Psychiatric adverse effects of corticosteroids

Thomas P. Warrington, J. Michael Bostwick

Research output: Contribution to journalReview articlepeer-review

268 Scopus citations

Abstract

Psychiatric adverse effects during systemic corticosteroid therapy are common. Two large meta-analyses found that severe reactions occurred in nearly 6% of patients, and mild to moderate reactions occurred in about 23%. Although disturbances of mood, cognition, sleep, and behavior as well as frank delirium or even psychosis are possible, the most common adverse effects of short-term corticosteroid therapy are euphoria and hypomania. Conversely, long-term therapy tends to induce depressive symptoms. Dosage is directly related to the incidence of adverse effects but is not related to the timing, severity, or duration of these effects. Neither the presence nor the absence of previous reactions predicts adverse responses to subsequent courses of corticosteroids. Corticosteroid-induced symptoms frequently present early in a treatment cycle and typically resolve with dosage reduction or discontinuation of corticosteroids. In severe cases or situations in which the dose cannot be reduced, antipsychotics or mood stabilizers may be required. This review offers an approach to identifying and managing corticosteroid-induced psychiatric syndromes based on the type of symptoms and anticipated duration of corticosteroid treatment.

Original languageEnglish (US)
Pages (from-to)1361-1367
Number of pages7
JournalMayo Clinic proceedings
Volume81
Issue number10
DOIs
StatePublished - Oct 2006

ASJC Scopus subject areas

  • Medicine(all)

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