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Suicidal Behaviors Linked to Steroid Treatments

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The research study that I am highlighting this month is especially for mental health professionals who follow my newsletters.  It may explain in part why your patients may do very well and then suddenly they are more depressed or suicidal.  The summary, which follows, discusses how glucocorticoid (steroid) therapy can increase depression and suicidal ideation in your clients.

Most commonly, I have seen Prednisone prescribed for bronchitis or asthma.  Sometimes steroids are also used for acute flare-ups of autoimmune diseases such as MS.  Although the research did not specifically look at local injections of steroids for joint pain, I have seen a few patients in my office struggling with depression and the deepening of the depression within the three-month window of steroid injection(s) for knee pain.

Let me state again: I am not against the use of medications.  I simply want people to know that they may experience depression or suicidal behaviors as a side effect of this medication.  If they wait it out, those side effects will go away.

In a United Kingdom study over a period of 18 years, researchers assessed 372,000 adult patients who received prescriptions for oral glucocorticoid compared with those patients who did not receive such prescriptions.  This is the largest study to date examining the effects of glucocorticoid treatment on adverse neuropsychiatric outcomes.

Simply put: Glucocorticoids increase the risk of suicidal behavior and neuropsychiatric disorders.

Authors Fardet, Petersen, and Nazareth reported “finding a high incidence of neuropsychiatric adverse events in the first 3 months of treatment with glucocorticoids.  Over all, the incidence was 15.7 per 100 person-years at risk.  For patients on their first course of glucocorticoids, it was 22.2 per 100 person-years at risk.  Older men were at higher risk of delirium, confusion, disorientation, and mania, while younger patients were at higher risk of suicide or suicide attempt.  Patients with previous histories of neuropsychiatric disorders and those treated with higher dosages of glucocorticoids were at greater risk for neuropsychiatric outcomes.”

These research findings should give us all pause.  Physicians must exercise caution in administering these drugs.  All of us have monitoring responsibilities.  Information and education for patients and their families are very important in order to eliminate, as much as is possible, adverse reactions and misinterpretations of side effects.