I have a rare auto-immune disease that requires high (160mg 2x day) dose prednisone to stop a severe blistering of mucosal tissue ., 2-3 degree burns of mouth, throat, sinus, eyes and even my heart. The possibility of this disease killing me without prednisone is real and my doctor explained that prior to prednisone a great majority of people with Erythema Multiforme – Major died.
So what’s the problem? Over many years and a dozen high dose treatments with prednisone I have been 302 committed and upon release my doctors where cautioned about this therapy.
During my most recent treatment, I went into a manic state or worse. I was PFA’d and removed from my home by police after scaring my wife and kids. I had to finish treatments at the hospital and I requested a psychological evaluation because I hadn’t slept in 5 days, almost lost my job, and was was manic or worse. After a discussion with a psychiatrist he added several different mood stabilizers and anti psychotic meds. I have come off the prednisone and the pshyc meds are taking effect. I cant wait until prednisone is out of my system.
My doctor now realizes after this last event a new protocol is being thought out with future treatments.
This I can tell you without a doubt in my mind that Prednisone is a miracle and a curse all rolled up into one medicine. If you are experiencing mental issues with prednisone tell your doctor immediately, insist on getting psychiatric support and PRAY.
In a recent case, I was asked to see a man, age 69, on the oncology service who was receiving corticosteroids every 2 weeks as part of his chemotherapy. The patient was admitted to the hospital for acute mental status changes 2 days after his last corticosteroid dose. He had pressured speech, grandiosity, and had not slept in 2 days. We started risperidone, 1 mg bid, and most of his manic symptoms resolved within 2 days. His chemotherapy was continued without corticosteroids. If this had not been not possible, I would have recommended continuing risperidone prophylactically.
Psychiatric Disorders : psychic disturbances, psychological dependence, insomnia. A wide range of psychiatric reactions including affective disorders ( such as irritable, euphoric, depressed and labile mood, and suicidal thoughts), psychotic reactions (including mania, delusions, hallucinations and aggravation of schizophrenia), behavioural disturbances, irritability, anxiety, sleep disturbances, and cognitive dysfunction including confusion and amnesia have been reported. Reactions are common and may occur in both adults and children. In adults, the frequency of severe reactions have been estimated to be 5-6%. Psychological effects have been reported on withdrawal of corticosteroids; the frequency is unknown.