Expert Opin Pharmacother. PubMed doi Beclomethasone nasal : drug information. Accessed March 7, Intranasal corticosteroids and adrenal suppression. The psychiatric side effects of corticosteroids. Ann Allergy Asthma Immunol. Steroid-induced psychiatric syndromes: a report of 14 cases and a review of the literature. J Affect Disord. Adverse psychological effects of corticosteroids in children and adolescents. Arch Dis Child. Psychiatric adverse effects of corticosteroids. Mayo Clin Proc.
Steroid-induced psychosis in an adolescent: treatment and prophylaxis with risperidone. Turk J Pediatr. Prednisone effects on neurochemistry and behavior: preliminary findings. Arch Gen Psychiatry. A steroid-induced acute psychosis in a child with asthma. Pediatr Pulmonol. Steroid-induced acute psychosis in a child with asthma: report of one case. Acta Paediatr Taiwan. Premedication before iv contrast-enhanced CT resulting in steroid-induced psychosis.
Phelan MC. Beclomethasone mania. Br J Psychiatry. Budesonide and psychic side effects. Ann Intern Med. Connett G, Lenny W. Inhaled budesonide and behavioural disturbances. Alotaibi S, Alshammari F. Inhaled corticosteroids adverse events in asthmatic children: a review. The Internet Journal of Pediatrics and Neonatology. Psychosis in a child inhaling budesonide. Chronic corticosterone administration in rats: behavioral and biochemical evidence of increased central dopaminergic activity.
Eur J Pharmacol. J Psychiatr Res. Potential conflicts of interest: None reported. Published online: March 31, doi Hide Abstract. There was no known family history of mood disorder. Findings of her routine laboratory examinations, including complete blood cell count with differentials, comprehensive metabolic profile, and thyroid function, liver function, and kidney function tests, were within normal limits.
After consultation with her pediatrician, the beclomethasone was discontinued and her manic symptoms resolved within 48 hours. She did not require mood stabilizer treatment or psychiatric hospitalization. The mechanism of the psychiatric side effects of corticosteroids remains unclear. Some studies suggest that the steroids increase dopamine concentration in the brain.
This case report suggests a temporal association between the use of inhaled corticosteroids and development of manic symptoms. The inhaled route has been used more widely and has generally been considered safe in the management of asthma in the pediatric population. However, caution is warranted as mood symptoms may develop as a result of this treatment. Inhaled corticosteroid—induced mood symptoms are not an uncommon condition, but they remain underdiagnosed and undertreated.
Therefore, the physician should routinely inquire about mood symptoms in patients taking any form of steroid. National Center for Biotechnology Information , U. Author information Copyright and License information Disclaimer. Corresponding author. Email: moc. Potential conflicts of interest: None reported. Expert Opin Pharmacother. Beclomethasone nasal drug information. Accessed March 7, Intranasal corticosteroids and adrenal suppression.
The psychiatric side effects of corticosteroids. Ann Allergy Asthma Immunol. Steroid-induced psychiatric syndromes: a report of 14 cases and a review of the literature. J Affect Disord. Adverse psychological effects of corticosteroids in children and adolescents. Arch Dis Child. Psychiatric adverse effects of corticosteroids.
Mayo Clin Proc. Steroid-induced psychosis in an adolescent: treatment and prophylaxis with risperidone. Turk J Pediatr. Prednisone effects on neurochemistry and behavior: preliminary findings. Arch Gen Psychiatry. Corticosteroid-related psychiatric complications in the treatment of Hodgkin's lymphoma in an adolescent. A steroid-induced acute psychosis in a child with asthma. Pediatr Pulmonol. Steroid-induced acute psychosis in a child with asthma: report of one case.
Corticosteroids should not be confused with anabolic steroids , which are used to stimulate muscle growth. Some people who use inhaled steroids may experience vocal hoarseness, referred to as dysphonia. This side effect can occur due to the drug's effect on the muscles of the vocal cords. Rarely, high-dose steroids may cause laryngopharyngeal reflux, in which stomach acids reflux into the throat, causing pain, vocal cord inflammation, and laryngitis.
In such cases, the dose may need to be reduced or the formulation switched. People who take inhaled steroids are at risk for oral thrush , a fungal infection of the mouth also known as oral candidiasis. Symptoms of oral candidiasis include:.
With oral thrush, a superficial white growth can be easily scraped off, often exposing inflamed and bleeding tissue underneath. The infection mainly develops on the roof of the mouth or back of the throat, and can also appear on the tongue, gums, and inner cheeks.
Thrush can be prevented by rinsing your mouth thoroughly with water and brushing your teeth immediately after inhaled corticosteroid use. Instead of water, some people prefer an alcohol-based mouthwash. You can also reduce your risk by attaching a spacer to the mouthpiece of the MDI. The tubular extender allows you to deliver more of the aerosolized inhalant into your throat instead of the mouth. Spacers do not work in DPIs, which have an opening rather than a tube-like mouthpiece. If thrush does develop, it can be treated with an antifungal mouth rinse or with Diflucan fluconazole tablets for more severe cases.
Inhaled steroids are known to place older adults at an increased risk for osteoporosis progressive thinning and weakening of bones. Though osteoporosis is far more likely when taking oral steroids , high-dose inhalants can also contribute to bone brittleness. Symptoms of osteoporosis may include:. Many people with osteoporosis do not even realize they have it until they experience an unexpected bone fracture.
A calcium-rich diet paired with a daily calcium supplement 1, to 1, milligrams combine is recommended for those at the highest risk of bone fractures, including post-menopausal women or older adults. Weight-bearing exercises such as walking and an adjustment in the steroid dose may also help if the bone loss is severe.
The long-term use of oral steroids is known to increase the risk of cataracts clouding of the eye lens and glaucoma optic nerve damage caused by increased inner eye pressure. It is possible for inhaled steroids to do the same, especially in older adults already at high risk of cataracts and glaucoma.
A study in the Digital Journal of Ophthalmology found that adults who used inhaled budesonide for no less than six months had significant increases in inner eye pressure. Similarly, inhaled steroid users exposed to a lifetime dose of two million micrograms suggesting high-dose, long-term use were found to be at greater risk of cataracts than those who received lower doses.
If you develop glaucoma or cataracts develop due to inhaled steroid use, the benefits and risks of your treatment need to be weighed on an individual basis and your treatment may need to be modified. Surgical intervention may also be considered, including laser trabeculectomy for glaucoma or extracapsular surgery for cataracts. While some of the side effects of inhaled steroids are concerning, it is always important to weigh the effect on your respiratory function against the possible consequences of use.
In most cases, inhaled steroids can be taken safely under the supervision and routine care of a doctor. If you are experiencing side effects from a steroid drug, speak with your doctor about alternatives or adjustments that may help.
But never stop treatment without your doctor's OK as this can lead to steroid withdrawal and a rebound of symptoms. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Practical considerations for dysphonia caused by inhaled corticosteroids. Mayo Clin Proc. Inhaled corticosteroids and systemic or topical antifungal therapy: A symmetry analysis. Ann Am Thorac Soc. Corresponding author. Email: moc.
Potential conflicts of interest: None reported. Expert Opin Pharmacother. Beclomethasone nasal drug information. Accessed March 7, Intranasal corticosteroids and adrenal suppression. The psychiatric side effects of corticosteroids. Ann Allergy Asthma Immunol. Steroid-induced psychiatric syndromes: a report of 14 cases and a review of the literature. J Affect Disord. Adverse psychological effects of corticosteroids in children and adolescents. Arch Dis Child. Psychiatric adverse effects of corticosteroids.
Mayo Clin Proc. Steroid-induced psychosis in an adolescent: treatment and prophylaxis with risperidone. Turk J Pediatr. Prednisone effects on neurochemistry and behavior: preliminary findings. Arch Gen Psychiatry. Corticosteroid-related psychiatric complications in the treatment of Hodgkin's lymphoma in an adolescent. A steroid-induced acute psychosis in a child with asthma.
Pediatr Pulmonol. Steroid-induced acute psychosis in a child with asthma: report of one case. Acta Paediatr Taiwan. Asthma and Cushing's syndrome. Premedication before iv contrast-enhanced CT resulting in steroid-induced psychosis. Phelan MC.
Beclomethasone mania. Br J Psychiatry. Budesonide and psychic side effects. Ann Intern Med. Connett G, Lenny W. Inhaled budesonide and behavioural disturbances. Alotaibi S, Alshammari F. Inhaled corticosteroids adverse events in asthmatic children: a review. The Internet Journal of Pediatrics and Neonatology.
Studies in persons free of medical morbidity suggest milder and specific reversible and dose-dependent deficits in verbal or declarative memory even during several days of corticosteroid administration. Physicians and patients may be less aware of memory loss with corticosteroids than mood changes.
Thus, this potential side effect should also be discussed with patients and monitored by physicians. Minimal data were found on the treatment of corticosteroid-induced psychiatric disturbances. However, until more studies are performed, some treatment principles can be suggested. Treatment should begin with dose reduction and discontinuation, if possible, thus avoiding the addition of a second medication with its own potential side effects.
In the past, this has been difficult because of a limited number of treatment options for most inflammatory disorders. However, with the advent of alternative pharmaceutical regimens such as methotrexate for rheumatoid arthritis and leukotrienes for asthma , this is a more feasible option. In cases in which psychiatric symptoms are severe, pharmacotherapy should be initiated. The only controlled treatment study for steroid-induced psychiatric symptoms used lithium.
Blood levels of 0. Although mood stabilizers such as lithium and valproic acid appear to be effective, carbamazepine should probably be avoided as this medication induces the metabolism of some corticosteroids, 29, 30 potentially lowering plasma levels of the steroid and increasing symptoms of the underlying disease process. As antipsychotics do not require monitoring of blood levels, and the newer atypical agents are rarely associated with dystonic reactions or extrapyramidal side effects, these medications may be safe and effective for psychiatric symptoms during corticosteroid therapy.
Dosages of olanzapine starting at 2. Anecdotal data suggest that tricyclic antidepressants, but perhaps not the newer antidepressants, can lead to a worsening of symptoms. As depressive symptoms are common in persons with chronic medical illnesses, it can be difficult if not impossible, to determine if corticosteroids are responsible.
Further investigations on the use of antidepressants are needed to determine the risks versus benefits for depression during steroid therapy. Antidepressants should probably be avoided as first-line treatment in persons with mood symptoms likely secondary to corticosteroids.
If an antidepressant is used, physicians should probably consider prescribing a selective serotonin reuptake inhibitor e. The cognitive effects of corticosteroids appear to be dose-dependent and reversible with discontinuation of the medication. Therefore, the same treatment principle of reducing the dosage and, if possible, discontinuing therapy, as recommended with mood disturbances, seems reasonable.
No specific pharmacotherapies for cognitive impairment have been reported in humans. In animals, agents that enhance the reuptake of serotonin and inhibit the release of glutamate e. Corticosteroids are given for a variety of common illnesses on both an outpatient and inpatient basis. Therefore, the psychiatric side effects of these medications are of concern to all physicians. The data available on incidence and prevalence are scant, and few controlled studies have been performed evaluating treatment for steroid-induced psychiatric problems.
However, the available data suggest that the psychiatric symptoms during corticosteroid therapy are dose dependent, often occur early in treatment, and include mania, depression, lability, and psychosis. Future research on the pharmacotherapy of both mood and cognitive symptoms with corticosteroids is needed.
Drug names: alprazolam Xanax and others , amitriptyline Elavil and others , carbamazepine Tegretol and others , dexamethasone Decadron and others , fluoxetine Prozac , olanzapine Zyprexa , phenytoin Dilantin and others , sertraline Zoloft , valproic acid Depakene. National Center for Biotechnology Information , U. Sherwood Brown , Ph. Chandler , M. Author information Article notes Copyright and License information Disclaimer. From the Department of Psychiatry Dr. Reprint requests to: E.
Sherwood Brown, Ph. Received Nov 7; Accepted Dec This article has been cited by other articles in PMC. Abstract Background: Physicians in the United States write approximately 10 million new prescriptions for oral corticosteroids each year. Table 1. Systemic Side Effects of Corticosteroids. Open in a separate window. Case study. Table 2. Table 3. Studies Examining Cognitive Effects of Corticosteroids.
Mood symptoms during corticosteroid therapy: a review. Harv Rev Psychiatry. Psychopathological and neuropsychological effects of 8-days' corticosteroid treatment: a prospective study. Recurrent cases of corticosteroid-induced mood disorder: clinical characteristics and treatment.
J Clin Psychiatry. Depression, somatization and steroid use in chronic obstructive pulmonary disease. Int J Nurs Stud. Prednisone effects on neurochemistry and behavior. Arch Gen Psychiatry. Acute adverse reactions to prednisone in relation to dosage. Clin Pharmacol Ther. Corticosteroids in cancer: neuropsychiatric complications. Cancer Invest. Reversible steroid dementia in patients without steroid psychosis. Am J Psychiatry. Corticosteroid-induced delirium and dependency.
Gen Hosp Psychiatry. Glucocorticoid-induced impairment in declarative memory performance in adult humans. J Neurosci. Decreased memory performance in healthy humans induced by stress-level cortisol treatment. Steroid-induced psychiatric syndromes. J Affect Disord. Mood and memory changes in asthmatic children receiving corticosteroids. Lithium prophylaxis of corticotropin-induced psychosis.
Lithium in the treatment of a manic patient with multiple sclerosis: a case report. Dis Nerv Syst. Effects of lithium on steroid-induced depression. Biol Psychiatry. Extreme mood lability associated with systemic lupus erythematosus and stroke successfully treated with valproic acid.
J Clin Psychopharmacol. Presentation of the steroid psychosis. This content does not have an English version. This content does not have an Arabic version. See more conditions. Request Appointment. Prednisone and other corticosteroids. Products and services. Free E-newsletter Subscribe to Housecall Our general interest e-newsletter keeps you up to date on a wide variety of health topics. Sign up now. Prednisone and other corticosteroids Weigh the benefits and risks of corticosteroids, such as prednisone, when choosing a medication.
By Mayo Clinic Staff. Show references Ritter JM, et al. The pituitary and the adrenal cortex. Elsevier; Accessed Oct. Grennan D, et al. Steroid side effects. Saag KG, et al. Major side effects of systemic glucocorticoids. Major side effects of inhaled glucocorticoids. Roberts WN, et al. Joint aspiration or injection in adults: Complications. Nieman LK. Pharmacologic use of glucocorticoids.
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