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Steroids and bipolar disorder.

JeighJJeigh Posts: 40
edited 06/11/2012 - 8:49 AM in Chronic Pain
Hello all,
I am new to the forum, and have been helped and educated so much already, I figured I should post about a subject that I could not find anywhere else on the forum.

I am not a doctor, and am only sharing my experience and information I have on the subject.

I have severe reactions to steroids. Both injections and pill form. My first experience was with 4mg Methylprednisolone 1 week cycle tablets. I quit taking them by the second day. My second experience was with an injection directly into my knee. I am unsure of the exact type. I was told I would not have the same reaction to the local injections (by three different doctors),because my liver would not metabolize them the same. This could have not been more incorrect in my situation.

I have bipolar 2 disorder. From searching the forum I have seen similar reactions from people with bipolar disorder, with no clear explanation as to why. In defense of the doctors that prescribed the shot, they did not know of my disorder, as I had not yet been officially diagnosed.

My reaction to the oral tablets was quick. It caused frustration, anger, and insomnia. I felt the strangeness coming by the end of the first day, and on the second day called my doctor, and he told me not stop taking the medication.

My reaction to the injection was much quicker and more severe. Within an hour I was soaring. I had more energy than I did when I was seventeen. The second side-effect was my appetite. It could not be satisfied no matter what I ate. I ate thirty dollars worth of affordable grocery store food in the first day.
Also in that first day, the rage came. Very confusing rage and swift changes in perspective. As I read in another post, "I was outside looking in, and not in a good way". While preparing food (which was constantly) I began to notice my kitchen cabinets, which I was not fond of, and started plotting to rip them off the walls. I knew that I could easily do this, despite my physical limitations. I wanted to badly, and had to continually talk myself out of it. I then started fantasizing about destroying everything in my apartment. TV, furniture, especially my computer, and definitely those kitchen cabinets. I was not at any point suicidal, actually homicidal. Unless you consider destroying everything around you suicidal (different post, for a different site). My only desire was to destroy.
This sounds extreme, because it was...very. I am a peaceful, loving person. I have some anger, like most of us in chronic pain, but never to the point of destroying things, or ever hurting another living creature.
By the second day I asked my girlfriend at the time to leave the apartment to stay with a friend. She had no problem with that. She saw Mr. Hyde clearly.
This feeling was only supposed to last a few days, but instead lasted over a week. In that week I gained twenty pounds and easily consumed well over two hundred dollars worth of reasonably priced groceries. I have a very fast metabolism, and will not gain a pound eating normally even when I am bed-ridden. If I did not get out and walk over five miles every day, I would have destroyed my apartment. I did not sleep a single wink in eight days.

By the end of the ordeal I was exhausted, depressed and crying.
My bipolar is not really very severe, and with meditation, I can manage it well. I do not take any anti-depressants or other smart drugs. The only other medicine I was taking was omeprozole for GERD, and 15 mgs of Percocet. These drugs have no known interactions with steroids as far as I can find.
As I said, I am not a doctor, and this is only my experience, however, if you feel you might have BPD, or have been diagnosed with it, I would talk it over with your doctor before taking any form of steroid.
there is a web page in the next post below that I found that may help you make your decision.

My reactions came on much quicker then they suggest in the link. If my only choice was to live in chronic pain the rest of my life, I would still not take steroids.



  • Steroids and Bipolar Disorder
    By Marcia Purse, Updated November 30, 2006

    In her memoir Skywriting, NBC-TV newswoman Jane Pauley disclosed that she has bipolar disorder. The illness appeared, she says, when she was given steroids for a case of hives. This revelation focuses attention on the relationship between steroids and manic depression.

    Pauley writes, in the portion of her book excerpted in the August 20, 2004 People, that she experienced hypomania following the first administration of steroids for her hives and depression with the second. The depression was serious enough that a low-dose antidepressant was prescribed for her, and she rebounded into an agitated mixed state and rapid cycling. Her doctor explained, she says, that the antidepressant "unmasked a never-before-suspected vulnerability to bipolar depression." But in fact the mood swings had begun before this - with the steroids. She was hospitalized at the time and was stabilized on lithium.

    What Are Steroids?
    According to the PDR Medical Dictionary, the term "steroid" applies to a very "large family of chemical substances, comprising many hormones, body constituents, and drugs." It is also a "generic designation for compounds closely related in structure to the steroids, such as sterols, bile acids, cardiac glycosides, androgens, estrogens, corticosteroids, and precursors of the D vitamins" (2000). It's certainly not necessary to know what all of those are - but obviously the body chemistry and functions composed of, regulated by, or associated with these substances is vast. It is safe to say that nothing happens in the body without the involvement of a steroid. Therefore, it should not be surprising that administered steroids can cause side effects, of which "steroid psychosis" is one documented outcome. "Steroid psychosis - or more appropriately, steroid-induced psychiatric effects - can include psychosis, mood disturbance (e.g., depression, mania, or both), and delirium" (Cortlandt Letters, December 2001).

    Anabolic steroids, used by a generation of athletes to build muscle and bulk until so many dangerous side effects appeared that most of these drugs were banned, can potentially induce mania. The corticosteroids, which would have included the medication prescribed for Jane Pauley's hives, have been seen to induce psychiatric symptoms in studies. In "Steroid-Induced Mental Disturbances" (Perry & Lund, revised 2004), the authors report on a 1972 study by the Boston Collaborative Drug Surveillance Program where patients who took different doses of Prednisone (a corticosteroid), from lowest to highest, had an increasingly greater incidence of mental disturbances: psychosis, mania and depression. The paper also mentions that while mania is the most frequent response to the use of steroids, depression is often triggered by steroid withdrawal.

    Some familiar medical steroids and their uses
    Some of the most commonly known names of corticosteroids include:

    * Cortisone and Hydrocortisone
    * Flonase® (fluticasone propionate nasal spray)
    * Lanacort® (hydrocortisone topical)
    * Prednisone
    * Nasonex® (mometasone nasal)

    and so many others it would be beyond the scope of this article to try to name most of them.

    Corticosteroids are used in the treatment of a wide variety of medical conditions including:

    * Asthma
    * Emphysema
    * Crohn's disease
    * Bursitis
    * Tendinitis
    * Ulcerative colitis
    * Hives
    * Insect bites
    * Nasal allergies
    * Eczema
    * Psoriasis

    Over-the-counter sales of another steroid hormone, DHEA, have come under fire from many in the medical community - one researcher called it "the snake oil of the '90s." Markowitz, Carson, and Jackson (1999) report, "... (DHEA) is among the most abundant steroids in the human body and appears to have diverse biochemical activities. This multifunctional hormone has long been a compound of interest to research psychiatrists. Its recent promotion and availability as an over-the-counter supplement to the general public has led to widespread use. Little is known about potential adverse effects of DHEA when consumed on an acute or chronic basis. We report a case of mania in an older man acutely admitted to our psychiatric facility with no previous personal or family history of bipolar disorder that appeared to be related to recent DHEA use. The patient had initiated DHEA use 6 months prior to admission and was taking 200-300 mg/day at the time of presentation." Unfortunately, various manufacturers have claimed that DHEA is a "miracle" drug or a fountain of youth. It is not.

    According to forensic psychiatrist Dr. Henry Lahmeyer, single-use steroids are highly unlikely to cause any kind of mental disturbance; rather, it is prolonged and steady administration of steroids where psychiatric side effects may be seen. In Pauley's case, she was taking steroids for five months before the mood swings began.

    Searching the relevant medical and psychological literature yields a number of case studies such as those referenced on page 1 of this article, which indicate that steroid use can spike instances of psychiatric disturbance. And while research has yet to reveal the definitive cause of these cases, some findings are beginning to shed light on this question. Wood et al (2004) report that in research with rats, chronic stress as well as administration of the stress hormone corticosterone causes physical changes in the organization of neurons in the hippocampus, a part of the brain. These changes are accompanied by behavioral changes.

    There is currently no research that gives indication that steroids can actually cause long-term mental instability or illness. Ingram and Hageman (2003) note, "A number of published reports describe the appearance of psychological symptoms with corticosteroid use. While the mechanism is unclear, the reaction is usually reversible with dose reduction or discontinuation of the corticosteroid. In cases where this cannot be done, typical treatment involves an antipsychotic medication." The research of Wood et al (2004) also indicates that some of the changes noted in the hippocampus can be prevented with "selective antidepressant and anticonvulsant drug treatments." These researchers explored the use of lithium in this role and found that the long-term treatment with lithium can protect the hippocampus as well. Continuation of this line of research in the future holds promise for better understanding both steroid-induced psychiatric effects and the mechanism behind the efficacy of drugs in the treatment of bipolar disorder.

    Cortlandt Forum. (2001, December). Are bipolar patients at higher risk with steroids?

    Ingram, D.G., &. Hagemann, T.M. (2003). Promethazine treatment of steroid-induced psychosis in a child. The Annals of Pharmacotherapy, 37, 1036-1039.

    Markowitz, J.S., Carson, W.H., & Jackson, C.W. (1999). Possible dihydroepiandrosterone-induced mania. Biological Psychiatry, 45, 241-242.

    PDR Medical Dictionary. (2000). Baltimore, Maryland: Lippincott Williams & Williams.

    Perry, Paul, Ph.D, BCPP, & Brian C. Lund, Pharm.D. (Revised 2004). Steroid-Induced Mental Disturbances.

    Wood, G.E., Young, L.T., Reagan, L.P., Chen, B., & McEwen, B.S. (2004, March). Stress-induced structural modeling in hippocampus: Prevention by lithium treatment. Proceedings of the National Academy of Science of the United States of American, 101, 3973-3978.
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