do any of these symptoms sound familiar to you?

My Personal Experience

Before I was prescribed prednisone, the drug that fixes one issue while simultaneously causing a dozen other ones, my doctor and I had a discussion about it. He reminded me that one of the most common side effects of this medication (insomnia) is going to be something that I would have to (unfortunately) deal with.

After explaining this, he said that since I am a pharmacist, I could tell him which medication I wanted to take along with the prednisone for the insomnia it would cause. It was as though I wrote my own prescription with his signature.

Prednisone and Psychiatric Side Effects

Incidence & Prevalence Of Psychiatric Side Effects Of Prednisone

It is important to note that more than half of people who take prednisone report a mood condition or mood swings as a result of taking it.

There is a 60% chance that you’ll have a mood or anxiety disorder while taking prednisone. While you may feel isolated and frustrated, you are not alone.

How many people are taking prednisone? There is a lot of confusion surrounding the exact numbers; however, the lowest estimate is 0.9% of the U.S. population takes prednisone.

In 2018, prednisone was the “31st most commonly prescribed drug behind thyroid medicines and blood pressure medicines and a few antibiotics.” There were 23.2 million prescriptions written in 2018.

Below is a picture that indicates these statistics.

Can Prednisone Cause Anxiety And Other Mood Changes?

Absolutely! Two of the most commonly experienced psychiatric side effects of prednisone are anxiety and depression.

Types Of Psychiatric Side Effects Of Prednisone

Someone taking prednisone may experience one or more of the following side effects:

• Irritability
• Euphoric hyperactivity
• Anxiety
• Memory Issues: cognition, difficulty with concentration, declarative memory, working memory, abstraction, and analysis
• Mania: unpredictable labile, manic, or hypomanic symptoms
• Psychosis
• Depression
• Insomnia

How Long Does It Take For Side Effects To Occur?

The side effects of prednisone vary from person to person, as well as the timing for the effects to show up. As seen in the chart below, patients may begin to experience side effects such as anxiety and insomnia when they first begin taking prednisone. Depression and fluctuating mood (mood lability) happens after a longer time. Memory loss is more likely to happen later on, after a longer time on prednisone, than in the beginning of treatment.

Presented here is a picture of the typical timing of when the side effects of prednisone typically start.

STEROID PSYCHOSIS (ONE PREDNISONE WARRIOR’S STORY)

Psychosis is one of the rarest side effects of prednisone. Unfortunately, there have still been people who have been deeply affected by this tragic side effect. One prednisone warrior’s wife recalls the story of her late husband who went through psychosis:

My husband was on lithium for a couple of decades. He was prescribed prednisone and it gave him night terrors. We got the doctors to wean him off sooner than planned but he had some sort of psychotic break and shot himself. I’ve been with him for 30 years, saw him manic, saw him depressed and this was not that. I’m just searching for information. I don’t know why psychosis isn’t included in listed side effects and I want to help change that. I don’t want anyone to have to face this tragedy.

This story is not meant to scare you all. While this is a rare occurrence, it is imperative that I speak on all of the side effects of this medicine. They used to call it steroid psychosis because of the severe psychiatric effects of prednisone.

Another Prednisone Warrior’s psychosis side effects were so severe that his friend wrote a book about his experience: Steroids Stole My Summer.

When can psychiatric side effects to prednisone happen?

• At any point during prednisone treatment
• Immediately upon taking prednisone
• After stopping prednisone

Below is a chart with the results of an experiment conducted on the timing of when the side effects of prednisone began to show up.

After conducting this experiment, it was found that 39% of people experienced a mood side effect within one week of starting prednisone. 62% within two weeks, and 83% of people within six weeks. The average median was 11.5 days.

There is a high chance that if you take prednisone, you will experience side effects rather quickly; however, it might not happen until you have completely tapered off. Another study showed that most people experienced side effects within one week. When I was taking prednisone, I began to experience these horrible side effects within a week of taking it.

While there is research that shows that people suffer from psychiatric side effects due to prednisone, there is no way to predict if someone will actually develop these side effects or not. The effects will vary from person to person, which is why it is important to pay attention to yourself and notice when you are not quite feeling like your usual self.

It’s possible to have side effects after just one dose. The dose does not predict the onset, severity, type, or duration of psychiatric side effects.

Side Effects During Withdrawal

One study looked at the incidence of side effects during the withdrawal period, a later time in prednisone use while tapering off, and found that for 100 person-years of taking prednisone, an incidence of:

• 11.2 for depression
• 3.9 for delirium, confusion, or disorientation
• 0.4 for mania
• 0.4 for panic disorder
• 0.03 for suicide attempt

Due to the heightened depression that prednisone causes, there is a (very small) chance that patients feel suicidal, but it is a seven times greater risk than those who haven’t taken prednisone. Only 0.03 out of 100 person-years of people who are on prednisone attempt suicide. If you ever feel suicidal ideations, please do not hesitate to reach out to mental health crisis hotlines or check yourself into the emergency department. In the USA, call 988.

Remember, it’s not you, it’s the drug!

Prednisone Risk Factors for Mood Side Effects

Those taking a low to normal dose (less than 40 milligrams) of prednisone had less psychiatric effects, such as depression and anxiety.

4.6% of people taking a higher dosage of prednisone (greater than 40 mg and less than 80 mg) suffered from extreme psychiatric effects. At a super high dose (greater than 80 mg), 18.4% of people had severe psychiatric side effects.

While the side effects are unpredictable, the research suggests that the higher dosage you are on, the more severe your symptoms may be.

Do Prednisone Side Effects vary by Gender?

Studies show that women are more likely to experience depression, while men are more likely to experience mania or delirium.

What About Age?

50% of children who take the “nightmare drug” are more likely to suffer from a behavior change, which can range from acting more hyperactive, trouble sleeping, to memory impairments. In addition to this, the elderly is also more likely to suffer from memory issues.

Those who are 18 to 30 years old are the most likely to suffer from a panic disorder, and those 18 to 50 years old are the most likely to be suicidal and follow through with their plans.

Patients over the age of 80 are more likely to experience side effects such as delirium, confusion, and disorientation.

The effects on concentration, recall, abstraction, and analysis have been called “steroid dementia” when extreme.

Who is at Risk for Prednisone Causing Psychiatric Side Effects?

• All patients should be considered at risk and should be monitored:
  • During treatment
  • During withdrawal
  • For some time afterward
  • For signs of changes in mood, memory, and behavior

Listed below is my favorite quote from the scientific article the majority of these facts came from:

“Educating patients about possible side effects and the need to report them is essential.”

This quote is important to me, as it is the foundation of what I do here as the Prednisone Pharmacist. Ensuring that others are aware of symptoms and ways to cope that I was not aware of when I started taking prednisone is truly essential in making sure that you all are making the right decision for your medical needs.

Stay in touch with your doctor and report the side effects if you cannot tolerate them.

How To Cope With Psychiatric Side Effects

But is there anything else you can do to cope with the psychiatric side effects of prednisone?

In this video, I highlight ways that you can cope with the side effects of prednisone.

https://youtube.com/watch?v=ChMPXJpOod

1. First Ask: “Should I Take Prednisone?”

Now that you’ve heard all that scary stuff, you may be wondering whether it’s worth it or not to take prednisone. If there’s nothing better and you’ve tried all the alternatives, then yes, benefits can outweigh the risks. With up to 150 total side effects possible, the reason you’re taking prednisone had better be pretty important to justify that kind of risk.

The scientific article continued, “Glucocorticoids in any form–oral, topical, inhaled, or parenteral–have the potential to disrupt HPA axis function and should be prescribed only if there is no effective non-glucocorticoid treatment for the medical condition.”

To translate that into plain English: ANY kind of steroid, whether a pill, a cream/lotion/gel, nasal spray, inhaler, or IV can cause side effects. They should ONLY be given if there’s no alternative that works.

ANY kind of steroid, whether a pill, a cream/lotion/gel, nasal spray, inhaler, or IV can cause side effects. They should ONLY be given if there’s no alternative that works. 

So, ask your doctor if there’s any other way to deal with your condition before taking prednisone.

2. Next Strategy: Stop or Decrease Prednisone (ONLY UNDER DOCTOR’S SUPERVISION)

• Stop prednisone
• Consult with your doctor to lower your dosage

a. Situation 1: Risks Worse than Benefits (Risks > Benefits)

If you’ve decided that the benefits of prednisone don’t outweigh the risks for you; that the psychiatric side effects are so miserable and disabling that you cannot tolerate them, then the next option is to get off prednisone. The first-line treatment is to stop taking prednisone altogether.

You never want to quit prednisone cold turkey unless under a doctor’s supervision. Stopping without tapering can cause a fatal consequence.

b. Situation 2: Benefits of Prednisone Important (Risks = Benefits)

If prednisone treatment is still worth it to you, lowering your dosage may also be an option. For example, if you are on 40 mg of prednisone, ask about getting lowered to 20 mg.

It is important to slowly taper off of prednisone and to be monitored by a physician.

c. Situation 3: Cannot Lower Prednisone as Benefits Necessary (Risks < Benefits)

If prednisone treatment is still necessary and you absolutely cannot decrease the dose, then the following coping strategies are for you.

3. Non-prescription ways to cope:

While you might think that you should jump straight to prescription drugs to treat these psychiatric changes, I recommend using non-prescription methods. The following techniques, habits, and strategies can help you counteract these side effects, or support the prescription drugs to work better.

• Meditation
• Breathing techniques
• Bedtime Routine: turn phone off before bed
• Exercise
• Memory: keep challenging your brain
• Eat green vegetables

4. Prescription Treatments for Psychiatric Side Effects to Prednisone

Prescription medications designed to help with psychiatric symptoms are an amazing gift we’ve been given in this modern era. If this is what you need to take in order to tolerate prednisone, then it’s worth it.

Remember, it’s not you, it’s the drug. 

So while it may be frustrating to be taking one medication just because of the side effects of another medication, if you’ve reached this point, then it’s worth it.

But you want to make sure what you’re taking is the best one, right?

According to the scientific article, these are the best prescription medications for specific psychiatric side effects to prednisone:

• Mood Lability & Mood Changes: 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, ElectroConvulsive Therapy (ECT)

Remember to give yourself grace while taking prednisone. Understand that there is absolutely nothing wrong with getting the help you need. These methods can be used alone, or you can combine more than one to ensure that you have a treatment that is unique for your needs. Again, I say: there is no shame in getting the help that you need.

Genetic Testing for Psychiatric Medications

Many of the medications listed above work better for certain genetic types of people. There may be a similar drug that would work better for you than the first drug offered, depending on your genes. Otherwise, you may spend weeks or months trying one drug after another, until you finally find the one that fits your personal genetic situation.

That’s why I recommend Pharmacogenomic testing. We can order a genetic test that shows your unique list of drugs that would work best for you. It’s a simple saliva test and I can help evaluate the results with you and your doctor. Just schedule an appointment so we can set it up!

Vitamin Deficiency and Psychiatric Changes on Prednisone

Another scientific article about how to cope with medications causing psychiatric disorders states the following:

“Vitamins play an important role in mental health. Various mental health conditions could develop due to vitamin deficiencies. Folate deficiency has been linked to depression. Vitamin B1 deficiency is associated with symptoms such as amnesia, anxiety, irritability, depression, and insomnia. Vitamin B12 deficiency is associated with mood disorders, psychosis, irritability, confusion, and dementia. Vitamin D deficiency has been associated with acute mood disorders, psychosis, and depression.”

Partner this with the fact the prednisone itself causes depletion of these vitamins, and now it’s easy to understand how prednisone can make us feel so miserable! Prednisone steals nutrients, and when we feel that loss, it can show up as a mental health condition.

No wonder we get side effects to prednisone!

What I Did To Cope…

The struggles I faced while taking prednisone caused me to ponder ways in which I could help not only myself but others who were struggling with the same side effects. I began to ask myself, “What can I possibly do to help? What can I do to prevent this from happening to me? How can I deal with these side effects?”

These questions piqued my interest to create a dietary supplement with vitamins and herbs designed specifically for those who take prednisone– Nutranize Zone®.

Nutranize Zone replenishes the nutrients that are depleted while taking prednisone. It is formulated to help calm your mood, get restful sleep, and fight against weight gain.

You can go to Nutranize.com to get of Nutranize Zone and feel like yourself again!

Conclusion

After reading this article, now you know that prednisone causes many psychiatric sid effects, how & when they happen, who is at most risk, and what you can do about it. No matter how bad these side effects are, please know that there is hope. There is healing.

There is a light at the end of this tunnel.

Do not hesitate to get the help that you need!

Resources:

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: Psychological, Cognitive, Behavioral Effects. Am J Psychiatry. 2014;171(10):1045-51. Link
3. Huynh G, Reinert JP. Pharmacological Management of Steroid-Induced Psychosis: A Review of Patient Cases. J Pharm Technol. 2021;37(2):120-126. doi:10.1177/8755122520978534
4. Raju NN, Kumar KSVRNP, Nihal G. Management of Medication-Induced Psychiatric Disorders. Indian J Psychiatry. 2022;64(Suppl 2):S281-S291. PMID: 35602361

Check out these other articles about the Psychiatric Side Effects of Prednisone:

• What I Wish My Family Knew About Prednisone Side Effects
• Prednisone: I only made it 3 days
• Adverse Mental Side Effects of Prednisone
• Steroids Stole My Summer
• Prednisone and Mental Health: Prednisone Warrior Jia
• Mental Health Side Effects: The Real Price of the Cheap COVID treatment
• 3+ Ways to Cope with Prednisone Mood Swings