Some patients say a commonly prescribed steroid triggered mania and suicidal ideation.

Overuse of steroids

Prednisone side effects

Prednisone side effects are well-known, however,

  • Prednisone is the most commonly prescribed steroid drug all over the world.
  • Millions of Americans receive prescriptions for the steroid prednisone frequently to treat chronic inflammation.
  • Although mood swings are a well-known side effect, other patients report significantly severe symptoms.
  • They claim that prednisone rendered them suicidal and manic. Some were required to visit the ER.

Prednisone side effects

It was the spring of 1978. Two years after, I graduated from medical school and enjoyed the start of my professional career. I had recently been hospitalized for a flare-up of vasculitis, a blood vessel inflammation condition that produces excruciating pain, numbness, and breathing difficulties. I was recommended 60 mg of prednisone, a corticosteroid that would lessen the inflammation because I was having trouble breathing.

The medication was effective, but after a few days, I went into such deep despair that I had to return to the emergency hospital since that was the only place I knew I wouldn’t be in danger of hurting myself. The psychological symptoms, which had nothing to do with my vasculitis, finally required a week in the hospital.

Because of abrupt insomnia that the prednisone brought me, I don’t remember much about this time. My vasculitis had been misdiagnosed as anxiety before receiving a diagnosis in January 2018, and the resulting medical stress made it difficult to communicate my feelings to my rheumatologist and pain psychologist.

My depression symptoms lessened as the prednisone was gradually taken down. I started to feel like myself again, around 10 mg of the medication.

Years later, I’ve come to the conclusion that the high amount of prednisone was probably what caused my sadness and suicidal thoughts; the bothersome thoughts that vanished as I weaned off the medication have never come again. To protect my mental health, my rheumatologists have agreed to stop me from taking large doses of prednisone.

I’ve since discovered that my situation is not unusual. I’ve spoken with four additional people who took large dosages of prednisone and suddenly developed serious psychiatric adverse effects.

Prednisone’s side effects are recognized to have adverse mental health impacts. Still, some patients and doctors claim they can be more severe than most medical professionals realize, especially for such a widely used medication. These prednisone side effects aren’t just “mood swings” but major crises that can cause suicidal thoughts, manic episodes, weeks of insomnia, and hospitalizations for mental illness. Admission to the psychiatric hospital after taking high doses of prednisone is “not an uncommon example of Side effects of prednisone,” according to psychiatrist and suicide epidemiologist Dr. Paul S. Nestadt of Johns Hopkins.

Insomnia - one of the side effects of prednisone

The issue is so widespread that one of the first things I do when a patient is admitted to my unit with psychiatric symptoms they never have before experienced is check the drug list for prednisone and other common offenders, the doctor explained.

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Prednisone has been used for decades to treat inflammatory bowel disease and autoimmune illnesses.

People with chronic inflammatory diseases such as inflammatory bowel disease, lupus, and rheumatoid arthritis frequently use prednisone to control flare-ups. The medication reduces immune system activity, which lowers inflammation and edema.

Common prednisone side effects

Prednisone is frequently referred to as a steroid, although it differs from anabolic steroids, increasing the body’s testosterone levels to encourage muscle mass and enhance sports performance.

Prednisone, used in the US since 1955, is a medication often prescribed; 11 million individuals are anticipated to take it in 2019. Given that the medication is used to treat some COVID-19 side effects, it is likely that this number has increased during the coronavirus pandemic.

Some prominent prednisone side effects such as elevated blood pressure, fluid retention, and weight gain, particularly in the face, even though it can significantly reduce inflammation.

Since there is no convincing evidence that those with a diagnosis of mental illness are more likely to experience severe psychiatric symptoms than those without one, the medication is not contraindicated for them. My doctor informed me in 1978 that individuals may experience mood swings or feel “a little out of it.”


However, according to a researcher who has examined the subject, Dr. Lorrin Koran, prednisone side effects on the mind happen “a disturbing regularity.” Psychiatric side effects of corticosteroids were “not infrequent,” according to a 2011 study coauthored by Koran, an emeritus professor of psychiatry and behavioral sciences at Stanford University.

Patients have spoken about euphoric mania, for instance, “such spending too much money, driving too fast, or indulging in activities that are not typical of them,” according to Koran. Others, however, claimed to have gone through depression or a mixed state of mania and depression.

Any doctor would be wrong, according to Koran, to consider the prednisone side effects on mental health to be “minimal.” In support of his claim that symptoms could be severe, he cited a 2013 review article in Rheumatology International that builds on fifty years of study.

According to Koran, “physicians are sometimes not as open to contemplating new alternatives or odd possibilities.” Some people I spoke with said they had trouble persuading their doctors that their new symptoms might be caused by high-dose prednisone steroid.

 Patients claim prednisone side effects led to manic episodes, incessant crying, and visits to the mental health emergency room.

Samantha Reid, the director of digital engagement at a policy institute in Washington, DC, says that in 2016, she first experienced mania after taking an 80 mg dose of prednisone for her Crohn’s disease. She said she had previously struggled with anxiety and sadness, but this was different.

Reid claimed that the only adverse effect her doctor had informed her about was facial swelling, so she wasn’t ready for prednisone-induced insomnia that exacerbated her mania. I was averaging four hours of sleep every night, she stated, adding that she would wake up and go boom, boom, boom the rest of the day.

Corticosteroids and possible prednisone side effects

The mania subsided when her dosage was cut, but she continued to experience depression periods, going for weeks at a time without speaking to anyone. Reid’s doctor gradually weaned her off the larger dose for reasons about her physical health, but she saw that the mania subsided once she stopped using prednisone.

In conversations with Insider, some patients who experienced mental-health crises while on prednisone said their doctors warned them they “may feel different” while on the drug. But none were warned by physicians about the possibility of adverse side effects like mania and paranoia. This was even though several already had a diagnosed mental illness.

That includes Rylie Cooper, a digital director outside Philadelphia with a borderline personality disorder. When they have prescribed 50 mg of prednisone for their Crohn’s disease in 2021, they weren’t told about the possibility they might experience more severe mental illness symptoms.

Immediately after starting prednisone, Cooper had a manic episode and began experiencing what they call “brain zoomies.” Insomnia kept them mentally exhausted, but their mania and paranoia pushed their mind to overthink nonstop. They felt increasingly unable to manage their borderline personality disorder and ultimately ruined a close personal relationship with constant, impulsive attempts at getting attention, including sending selfies, paragraphs-long texts, and frequent calls.

Cooper has since weaned off prednisone; they said they never told their doctor about their symptoms because they didn’t think they would be believed.

Sararosa Davies, a podcast producer with mast cell activation syndrome, raised reservations about taking medicine when she has prescribed prednisone for her persistent hives in 2018. Davies suffers from bipolar disorder, and her mother, a nurse with advanced training in psychiatry, was worried that it would make her symptoms worse.

She claimed that the doctor dismissed Davies’ worries, and the outcomes were devastating. She spent the night in an emergency room for mental health. She claimed that after that, she went through her worst depression episode to date and could not get out of bed.

Nestadt, the psychiatrist at Johns Hopkins, claimed that it wasn’t unusual for medical professionals to disregard a patient’s pre-existing mental disorder when determining whether to administer prednisone. “I have witnessed people with mental health conditions receiving steroids without any evidence that they were informed of the risks associated,” he said.

Anyone can be impacted, even those without comorbidities. When Gemma Cooper-Novack, a professor in the state of New York, was prescribed prednisone for the first time in 2009 after being diagnosed with ulcerative colitis, she had no history of mental illness.

She added, “Prednisone was given to me as the next logical course of treatment,” adding that her doctor had not mentioned any potential adverse effects of prednisone on mental health.

Soon, Cooper-Novack started having uncontrollable weeping fits and developing sleeplessness. While the difficulties, she continued with her master’s program despite feeling stuck on an exhausting, continual mood roller coaster.

Cooper-Novack used to blame her dramatic mood swings on the emotional strain of adjusting to life with a chronic disease, but she now thinks the medication was a factor. She claimed that the negative effects disappeared after she weaned off the prednisone.

Cooper-Novack claimed that throughout her prednisone treatment, “either it knocked me out completely, or I was awake at 2 in the morning, wide awake, and couldn’t do anything about it.” “Whatever it was doing in the first place was made worse by the influence on the sleep patterns.”

Higher dosages of prednisone required for some medical conditions are associated with increased psychological concerns and severity of prednisone side effects.

Prednisone dosages usually depend on the patient’s state of health and diagnosis. Prednisone doses for lupus and vasculitis patients can be up to 16 times higher, at 60 to 80 mg, according to the American College of Rheumatology. In comparison, for rheumatoid arthritis, patients have often been prescribed 5 to 10 mg.

Studies have shown that the risk of participants in the studies experiencing unfavorable psychiatric prednisone side effects increases with prednisone dose. Some medical organizations and governmental organizations, such as the National Health Service in the UK, are looking at whether doctors are giving corticosteroids to patients more frequently or at larger doses than is necessary.

Dr. Kristen Young, a rheumatologist in Arizona, claimed that she had witnessed serious psychiatric side effects on dosages of as little as 10 mg in both patients with and without the previous mental disease. Young stated that she has identified “steroid dementia” in some older patients using prednisone, which is most likely exacerbated by insomnia. When they stop taking medicine, it often turns around.

However, for people who have frequently had to spend years fighting for a diagnosis – or for increasing symptoms to be treated – pushing for a lower dose of prednisone, or for a different medicine, can be taxing. In the area of chronic inflammatory illnesses, according to Young, such is typical.

Every person who is diagnosed with ailments that require taking significant doses of steroids has often been through it and been through the mill, according to Young.

Prednisone alternatives are available, although they are few and disease-specific

Prednisone has been around for more than 60 years, but substitute medications for those experiencing active flare-ups of chronic illnesses are still being developed. Most are conditional.

There have been significant developments over the past five years, such as the approval of the vasculitis medication Avacopan and work on non-prednisone treatments for Duchenne muscular dystrophy and severe asthma.

It is, however, a game of chance as to which patients will obtain alternative options first, with the time it takes from drug discovery to pharmacy shelves taking an average of 10 years in the US.

Dr. Alfred Kim, a rheumatologist at Washington University in St. Louis who specializes in treating patients with lupus and vasculitis, said that to get patients on less dangerous medications sooner, it is also necessary to diagnose their diseases more promptly in the first place.

Doctors can lessen the likelihood that their patients will have the severe, uncontrolled flare-ups of inflammation that high-dose prednisone is required to cure by detecting and treating them early in the illness course. According to Kim, researchers studying lupus and vasculitis are under pressure to discover the cause so that diagnosis times will drop from five and a half years to only five.

More focus on mental health is desired by medical professionals and patients.

It can be challenging to convince clinicians that prednisone side effects might impact a patient’s mental health, particularly for underrepresented groups accustomed to having their chronic illnesses written off as signs of worry and sadness.

Doctors must evaluate a patient’s mental health when assessing how well they are responding to prednisone, according to Kim. He claimed that even side effects like mood swings, which may appear insignificant on paper, might have an impact on patients’ life.

The open discussion of risks and advantages will be a part of that procedure, Kim added. “It goes far beyond the main risk factors and discusses the less common ones as well. And even the most common ones have the potential to be severe.”

Young advises patients to continue taking the medication and get in touch with the doctor who prescribed it as soon as they notice any psychiatric side effects. According to the American College of Rheumatology, abruptly quitting prednisone without medical supervision can result in serious, occasionally life-threatening side effects.

Many doctors and patients Insider spoke with believe the drug should be accompanied by mental-health care and counseling in situations where prednisone is the only treatment available to combat a flare-up.

Young suggested including a psychiatrist on the patient’s care team to prescribe antipsychotic or antianxiety medication as necessary for those who have already experienced mental illness associated with prednisone side effects.

Kim and Young concur that anyone who feels their doctor is downplaying their symptoms or health concerns with prednisone side effects should get a second opinion.

Young advised, “It’s probably time to move on to another individual if you don’t have someone taking care of you who you truly trust.”

How to avoid prednisone side effects.

My name is Victor Tsan, and I’m the medical director of the Philadelphia Holistic Clinic. My clinical experience is more than 45 years. In this article, I described the possible prednisone side effects. For some of my readers, it may sound like I’m recommending not to follow your primary care practitioners and not to take prednisone.

Ask Dr. Tsan how to avoid prednison side effects

If this is what you understood from my article, I’ve done a bad job.

Prednisone is one of the most important drugs available, and the use of prednisone is mandatory in many medical situations. This medicine saves the lives of millions of people all over the world. If I must name the three most important pharmaceutical drugs in the world, they are Insulin, Prednisone, and penicillin.

However, very often, this medicine is used in situations when it is not necessary and not even beneficial. Prednisone side effects are the most important point to consider.

When prednisone is the only medicine that can change the further development of the disease or lead to remission, prescription of the steroid is medically reasonable and necessary.

In many cases, however, a holistic approach could be much more effective than steroids, safer, and affordable.

Even those medical conditions requiring the use of steroids regardless of prednisone side effects can often be treated with a combination of pharmaceutical drugs, acupuncture, or homeopathic remedies. When this approach is chosen, your physician may prescribe lower doses of prednisone or exclude it from the treatment protocol.

Contact Philadelphia Holistic Clinic at (267) 403-3085 and book your appointment for evaluation and treatment. Let’s try to get you off steroids and prevent further prednisone side effects.

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