What Is Steroid Psychosis?

Individuals who take corticosteroid medications may develop depression and severe mood swings.
Steroid psychosis may cause some people to become irritable.
Doctors prescribe corticosteroid medications such as prednisone to treat autoimmune disorders, such as lupus and rheumatoid arthritis.
Steroids and syringes.
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  • Written By: Stephany Seipel
  • Edited By: Angela B.
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  • Last Modified Date: 08 October 2014
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Steroid psychosis is a psychotic disorder caused by the use of corticosteroid medications. Affected people develop psychiatric symptoms such as depression and mania. The treatment options vary depending on the patient's pre-existing medical condition.

Corticosteroids are drugs that mimic cortisol, a hormone produced by the body. They reduce inflammation and suppress the immune system. Doctors prescribe corticosteroid medications such as cortisone and prednisone to treat autoimmune disorders such as lupus and rheumatoid arthritis.

Researchers believe steroid psychosis occurs when high doses of corticosteroids cause an increase in dopamine levels in the brain. Increased dopamine levels lead to symptoms such as depression, mood swings and psychosis. Corticosteroids also lower the serotonin levels in the brain, worsening the patient's depressive symptoms.

Most patients who develop this disorder begin to manifest symptoms between three 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 this kind of 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 corticosteroid treatment.

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A person's previous history of mental illness does not play a part in determining whether he will develop steroid psychosis. The patient's age also appears to be unrelated. Patients who take large doses of corticosteroids are at higher risk than patients who use moderate or low amounts.

Doctors treat this condition by weaning the patient off the medications. About 92 percent of patients will make a full recovery if the drugs are tapered off. The symptoms of delirium usually clear up within three days, while manic and depressive symptoms improve within three to four weeks after the medication is stopped.

Some patients have severe or life-threatening medical conditions and cannot stop using corticosteroids without suffering serious repercussions. In these instances, doctors will prescribe antipsychotic medication. Approximately 84 percent of patients recover from the psychosis if they use antipsychotic medications but continue corticosteroid treatment.

Not all patients make a complete recovery. Between 5 percent and 7 percent of patients develop long-term depressive or psychotic disorders after using corticosteroids and experiencing steroid psychosis. Some people may continue to have recurring symptoms long after they stop using the medication. Approximately 3 percent of patients with this condition commit suicide.

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anon958080
Post 35

My daughter suffered a psychotic break as a result of being given massive doses of Prednisone for an inability to breathe. It has been a year and a half of absolute insanity with five hospitalizations, and drug after drug to try and counter the effects of this drug. The anti psychotic drugs had their own side effects.

No one would listen when I told them the drugs were causing her to experience many of the side effects listed in the drug printout, which I requested after she had been hospitalized. The side effects read like a laundry list of her symptoms, yet for all of my protesting, no one would listen and I was told my protest was not in my daughter's best interest.

I guess the reason I am writing this is because I have felt totally frustrated by the lack of accountability shown on the part of the doctors and hospitals that are prescribing these life altering drugs. My hope is that others will join in holding those prescribing and those producing these drugs accountable for the damage they have done.

I would hope that the professionals at least know the side effects and take note of them and monitor a patient closely with that in mind.

Thank you everyone for your posts. There is some comfort in knowing others have had the same experience, however no one should have to go through the trauma of prednisone induced psychosis. Not another soul!

anon950536
Post 34

My mum has had to be hospitalized today after nearly throwing herself under a train and it took five grown men to get her on a hospital trolley. My mum is the most amazing, loving person and these steroids have changed our lives in such a horrible way.

brendameyer1
Post 33

My husband was on 40mg of prednisone and just got off. He swears he saw a ghost in our bedroom and there is no deterring him! He woke me at 1:30 in the morning and had me freaked out! I am nervous as the condition for which he took the prednisone has not gone away and he has another doctor's appointment tomorrow. At his last appointment, there was talk of greatly increasing the dosage.

He sees the prednisone as helpful as it brought the swelling of his finger way down. I've discussed this side effect and he pooh-poohs it. I am terrified of what he might see/do on an even higher dosage. Advice would be appreciated!

anon944554
Post 32

After having a large cortisone shot, it appears a loved one is now hallucinating and showing psychosis, but has yet to recognize it/seek treatment. Has anyone else had this problem? Doctors should give out warnings before hand to give you the option, or at least make you aware if your reality starts to deteriorate, what might be the cause!

anon941585
Post 31

My husband has been on prednisone for his Crohn's for 13 years now, he is a monster. He exhibits all - mania, paranoia, anxiety, aggression, verbally abusive language, antisocial, the only thing he has not done is to physically hurt me. This drug has made him into a mad man. Everything sets him off.

anon932194
Post 30

My Dad will be 80 in July and went through steroid psychosis for almost a week before we had him hospitalized. He was in the hospital for a week and was discharged because they couldn't find anything wrong with him physically. He's been at home now for almost two weeks and the recovery has been slow but he's getting better every day.

The doctors had no clue what was wrong with him, and after speaking with RN's, internet research, etc., we suggested prednisone psychosis several times. But, since the dosage he was on was so small -- 25mg for the first and second day, 20mg third and fourth, decreasing the amount 5mg every two days they said that this couldn't be the problem. How wrong they were!

They also had him on Tramadol (Ultram) for pain while he was home. Please be aware of the side affects of Tramadol. This is a very powerful drug as well.

So now we have told the drugstores not to allow prednisone or Tramadol prescriptions to be filled. I hope this helps some other families out there.

anon928771
Post 29

How do I go about contacting people who want to write their story? I'm up for this. I have never had so many side effects from a three day course of steroids, and am now undergoing major specialist checks on a daily basis. I have developed acute glaucoma, had a heart rate of 90 bpm for seven days, blood pressure of 180/110, and have also seen an ENT specialist. I get my blood tested tomorrow and an ultrasound scan on Tuesday and a laser eye treatment in February. Please advise as I need to spread this word to the world. I have many friends who are journalists and they are going to help me write and publish this article.

anon926241
Post 27

I have just lost a week of my life, from a three day course of prednisole. I was absolutely mental and feared for my life. Today is the first day that I feel calm, and a friend urged me to see a private doctor who diagnosed steroid psychosis.

I have had laryngitis, so I was also on a steroid inhaler. The awareness of how dangerous this drug is needs to be shouted out to the world. Never again will I touch a steroid. I would rather die of an incurable illness than experience what I just went through.

anon356914
Post 26

My sister-in-law was on prednisone for decades treating lupus. There was a significant change in her behavior that was not noticeable prior to the medication. Her manipulative behavior and lying created nonexistent situations that brought the family to its knees. She would obsess over certain individuals in the family and make their life a living hell. she had paranoia, and a constant need to be the center of attention. This behavior started slowly and became more noticeable as the years passed. She was easily agitated and mean when speaking to family members.

anon351440
Post 25

I'm living in hell. I had a steroid injection eight months ago and haven't slept properly since! I can't control my brain and no one can or will help me. I wish I had known of this steroid psychosis before my injection.

Tesil
Post 24

Posts 15, 12 and 6: How are you doing?

anon339923
Post 23

There needs to be a warning put on the leaflet of these boxes. My daddy is on steroids long term and has now developed steroid psychosis. People should know about it before using them.

anon336590
Post 22

I have just been on Decadron and Solumedrol IV for 6 days in hospital and had four steroid shots in my sciatic nerve in theatre. I have a neurological autoimmune illness and RA. You can never compare oral steroid psychosis to what I am going through! IV steroid doses are massive in quantity and duration compared to oral Prednisone. I want to die! My chest is on fire and I can't breath in or move my right side. I have asthma and sarcoidosis. I swear I am going to overdose on Midazolam just to escape this.

anon336548
Post 21

My daughter was treated with large quantities of steroids when she was hospitalized for a brain tumor. The steroids were to take the swelling down before surgery. She was then given oral steroids which we weaned her off of when she was released from the hospital.

We, like many of you, were never warned about the severe ramifications of this drug. Within two weeks of discharge, my daughter's behavior began to change. She became gradually more and more manic and delusional. She was completely convinced she was pregnant for no apparent reason and completely manic and prone to fits of anger and violence. She ended up being hospitalized and put on ativan, as well as geodon and depakote.

She spent two and a half weeks in the pediatric unit (she was 17 years at the time) on these drugs and continued to be in and out of psychiatric treatment for almost a year. She has now been diagnosed with early onset bi-polar disease due to the steroids. Yes it has changed her life and our whole family's life. We had no idea when we left the hospital the first time after the surgery that there was even the remotest possibility that this could happen. Had we known we would have been able to look for symptoms and catch the problem earlier.

anon335467
Post 20

What a wild ride! I came down with a real bad case of pneumonia and an urgent care doctor put me on prednisone. It started off high and tapered slowly. I noticed how crazy I felt about an hour after my dosing. I kept telling my husband how bad I felt and that I felt high, but I don't think he believed me.

Finally, I told my brother how bad I felt and he told me about this condition (he's an RN) called steroid psychosis. I was walking through my house crying and shaking and feeling like I was in someone else's body. Chantix nearly killed me when a doctor prescribed it, and these steroids have totally rocked my world! They need to inform people about these dangers!

anon332902
Post 19

This happened to me six years ago and this year, I am finally better. My asthma doctor would not believe me, but the psychiatrist I saw when I hallucinated and thought everyone was out to kill me was the one who did. I just now am starting to see information on steroid psychosis out there. I have not touched prednisone since, but still use inhalers for my asthma. I was suicidal for a year. I spent one whole year keeping myself alive. This medication changed my life.

anon326066
Post 18

Two years ago I was hospitalized for the flu, which seems to settle in my lungs, and I have COPD. I was treated with IV steroids, and after three days, I realized I was was having conversations with people who were not there. I knew I was talking out loud to no one. I mentioned this to the nurses and doctors, and the inhalation therapists four times a day.

One evening I woke up and decided it would be a good idea to sleep on the heating unit. I took a blanket to put under me, the sheet over me, opened the window, took my pillow and fell asleep. The nurse came in to give me meds, and woke me up. Still, no one ever mentioned steroid psychosis.

I was hospitalized for eight days, and had cortisone therapy for six weeks. On occasion, I still speak out loud. After two weeks I went to my PCP told him of the strange things. He told me it was steroid psychosis. I had not even heard of that and I have worked in the clerical end of medicine for over 30 years.

anon322720
Post 17

My daughter and myself, we accidentally overdosed by prescribed topical creams for eczema that had steroids in it. I applied the creams to her and was dosed that way.

We are recovering 3 years now and it had changed our lives entirely and we keep trying each day to get our lives back.

The effects are unimaginable, excessive weight gain, mood swings, tooth loss, etc....

I post this as a warning to be so careful what you use these days. Also because I feel like a survivor and wished to post as a therapeutic measure, and say, if you have been there or are there, I feel for you, deeply and keep on trekking.

anon322596
Post 16

In May 2012, my dentist struck my lingual nerve while injecting novocaine to prepare my tooth for a crown. By injecting my lingual nerve, he effectively "killed" it, which resulted in my tongue being numb and loss of taste. He prescribed .75mg Dexamethasone every eight hours for four days. However, 20 minutes after taking the first dose, I was noticeably agitated, but dismissed it to the stresses of life.

I couldn't sleep at night for the next few days and was becoming irrationally angry about everything. By the fourth day, I went out of my mind and became suicidal, paranoid, manic and couldn't comprehend reality. Long story short, I engaged in a standoff with deputy sheriffs as I had a gun and was threatening suicide. I remember the very beginning and the very end of the standoff, but still have no recollection of what happened during the episode. I learned later that, with 30 or 40 tactical deputies surrounding my home, that I threatened to kill two sheriff's negotiators.

Ultimately, I was taken to jail and charged with two class C felonies for intimidation. I have never been in trouble with the law. I have two young children, a Master's degree, earn a good living and am married to a police officer. I am a 44 year old male and have never behaved like I did when on corticosteroids.

I would like very much to see strict prescribing guidelines for corticosteroids, including informing a close friend or family member of the patient of the potentially serious side effects of corticosteroids; requiring the physician's office to call the patient at least twice a day to check on the welfare of the patient (tell-tale symptoms of the onset of corticosteroid induced psychosis are obvious); a plan of safety should corticosteroid induced psychotic symptoms develop, such as the prescribing of a fast acting tranquilizer to be taken as soon as psychotic symptoms materialize, along with mandatory transport to a hospital where medical intervention can save that patient from harming him/herself or being harmed by law enforcement.

I have learned that corticosteroid induced psychosis is very common, particularly in cancer patients as they are routinely prescribed corticosteroids. Cancer physicians are keenly aware of corticosteroid induced psychosis but dentists, general practitioners, etc., are not as versed with regard to the potentially serious side effects of corticosteroids, which is why I advocate for more stringent prescribing guidelines. --Indiana

anon320081
Post 15

I was sprayed with herbicides and consequently needed large doses of steroids for my breathing, to survive. I was not told that there was such a thing as steroid psychosis. It started with severe irritation then panic attacks. Then on the fourth steroid,I became depressed and I started to think about suicide.

A month later, I had a four day binge of irritation, panic,depression, and severe suicide thoughts. I told my doctor because I didn't realize it would happen again and again. He put me in the hospital and on antidepressants. It's been five months and I'm still fighting it -- not as severe, but I'm afraid this is going to last the rest of my life.

Antidepressants are scary. Most have their own severe side effects. This one has made me gain 40 pounds. I'd have died without the steroids. Just can't believe the doctors don't tell a person about steroid psychosis, especially when giving them such large doses.

anon316798
Post 14

I received an injection of Decadron at my doctor's office for a simple upper respiratory infection. Within an hour, I felt like I would run through a brick wall and was so nervous I couldn't put it in words.

I went to the ER because I felt I had possibly been given the wrong medicine or was losing my mind. The told me it was normal with a steroid and would taper off over a couple of days.

I cannot put into words what the next two months were like for me. I was not in touch with reality. I was afraid to be left alone with my kids because I felt "crazy" and unstable. Repeated trips to my doctor's office resulted in me getting a label of panic disorder, depression, etc. I knew in my heart this was caused from the shot I received.

I was given Ativan to help with symptoms which did not work. I finally was given Xanax which did at least help me to be able to work and take care of my children on some level.

I researched deep and wide to prove my case so others didn't think me crazy, and found maybe one or two places on the internet that spoke of this. Now look at today! Perhaps at least I can prove to "some" I wasn't a nut case as presumed.

anon311055
Post 13

Do inhaled steroids cause psychiatric problems? A friend of mine is on steroids for his asthma problem for a long while. He seems to get irritated so easily.

anon310248
Post 12

I am a "Steroid Psychosis" survivor. I say it that way because if you've been through a full blown psychotic episode and live through it, you are a survivor. I had sudden onset adult asthma that sent me to the hospital (in-patient and ICU) more than eight times a year. I was given huge doses of prednisone. Once I was dosed down, it would start all over again. It cost me everything - relationships with my family, my children, and even my career. It wasn't until my marriage fell apart that I was diagnosed by our therapist with steroid psychosis. Not one doctor ever informed me of the possible side effects of the steroids I needed to save my life.

I am interested in learning about others who have suffered as I have. When I was diagnosed in 2006, there wasn't much information available. I would like to someday write a book about this horrible side effect of such a common drug. I can't help but wonder how many are suffering - not knowing what is wrong with them....or the families that don't know what's happened to their loved one. Would anyone be willing to share your story with me?

anon307664
Post 11

My husband started injecting 200cc of testosterone in March 2012. Two weeks ago he doubled-dosed because the liquid leaked out after the injection. He started being depressed, paranoid, hallucinating, having suicidal thoughts and it was extremely scary for the entire family.

He was diagnosed by our GP with steroid psychosis and is on clonazepam now to handle the anxiety attacks and self defeating thoughts until we can get the testosterone out of his system.

anon298847
Post 10

I wrote post 9. I had a typo, so I should have read it first. I meant to say, "I'm not going to proof this." Well, I did post. Sorry, it was so negative. However, this medicine caused me to behave in such a manner (most of which I don't even remember) that my family is totally fractured.

I was very close to my son. I have not had contact with him (in spite of many tries) in 12 years. My only biological grandchild is now 15 and I have not been allowed to even see her since she was three. I took care of her for most of those first three years.

My daughter does talk with me and comes to see me, but doesn't believe the Prednisone is the cause of my physical and mental problems. I still have to get steroid injections in knees and use steriod inhalers. I am confined to a lift chair or wheel chair. Yes, Prednisone saved my life, but the cost was way too high.

anon297639
Post 9

Twenty three years ago, I developed asthma. Time after time I was in emergency room and "barely made it." For a year it kept getting worse and allergists and pulmonologists couldn't find anything that would improve it. One doctor finally told me there was a drug, but it had bad side effects. However, if I did not take it, I would, most likely, die -- probably sooner than later because I would be caught in a situation where I couldn't get help in time. I was 45 years old and not ready to die.

I didn't even ask about the side effects because it didn't matter. The drug was Prednisone, and I was started on 40 mg. per day. I improved, but the dosage had to be increased until I was taking 80 mg. per day. I had 40 mg. per day for three years and 80 mg per day for two more, plus a reduced dosage for almost three years to get off the daily dosage. I have Cushing's Syndrome, weigh 280 pounds (was 124), have diabetes, a hump on my back, and have terrible truncal obesity. I am a freak. My mother was mentally ill, so family members and former friends believe I am too. Plus, now, I'm fat,lazy, etc.

I wish I had died. Endocrinologists don't understand why I didn't die being on that dosage for that long. I'm not even going to post this as I might lose my courage if I go back and read. It is a miracle drug in small doses, but a cruel trick of medicine in large, extended doses.

anon293363
Post 8

I have a long and ugly relationship with steroids and steroid psychosis, so much so that I am considering opening up my medical records for study by doctors that are interested in learning more about this rarely spoken about disorder.

I am one of the very small percentage who has suffered permanent damage from my years long love/hate relationship with prednisone. Yes, it saved my life and nearly ruined it at the same time. I would be glad to discuss the specifics of my ordeal with anyone who is interested.

anon279973
Post 7

I have COPD and have had numerous lung and immune system problems over the last 20 years. The drug of choice was (and still is) prednisone for my lungs. One morning, about 15 years ago, I walked my two grade school children to school, came home, started washing the dishes, and the next thing I remember was coming to in the ICU after I, apparently, swallowed a couple bottles of pills. I have no recollection of doing it and I had no psychiatric problems before that.

After this happened, my docs were pretty careful about putting me on steroids, but they continued, for lack of a better option. What I found is that my mood changes significantly. I'm not the same person when I'm taking them. I have decided, for my marriage, my children and for myself, that I won't be taking them anymore. There will have to be another option.

anon274150
Post 6

I had steroid psychosis five years ago from the Medrol Pack. I had visual hallucinations and felt things that were not there. I also had delusions and I was paranoid.

They put me on the antipsychotic Geodon which pulled me out of it.

It's now five years later and I am going to try cutting the Geodon out to see what happens, under my doctor's supervision. This will be the true test. I hope I'm not one of the percentage that will need an antipsychotic the rest of my life.

anon257620
Post 5

My husband is in terrible shape right now. He's made a real dent in the relationship, blowing things out of proportion, verbally abusing me, becoming paranoid and troubled about my daily goings on.

I'm beginning to hide things from him, in order to avoid setting his temper off. Every few days we'll discuss the fact that he knows that he does these things and doesn't like it, but we both realize for the time being, it may be impossible to control. I know he plans on surgery and in the meantime, I might ask him about considering the medication necessary to calm him.

anon257600
Post 4

Wish my doc would have warned me about the potential of this side effect before I woke up with someone else's brain chemistry and that person was crazy. Thankfully it cleared up in a few days and I didn't jump off a bridge during those few days. Stupid steroids. Now to find another way to deal with my arthritis.

bmuse
Post 3

Would a family history of schizophrenia make corticosteroid use inadvisable?

Hannah77
Post 2

I’m so glad I've read this! Her physician wants to put my mother on corticosteroids for her rheumatoid arthritis. When we met with the doctor, this wasn’t a side effect ever mentioned to us. I'm disturbed we weren't warned of the possibility of psychosis. This is something people should know about so that they can make informed decisions.

rs4life
Post 1

My daughter has lupus and developed prednisone psychosis after being on her medication for about a week. Fortunately, she recovered fully after going off the drug, but it's been a battle for her to find a treatment for her illness. She's unwilling to take the steroids and counter them with antipsychotic medication.

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