Steroid psychosis is a psychotic disorder caused by the use of corticosteroid medications. Affected individuals develop psychiatric symptoms such as depression and mania. Treatment options vary depending on the patient's pre-existing medical condition.
Corticosteroids are medications that mimic cortisol, a hormone produced by the body. They reduce inflammation and suppress the immune system. Doctors prescribe corticosteroid medications like cortisone and prednisone to treat autoimmune disorders like lupus and rheumatoid arthritis.
Researchers believe that steroid psychosis occurs when high doses of corticosteroids cause increased levels of dopamine in the brain. Increased dopamine levels lead to symptoms like depression, mood swings, and psychosis. Corticosteroids also lower serotonin levels in the brain, worsening the patient's depressive symptoms.
Most patients who develop steroid psychosis begin to manifest symptoms between 3 and 11 days after starting corticosteroid therapy. Many people become overly excited, irritable, or depressed. Others have rapid mood swings, and some become suicidal. Severely affected patients may hallucinate or lose contact with reality.
Gender may play a role in determining who develops steroid psychosis. Studies indicate that women are somewhat more likely to develop the condition than men. This may have to do with the fact that women are more likely than men to develop conditions such as lupus that require treatment with corticosteroids.
A person's prior history of mental illness does not play a role in determining whether they will develop steroid psychosis. Patient age also appears to be unrelated. Patients taking large doses of corticosteroids are at higher risk than patients using moderate or low amounts.
Doctors treat steroid psychosis by taking the patient off the drugs. About 92 percent of patients will make a full recovery if the drugs are tapered off gradually. Delirium symptoms usually subside within three days, while manic and depressive symptoms improve within three to four weeks after the medication is stopped.
Some patients have serious or life-threatening medical conditions and cannot stop using corticosteroids without serious repercussions. In these cases, doctors will prescribe antipsychotic medications. About 84 percent of patients recover from steroid psychosis if they use antipsychotic medications but continue corticosteroid treatment.
Not all patients fully recover. Between 5 and 7 percent of patients develop long-term depressive or psychotic disorders after using corticosteroids and experience steroid psychosis. Some people may continue to have recurring symptoms long after they stop using the medication. Approximately 3 percent of patients with steroid psychosis commit suicide.