Mood and Cognitive Changes During Systemic Corticosteroid Therapy

E. Sherwood Brown, Ph.D., M.D., and Patricia A. Chandler, M.D.

Background: Physicians in the United States write approximately 10 million new prescriptions for oral corticosteroids each year. Common side effects of corticosteroids include weight gain, osteoporosis, and diabetes mellitus. This article reviews the available literature on psychiatric and cognitive changes during corticosteroid therapy.

Method: A search of the MEDLINE and psycINFO databases was conducted to find clinically relevant articles on psychiatric and cognitive side effects with corticosteroids using search terms including corticosteroid, prednisone, mania, depression, psychosis, mood, memory, and cognition.

Results: Symptoms of hypomania, mania, depression, and psychosis occur during corticosteroid therapy as do cognitive changes, particularly deficits in verbal or declarative memory. Psychiatric symptoms appear to be dose-dependent and generally occur during the first few weeks of therapy. Patients who must remain on corticosteroids may benefit from pharmacotherapeutic approaches, such as lithium and the new antipsychotic medications.

Conclusion: Mood and cognitive changes with corticosteroids appear to be common but generally mild and reversible side effects. More studies are needed to determine effective treatment for steroid-induced psychiatric disorders.

(Primary Care Companion J Clin Psychiatry 2001;3:17-21)

Received Nov. 7, 2000; accepted Dec. 12, 2000. From the Department of Psychiatry (Dr. Brown) and the Department of Family Practice and Community Medicine (Dr. Chandler), the University of Texas Southwestern Medical Center at Dallas, Dallas.

Supported, in part, by the National Alliance for Research on Schizophrenia and Depression (NARSAD), Great Neck, N.Y.; the Sarah M. and Charles E. Seay Center for Basic and Applied Research in Psychiatric Illness, Dallas, Tex.; the John Schemerhorn Psychiatric Fund, Dallas, Tex.; and the Theodore and Vada Stanley Foundation, Bethesda, Md. (Dr. Brown).

Reprint requests to: E. Sherwood Brown, Ph.D., M.D., Department of Psychiatry, the University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX 75390-9070 (e-mail: Sherwood.Brown@UTSouthwestern.edu).