My Experience with Steroid Induced Psychosis

Content Note: This article contains themes of depression and suicidal ideation. If you or a loved one are struggling, consider reading our mental health resources page.

If you have ever been on steroids, you know they come with a smorgasbord of symptoms. Short-term use of steroids can cause problems like insomnia, insatiable hunger, and even anger for some people. Longer and more frequent use of steroids has a list of its own.

I have been on and off prednisone for many years now and am faced with many different side effects. Although I am only in my mid 30’s I already have to take medicine for osteoporosis. I also have extreme swings in blood sugar due to steroid use, whether I am currently on steroids or not. I have to use a biologic medicine to keep my sugars from going too high and too low. Steroids have also had a significant impact on my immune system making me more susceptible to any kind of infection. But last year I encountered a side effect that I had never experienced before.

One of the more infrequent side effects of steroids is steroid-induced psychosis. It is estimated that 5-18% of people treated with corticosteroids will experience psychosis.¹ According to the Diagnostic and Statistical Manual IV, steroid-induced psychosis is a diagnosis of exclusion. In order to meet the criteria for this diagnosis, symptoms must begin shortly after starting a systemic course of steroids and include hallucinations and/or delusions that interfere with the ability to function. Additionally, depression, anxiety, and even suicidal thoughts and behaviors might be present.²

Starting steroids because of asthma symptoms

As I mentioned above, I’ve been taking prednisone on and off for years and years. It is a medication that I always kept in my medicine cabinet, always at hand in case of an asthma attack. This particular time, I was sensing an impending asthma exacerbation, and after discussing it with my pulmonologist, we decided to go ahead with a quick burst of steroids to help ward off any severe symptoms. This was not an unusual occurrence in my life as a severe asthmatic.

Experiencing a side effect: steroid-induced psychosis

The next afternoon, I noticed that my mind was racing. I have struggled with anxiety and depression in the past, and even self-harm as a teenager. So these symptoms were not unfamiliar, but they erupted out of nowhere. I began ruminating on thoughts of self-harm and suicide. Having dealt with these feelings in the past, I did my best to use my coping skills to deal with them. But as the night dragged on, my thoughts and feelings started to get away from me. These thoughts had been abstract, up until the point when they were not. As a solid plan for self-harm formed in my mind, I knew it was time to head to the emergency room (ER).

With tears of frustration and anger, I walked into the ER and told them what was going on. I was quickly taken back to one of the psych rooms in the emergency room, and evaluated by one of the physicians. Unfortunately, they determined that I was not safe to go home and I was admitted to the psych ward early the next morning.

My symptoms lasted four days before they started to subside. It was the worst four days I have ever experienced. It felt like an out-of-body experience. The thoughts, feelings, and emotions were not mine. I felt out of control in my own body and felt powerless to do anything about it.

After those four days, my symptoms left as quickly as they had set in. It was such a relief to feel like I was in my right mind again. I spent a total of five days in the psych ward before they felt comfortable discharging me and I was more than ready to be home.

A change in my asthma treatment plan

I have been unable to use prednisone since then. The reaction was so severe that it’s too risky to ever take it again. Thankfully I have been able to use Medrol (methylprednisolone) since then and have not had any issues taking it. Switching to a different steroid was a bit of an adjustment for me and my doctors. Although they work in very similar manners, prednisone and Medrol are dosed differently, and the taper is slightly different as well. It took a while, but I’m finally comfortable with the change in dosing and am able to adjust the dosing myself as I used to do with prednisone.

Steroid-induced psychosis is not a very common side effect of steroids, but when it hits, it can be intense. I’m thankful that nothing worse happened and that I was able to get treatment right away.

If you ever feel thoughts of self-harm or suicide, please go to the emergency room immediately so that you can get the proper care. It is certainly scary in those moments of confusion, but the ER is the safest place to be.

What kind of strange side effects have you had from taking steroids? Let us know in the comments.