The Neuropsychiatric Effects of Glucocorticoid Therapy
the MPR take:
Glucocorticoids are commonly prescribed for immune system suppression and to decrease inflammation for a range of medical conditions, but they may also carry a risk of severe adverse neuropsychiatric effects. Most evidence has been collected from individual case or case-series reports; in one case-series study of 80 patients completing their first lifetime glucocorticoid therapy, 52.5% of patients developed one more mood-related conditions. A larger study of 261,272 patients found that during the first three months of oral glucocorticoid therapy, the risk of suicide or serious suicide attempts was increased seven-fold and with markedly higher risks of other severe neuropsychiatric conditions as well. While cognitive disturbances usually disappear after treatment discontinuation, severe and persistent impairment has been seen in some patients on longer-term treatment. It is believed that synthetic glucocorticoids may preferentially activate pituitary glucocorticoid receptors while suppressing adrenal cortisol secretion, thus depleting the brain and body of endogenous cortisol. This imbalance between mineralocorticoid receptors and glucocorticoid receptors may be the cause of these neuropsychiatric conditions, particularly in patients taking higher doses for a prolonged period of time. Patients should be advised regarding these potential side effects and encouraged to inform their clinician of any neuropsychiatric changes after initiation of glucocorticoid therapy.
Glucocorticoids are the most commonly prescribed anti-inflammatory/immunosuppressant medications worldwide. This article highlights the risk of clinically significant and sometimes severe psychological, cognitive, and behavioral disturbances that may be associated with glucocorticoid use, as well as ways to prevent and treat these disturbances.
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