Discussions By Condition: Mental conditions

Steroid Induced Psychosis

Posted In: Mental conditions 4 Replies
  • Posted By: harveya
  • September 2, 2010
  • 03:09 PM

Help!!!

My Wife was diagnosed back in January with Giant Cell Arteritis and prescribed Prednisolone (Initially 30mg and then raised to 40mg per day). While this is now under control, for the last 8 months she has suffered from various flavours of Steroid Induced Psychosis. This was presented as follows.

1. After about 3 - 4 days she started to get elevated mood which eventually developed into full blow Mania. She was Sectioned in February with full blown Mania and eventually stayed in an acute psychiatric hospital for 2 months after which she was discharged with only a slightly elevated mood but generally OK.

2. After being out of hospital for about 2 1/2 weeks she started to become depressed which got worse and worse although the local crisis team tried to manage this at home (and she was also prescribed Venlafaxine) she eventually took a very large overdose of Amytriptiline (2800mg) which she had been taking previous to the GCA for pain management with suspected Fibromyalgia. She survived this overdose against all the odds with no lasting side effects and was admitted after 5 days in ITU back into the acute Psychiatric hospital. Her depression had persisted however after a week she was put back onto Venlafaxine and got better within 3 weeks and was discharged after 4 weeks.

3. After approx 3 weeks the depression returned and rather than go down the route of managing at home based on the suicide risk, she was admitted back into the Psychiatric hospital and has been there for 7 1/2 weeks with no improvement.

4. During her stay, first the Venlafaxine was doubled, then Mirtazipine was added as an adjunct, then raised and then the Venlafaxine has been raised twice within the last week. She continues to get worse, more depressed, more anxious, more suicidal (luckily she is in a safe place) and feeling utterly hopeless.

Has anyone got experience of treatment of Steroid Psychosis, I have heard of Lithium Carbonate being a good fix for both future protection as well as the treatment of existing conditions however I know of the somewhat worrying side effects. The Psychiatrist is set on continuing with the Venlafaxine / Mirtazipine therapy as they have worked for her in the past (she had postnatal depression and post menopausal depression after a hysterectomy).
I'm beginning to lose my patience with the treatment, if is painful to watch your loved one go through something that is akin to Torture and to remain in a condition which could be described as a living ***l.

Has anyone out there experience of Steroid Psychosis (whatever flavor it comes in) and it's successfull treatment. I kind of need all the help I can get in getting the Psych to change track as I think he is going down the wrong route (but then what do I know, I'm only a layman and have only know my wife for 20 years).

Andy

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4 Replies:

  • Hello.I read your post and I am sorry for what you're going through.My mother developed steroid psychosis and her doctors couldn't come up with an alternative to prednisone. She was hospitalized twice as a result of her negative reaction to prednisone.Thankfully, a doctor finally suggested methotrexate as as an alternative to prednisone because methotrexate held the possibility of fewer psychiatric side effects.You should consult with your physicians and ask about the possibility of using methotrexate.
    Anonymous 42,789 Replies
    • November 14, 2010
    • 06:59 AM
    • 0
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  • Hello. I read your post and I am sorry for what you're going through. My mother developed steroid psychosis and her doctors couldn't come up with an alternative to prednisone. She was hospitalized twice as a result of her negative reaction to prednisone. Thankfully, a doctor finally suggested methotrexate as as an alternative to prednisone because methotrexate held the possibility of fewer psychiatric side effects. You should consult with your physicians and ask about the possibility of using methotrexate. Thanks for your concern, Steroid Psychosis is a nasty beast ad seemingly quite difficult to treat especally in the dpressed flavor. Thankfully my Wife has now made significant improvements and will be coming out of Hospital on Monday (after 20 weeks this time). After much bdgering of the doctors I managed to get them to put her on Lamotrigine (an anti-epilepsy drug that I have seen good reports of for treating Steroid Induced Depression and seems also to be good in preventing re-occurance of the depression while we get her off these ***n steroids). Unfortunately for my wife Methotrexate was not an option as the Giant Cell Arteritis was very severe and methotrexate was just not strong enough and to be fair to the steroids they have cleared up her GCA nicely.Hopefully we can now maybe transition her to Methotrexate to control the Polymyalgia Rheumatica if she does in fact need anything. Unfortunately because of the complications whe has had we won't be reducing the steroids too quickly for fear of knocking her back down into depression again - I just can't see her go through that again - she has spent far to much of the past year fealing suicidal and one serious attempt (she was very lucky to come back from that - no way was it a cry for help, she definatley meant for it to work) was just one too many.
    harveya 4 Replies
    • November 19, 2010
    • 09:49 AM
    • 0
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  • Thanks for your concern, Steroid Psychosis is a nasty beast ad seemingly quite difficult to treat especally in the dpressed flavor. Thankfully my Wife has now made significant improvements and will be coming out of Hospital on Monday (after 20 weeks this time). After much bdgering of the doctors I managed to get them to put her on Lamotrigine (an anti-epilepsy drug that I have seen good reports of for treating Steroid Induced Depression and seems also to be good in preventing re-occurance of the depression while we get her off these ***n steroids). Unfortunately for my wife Methotrexate was not an option as the Giant Cell Arteritis was very severe and methotrexate was just not strong enough and to be fair to the steroids they have cleared up her GCA nicely.Hopefully we can now maybe transition her to Methotrexate to control the Polymyalgia Rheumatica if she does in fact need anything. Unfortunately because of the complications whe has had we won't be reducing the steroids too quickly for fear of knocking her back down into depression again - I just can't see her go through that again - she has spent far to much of the past year fealing suicidal and one serious attempt (she was very lucky to come back from that - no way was it a cry for help, she definatley meant for it to work) was just one too many.Thank you for your response to my post about Methotrexate as an alternative for prednisone in patients (like my mom) unable to tolerate prednisone. And thanks for mentioning Lamotrigine; I have taken a quick look at Lamotrigine and will look further.By the way, I thought that I should mention that, after her first hospitalization for psychosis resulting from prednisone, my mother was then incorrectly diagnosed with Polymyalgia Rheumatica, which I think you know sometimes occurs in patients with GCA. In her case, she did NOT have Polymyalgia Rheumatica. In fact, she was found to be suffering from steroid myopathy, which is a muscle ailment resulting from too many steriods (in her case prednisone) over too long a period. Good luck and best wishes for your wife.
    Anonymous 42,789 Replies Flag this Response
  • Thank you for your response to my post about Methotrexate as an alternative for prednisone in patients (like my mom) unable to tolerate prednisone. And thanks for mentioning Lamotrigine; I have taken a quick look at Lamotrigine and will look further. By the way, I thought that I should mention that, after her first hospitalization for psychosis resulting from prednisone, my mother was then incorrectly diagnosed with Polymyalgia Rheumatica, which I think you know sometimes occurs in patients with GCA. In her case, she did NOT have Polymyalgia Rheumatica. In fact, she was found to be suffering from steroid myopathy, which is a muscle ailment resulting from too many steriods (in her case prednisone) over too long a period. Good luck and best wishes for your wife. Unfortunately my wife definately seems to have PMR which probably brought on the GCA - she had what they thought was Fibromyalgia for 4 years before the GCA came on - if they had treated her with low dose steroids rather than the treatment for Fibromyalgia which was Amitripyline for pain then maybe she would never have got the GCA. That being said neither I or my wife are the greatest fans of steroids now but at least they got the GCA under contro. Unfortunately they have left her with possibly long term Bipolar Affective disorder and she is on a cocktail of psychiatric drugs that would make a pharmacist go white - 2 types of mood stabilizers (Lamotrigine and Quetiapine), 2 anti-depressants (Mirtazipine and Venlafaxine) plus diazepam, sleeping pills and the nasty little steroids that started all of this. Now we have the long and careful process of reducing the drugs down to something more manageable - Venlafaxine for one is a nasty drug to come off with some awful withdrawl symptoms (she has had two bouts of depression already since coming out of hospital in November since they have tried reducing the Venlafaxine). She often says that she wishes she had never taken the steroids in the first place and just taken her chance with the GCA although I can't quite subscribe to that as at least I have still got her around, I can see her point. 10 months out of 12 in an acute psychiatric hospital is no-one's definition of fun. Still at least she now seems to be relatively mentally stable but we still take each day as it comes and take nothing for granted. I do hope your Mom is doing well. All the best
    harveya 4 Replies Flag this Response
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