Corticosteroid-induced psychosis is an adverse reaction to medications used to treat inflammation, pain, and some chronic immune conditions. These drugs can produce psychiatric symptoms, of which the most marked is a cluster of issues like hypomania, depression, and anxiety. Some patients also experience true psychosis, a break with reality that can include paranoid thoughts and hallucinations. Treatment options depend on how the condition presents and why the patient is on steroids.
Patients taking high doses of corticosteroids, particularly in combination with other medications or in the long term, can be at a higher risk of corticosteroid-induced psychosis. A history of psychiatric problems isn’t a risk factor, according to numerous studies, and the abnormal psychiatric state is usually temporary, stopping once the patient gets off the medication and finishes metabolizing. Some research has suggested that corticosteroids can be associated with the onset of bipolar disorder, but a definitive link has not been established.
Symptoms of corticosteroid-induced psychosis can vary widely between patients. Some may develop hypomania, where they feel very energetic, have difficulty sleeping,, and can start to feel unstoppable. Other patients can experience depression or mood swings. Anxiety, agitation, and irritability are also signs of steroid-induced psychosis. Hallucinations and false beliefs about the world around the patient can also develop; for example, a patient may believe that medical providers are involved in a conspiracy.
Simply stopping steroids may not be possible, both because they may be necessary for treatment and because abrupt cessation of steroid therapy can be dangerous. One option for treating corticosteroid-induced psychosis may be a gradual tapering down, if it is possible to safely take the patient off the medication and try another therapy. Psychotherapy can also be considered, along with psychiatric medications. Hospitalization may be necessary if there are concerns about the patient’s health and safety.
Severe cases of corticosteroid-induced psychosis are relatively rare, but can happen. People who start to notice unusual bursts of energy, sadness, and other strange mood changes on steroids may want to discuss this with the practitioner who prescribed the medication. An evaluation can determine if the patient appears to be developing a psychiatric problem, and can help with decision making about how to proceed with treatment. For patients who need to be on medication in the long term to treat a chronic condition, it is important to be aware that psychiatric symptoms could emerge at any time, although they are more common when first starting out on corticosteroids.