Published: 2 June 2016

Publications

Inhaled and Systemic Corticosteroids and Mood Disorders

This article is more than five years old. Some content may no longer be current.

Prescriber Update 37(2): 29-30
June 2016

Corticosteroids are used in the treatment or symptom control of a number of different medical conditions. Indications for use range from endocrine disorders such as adrenal insufficiency, to allergic skin reactions, blood disorders (eg, leukaemia), pulmonary disorders (eg, asthma and emphysema) and connective tissue disorders (eg, systemic lupus erythematosus). However, not all corticosteroids are approved for all indications.

Corticosteroids are available in a variety of different formulations including tablets, injections, aerosols for inhalation, eye drops and topical applications.

Healthcare professionals are reminded that inhaled and systemically available (oral and injectable) corticosteroids have been associated with adverse psychiatric and behavioural reactions. Adverse effects may include euphoria, insomnia and mood swings such as irritability and hyperactivity, or personality changes, severe depression and even psychosis^1,2,3.

Particular care is needed when considering the use of corticosteroids in patients with existing or a previous history of severe affective disorders as these tendencies may be aggravated by corticosteroid use¹.

The Centre for Adverse Reactions Monitoring (CARM) received 48 reports containing 70 adverse psychiatric or behavioural reactions associated with corticosteroid treatment from 1 January 2000 to 31 December 2015 (Table 1).

The reaction terms most frequently reported include agitation (six reports), insomnia, confusion, anxiety and depression (five reports each). Somnolence, hallucination and psychosis have also been reported.

Table 1: Number of adverse psychiatric or behavioural reactions reported in association with different corticosteroids in New Zealand (1 January 2000 to 31 December 2015)

Corticosteroid	Number of Reports
Prednisone	14
Fluticasone, Dexamethasone	6
Hydrocortisone, Triamcinolone	5
Prednisolone, Budesonide (with Eformoterol), Betamethasone	3
Budesonide	2
Beclomethasone	1

There have been no reports of psychiatric reactions with methylprednisolone or fludrocortisone. Tetracosactide was not included as used only for diagnostic purposes.

The risk of experiencing these adverse reactions is lower with short-term, occasional corticosteroid treatment or local application (eg, into the eyes, onto the skin or an injection into the joint). The incidence of these reactions increases with increasing corticosteroid dose.

These reactions often occur within days or weeks of starting treatment and dose reduction or withdrawal usually helps symptom resolution¹. Dose tapering needs to be carefully managed to avoid hypothalamic-pituitary-adrenal (HPA) axis suppression, which may result in secondary adrenal insufficiency, recurrence of the underlying condition or corticosteroid withdrawal syndrome¹. As with many other medicines, corticosteroids should be titrated to the lowest effective dose.

Healthcare professionals are encouraged to continue reporting adverse reactions to corticosteroids to CARM. Reports can be submitted on paper or electronically (https://nzphvc.otago.ac.nz/reporting/).

References

1. Munjampalli SKJ, Davis DE. 2016. Medicinal-Induced Behavior Disorders. Neurologic Clinics 34: 133-169.
2. Douglas Pharmaceuticals Ltd. 2011. Dexamethasone Data Sheet 24 May 2011. URL: www.medsafe.govt.nz/profs/datasheet/d/Dexamethasonetab.pdf (accessed 11 April 2016).
3. AstraZeneca Limited. 2016. Symbicort Turbuhaler Data Sheet 3 March 2016. URL: www.medsafe.govt.nz/profs/datasheet/s/Symbicortinh.pdf (accessed 11 April 2016).