Glucocorticoids psychiatric treatment

Treatment with steroids may initially evoke euphoria. This reaction can be a consequence of the salutary effects of the steroids on the inflammatory process or a direct effect on the psyche. The expression of the unpredictable and often profound effects exerted by steroids on mental processes generally reflects the personality of the individual. Psychiatric side effects induced by glucocorticoids may include mania, depression, or mood disturbances. Restlessness and early-morning insomnia may be forerunners of severe psychotic reactions. In such situations, cessation of treatment might be considered, especially in patients with a history of personality disorders. In addition, patients may become psychically dependent on steroids as a result of their euphoric effect, and withdrawal of the treatment may precipitate an emotional crisis, with suicide or psychosis as a consequence. Patients with Cushing s syndrome may also exhibit mood changes, which are reversed by effective treatment of the hypercortisolism. 

The psychostimulant effects of the glucocorticoids are well known (80), and their dose dependency is recognized (SED-11, 817) they may amount to little more than euphoria or comprise severe mental derangement, for example mania in an adult with no previous psychiatric history (SEDA-17, 446) or catatonic stupor demanding electroconvulsive therapy (81). In their mildest form, and especially in children, the mental changes may be detectable only by specific tests of mental function (82). Mental effects can occur in patients treated with fairly low doses they can also occur after withdrawal or omission of treatment, apparently because of adrenal suppression (83,84). 

---