Psychological Effects of Oral Corticosteroid Use
There has been a lot of buzz about oral corticosteroid (OCS) use for asthma.
The good, the bad and the ugly
Until recently I wasn’t aware of an actual movement to address the overuse of OCS in asthma and the development of alternative options.
Finally! I feel like patients have been saying this for such a long time. Give us an option that is not “go take a steroid”. It is important to note that not everyone has the same experience with OCS. It is thought that OCS are generally well tolerated under 7.5mg/daily.1 I fall into the “I do not want the only answer to be OCS category." There are new options coming to the table in the form of biologics, they are providing some with new options, renewed hope, and improvement.
I have been asked why I dislike OCS use so much; other than all the physiological side effects that I have experienced is the impact of the psychological ones. I seem to be especially sensitive to these. If I had to describe it in a nutshell, I would say that it is the fact that I don’t feel like myself while on moderate to high dose daily OCS. I had been able to “get through” being on the lower doses. However, being on the higher doses just make me feel foggy, disconnected and especially moody.
As you may have suspected, not everyone appreciates my mood. I found this particularly challenging to manage in the workplace, it is like I don’t have a filter while I am on OCS. I have realized that not everyone wants to work with the cranky, negative Nelly. I am not trying to be negative but before I can process what I am saying, I have said something in a manner in which I did not want to deliver it. Ugh…
I sought out to investigate further what the psychiatric correlations with OCS use were. I discovered that mania, depression, mood lability and psychosis have been associated with oral corticosteroid use.2
The health system is working collectively on not only an alternate option to OCS treatment but also reevaluating there the appropriate use and prescribing. For example is there a lifetime maximum amount of OCS that a person could safely receive? Are there patients that do better than other on OCS and should use be limited to those patients?
What's your experience?
I believe that mood lability is the most difficult part and I loved discovering the scientific term for this. I am going to try and work it into waiting room conversations or at dinner parties. Have you experienced any of the symptoms? Have you had a discussion with your care team about your concerns about psychiatric symptoms?
Do you get muscle cramps caused by your asthma medicine?