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How NOT To Lose Your Mind While on Prednisolone

5/3/2020

First of all, we'll talk about who is affected by Prednisolone side-effects, next we'll talk about what you can actually expect if you're taking Prednisolone as far as how it's going to affect your personality and your mood, and finally we'll talk about how you can cope with it.

You'll notice the references there I based all of this on evidence that is published in the medical literature. These are two reviews of medical literature that I'm going to summarize and simplify for you today.

First of all, this quote is directly from one of those articles. It says educating patients about possible side effects and the need to report them is essential and I couldn't agree more, that really is my goal as a Prednisolone pharmacist to educate people about Prednisolone and how it is bothering them and what they can actually do about it. In that same article they told this story and I just wanted to share it with you really quick.

It says three days after starting high-dose Prednisolone a patient - a 50-year-old married white woman began experiencing depression, intense fatigue, malaise weight gain and swelling of her lower extremities. She felt higher than a kite, she was unable to sleep, lacked impulse control and was inappropriately humorous, that would have been interesting. Her mind was flooded with unrelated thoughts and her thing he became so disorganized, she couldn't even Drive. She had memory problems and required multiple reminders including pinning it to her clothes so that she wouldn't forget her responsibilities and appointments. Her doctor had told her “you might become hyperactive”, but she was not prepared for the magnitude and extent of the changes she experienced during taking Prednisolone, nor for when she had to go back at back on Prednisolone again later what kind of depression she would have during the first taper period, and in other treatment cycles.

When her depression became so bad, she sought help from a psychiatrist she even after stopping Prednisolone she continues to report memory problems, some loss of cognitive clarity and vulnerability to overreacting distress. Does any of that sound familiar to you? it sure does to me. For me my personal experience was my doctor in the hospital said “alright you're a pharmacist you know this drug is probably gonna cause insomnia - you choose which medicine you want us to give you for your insomnia”. Okay, cool so they let me prescribe my own, basically with his signature. Well let's learn about when does this happen so is it in your head are you going crazy or is it the drug? that's the question we're answering. And if you follow what I'm about to explain you will find the answer.

First of all, more than half of people who take Prednisolone report a mood condition - we'll explain more about what those are later. For people taking Prednisolone there there's a lifetime risk of 60% chance that you'll have a mood or anxiety disorder while taking Prednisolone. For serious side effects 15.7 out of 100 person years, so if one person takes a medicine for one year that's one-person year, so 15 of those out of 100 will have serious severe depression or even possibly commit suicide. With a 5.7 percent chance of having severe side effects. And how many people are even taking Prednisolone anyway? well there's a lot of confusion about it. The lowest estimate is that 0.9% we'll just round that up to say 1% of the population of the United States of America is taking Prednisolone at any time. And in 2018 it was the 31st most commonly prescribed drug behind thyroid medicines and blood pressure medicines and a few antibiotics. It was number 31 there were twenty 3.2 million prescriptions in 2018. And how bad is it anyway? Well, seven percent of people taking Prednisolone or hospitalized for psychiatric side effects. And how many people could possibly be affected by psychiatric side effects? well the range could be 1.8% to 57% - that's how broad it could be in the literature. Or maybe 30 to 13 to 62 percent, but let's just settle on 27 percent. That's the middle best estimate.

How NOT To Lose Your Mind While on Presnisolone

So, the real answer here is - this drug causes serious psychiatric side effects, but you need to be aware of so that you can have a plan to deal with it. What side effects are they. So, we'll start on the Left. First of all is mood lability, now what in the world does that mean? So, to have a labile mood it means that you jump way more quickly between moods than is normal for you or for most people. Basically, you are more likely to be happy and then suddenly be in tears. Or to be enjoying time with your children and then suddenly screaming at them. Or to be just peacefully driving down the freeway and then suddenly about ready to cut somebody off or something worse. So that's a fairly common side effect.

Then there's anxiety which is restlessness or worry or fear and agitation, insomnia can be related to that and it's characterized by restlessness, waking up in the middle of the night and not being able to fall asleep because your mind is racing and then depression so you'll see that little down arrow. They call this a negative symptom and basically you are lacking in energy you're tired or maybe you're not tired maybe you're you just can't sleep.

The very most extreme of this is suicidal. And it is more… I'll tell you more about that in a minute. Then there's memory impairments so even though you're young taking Prednisolone you might feel like do I have Alzheimer's disease. Am I forgetting everything already do? I have dementia? It might be distracting so you won't be able to focus and complete a task as well as you normally could. And maybe even be confused and disoriented, not sure where you are.

The next one is mania, so mania can range from something as simple as euphoria just feeling really good and having extra energy to hypomania when you might not even need sleep, because there's so much pressure to just do and you might be more irritable and then pressured speech, which I've got a soporific a soda I got to just talk talk talk talk talk, get it out and you're not normally a talkative person but it's just got to come and it comes really fast.

Then psychosis. This is the most extreme and the rarest. It's not very likely that this will happen but it does. They used to call it steroid psychosis, because Prednisolone is a steroid. And it's characterized by delirium. Like “where am I?”, “what's going on?”, hallucinations, seeing things that aren't there, disorganized thoughts like jumping from topic to topic and it doesn't make any sense why you're talking about one thing and then the next thing and delusions like thinking you're the President of the United States or something.

So, these are all possibilities when you're taking Prednisolone, so when do they happen? And this isn't true for everyone, this is just a huge generalization of what could possibly happen in the medical literature. So first you take the Prednisolone, and at the beginning it's more likely that you'll feel that euphoria and extra energy and maybe even mania - all those positive symptoms and then as time goes by you might get anxiety or insomnia, and later on when you've been taking it awhile it's more likely to have depression and the mood lability could really be anytime. And when it's extreme it could be psychosis and memory impairment, and finally you could be suicidal. And I want to be really sensitive here - it's extremely, extremely rare - only point zero three percent of people who are on Prednisolone commit suicide, so don't get any ideas you're worth it is worth fighting for whatever you're going through Prednisolone is miserable and awful but there's a way to cope with it so please preserve your life. This is really important and I'm your advocate, just message me on this page and I'll help you get through it, there are suicide hotlines, you are worth fighting for.

You'll notice the references there I based all of this on evidence that is published in the medical literature. These are two reviews of medical literature that I'm going to summarize and simplify for you today.

First of all, this quote is directly from one of those articles. It says educating patients about possible side effects and the need to report them is essential and I couldn't agree more, that really is my goal as a Prednisolone pharmacist to educate people about Prednisolone and how it is bothering them and what they can actually do about it. In that same article they told this story and I just wanted to share it with you really quick.

It says three days after starting high-dose Prednisolone a patient - a 50-year-old married white woman began experiencing depression, intense fatigue, malaise weight gain and swelling of her lower extremities. She felt higher than a kite, she was unable to sleep, lacked impulse control and was inappropriately humorous, that would have been interesting. Her mind was flooded with unrelated thoughts and her thing he became so disorganized, she couldn't even Drive. She had memory problems and required multiple reminders including pinning it to her clothes so that she wouldn't forget her responsibilities and appointments. Her doctor had told her “you might become hyperactive”, but she was not prepared for the magnitude and extent of the changes she experienced during taking Prednisolone, nor for when she had to go back at back on Prednisolone again later what kind of depression she would have during the first taper period, and in other treatment cycles.

When her depression became so bad, she sought help from a psychiatrist she even after stopping Prednisolone she continues to report memory problems, some loss of cognitive clarity and vulnerability to overreacting distress. Does any of that sound familiar to you? it sure does to me. For me my personal experience was my doctor in the hospital said “alright you're a pharmacist you know this drug is probably gonna cause insomnia - you choose which medicine you want us to give you for your insomnia”. Okay, cool so they let me prescribe my own, basically with his signature. Well let's learn about when does this happen so is it in your head are you going crazy or is it the drug? that's the question we're answering. And if you follow what I'm about to explain you will find the answer.

First of all, more than half of people who take Prednisolone report a mood condition - we'll explain more about what those are later. For people taking Prednisolone there there's a lifetime risk of 60% chance that you'll have a mood or anxiety disorder while taking Prednisolone. For serious side effects 15.7 out of 100 person years, so if one person takes a medicine for one year that's one-person year, so 15 of those out of 100 will have serious severe depression or even possibly commit suicide. With a 5.7 percent chance of having severe side effects. And how many people are even taking Prednisolone anyway? well there's a lot of confusion about it. The lowest estimate is that 0.9% we'll just round that up to say 1% of the population of the United States of America is taking Prednisolone at any time. And in 2018 it was the 31st most commonly prescribed drug behind thyroid medicines and blood pressure medicines and a few antibiotics. It was number 31 there were twenty 3.2 million prescriptions in 2018. And how bad is it anyway? Well, seven percent of people taking Prednisolone or hospitalized for psychiatric side effects. And how many people could possibly be affected by psychiatric side effects? well the range could be 1.8% to 57% - that's how broad it could be in the literature. Or maybe 30 to 13 to 62 percent, but let's just settle on 27 percent. That's the middle best estimate.

So, the real answer here is - this drug causes serious psychiatric side effects, but you need to be aware of so that you can have a plan to deal with it. What side effects are they. So, we'll start on the Left. First of all is mood lability, now what in the world does that mean? So, to have a labile mood it means that you jump way more quickly between moods than is normal for you or for most people. Basically, you are more likely to be happy and then suddenly be in tears. Or to be enjoying time with your children and then suddenly screaming at them. Or to be just peacefully driving down the freeway and then suddenly about ready to cut somebody off or something worse. So that's a fairly common side effect.

Then there's anxiety which is restlessness or worry or fear and agitation, insomnia can be related to that and it's characterized by restlessness, waking up in the middle of the night and not being able to fall asleep because your mind is racing and then depression so you'll see that little down arrow. They call this a negative symptom and basically you are lacking in energy you're tired or maybe you're not tired maybe you're you just can't sleep.

The very most extreme of this is suicidal. And it is more… I'll tell you more about that in a minute. Then there's memory impairments so even though you're young taking Prednisolone you might feel like do I have Alzheimer's disease. Am I forgetting everything already do? I have dementia? It might be distracting so you won't be able to focus and complete a task as well as you normally could. And maybe even be confused and disoriented, not sure where you are.

The next one is mania, so mania can range from something as simple as euphoria just feeling really good and having extra energy to hypomania when you might not even need sleep, because there's so much pressure to just do and you might be more irritable and then pressured speech, which I've got a soporific a soda I got to just talk talk talk talk talk, get it out and you're not normally a talkative person but it's just got to come and it comes really fast.

Then psychosis. This is the most extreme and the rarest. It's not very likely that this will happen but it does. They used to call it steroid psychosis, because Prednisolone is a steroid. And it's characterized by delirium. Like “where am I?”, “what's going on?”, hallucinations, seeing things that aren't there, disorganized thoughts like jumping from topic to topic and it doesn't make any sense why you're talking about one thing and then the next thing and delusions like thinking you're the President of the United States or something.

So, these are all possibilities when you're taking Prednisolone, so when do they happen? And this isn't true for everyone, this is just a huge generalization of what could possibly happen in the medical literature. So first you take the Prednisolone, and at the beginning it's more likely that you'll feel that euphoria and extra energy and maybe even mania - all those positive symptoms and then as time goes by you might get anxiety or insomnia, and later on when you've been taking it awhile it's more likely to have depression and the mood lability could really be anytime. And when it's extreme it could be psychosis and memory impairment, and finally you could be suicidal. And I want to be really sensitive here - it's extremely, extremely rare - only point zero three percent of people who are on Prednisolone commit suicide, so don't get any ideas you're worth it is worth fighting for whatever you're going through Prednisolone is miserable and awful but there's a way to cope with it so please preserve your life. This is really important and I'm your advocate, just message me on this page and I'll help you get through it, there are suicide hotlines, you are worth fighting for.

See Also