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.
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.