Severe Mood Swings on Corticosteroids?

[LettertoHerms]

I haven't posted a thread in health before, hope this is right place, I've been googling but I'm wondering if anyone has more experiences/answers.

DP has been prescribed an oral corticosteroid for sarcoidosis. I'm not sure of the dose, I believe the specific drug is prednisolone.

To put it mildly, he hasn't been himself recently. He's had some massive, horrible overeactions and irrational behaviors. Things even he can't explain, just that he was overcome with emotion at the time and acted completely rashly.

I'm about at the end of my tether. To tell truth, I'm nearly ready to call it quits, I can't reconcile his recent behavior. Except... I totally forgot he's been taking this medication, with mood swings as a side effect. I've been reading up on it this evening, and it seems as though severe swings to the point of manic episodes are a possibility.

I'm not sure if this is my answer. Does anyone have experience with this that can shed some more light?

I've been prescribed prednisone a few times and mostly have felt fine bit on one occasion had a bad reaction and felt extremely low and paranoid and suicidal so they certainly can have significant effects on someone's mood.
is he aware of how he is behaving? I think a trip to the gp would be a good idea.

Thanks so much for the reply, away. That's thrown me too, this is his second round, the first time he may have been mildly snappish, nothing like this time, which is a longer cycle.

He's aware, he's been describing it himself as being unable to see through/control his emotions. Neither of us have thought to connect it to the medication before.

I've taken pred a few times and always get similar side effects and a particularly short temper. It's common and they refer to it as " 'roid rage". Speak to the GP for an alternative medication.

Yes there's also in rare cases steroid psychosis so imagine it can cause mood swings.

Chat to the GP.

Thanks for the replies. He actually stopped taking it a week ago apparently (because he lost them at work ) and will see his lung doctor soon.

This is reassuring, just trying now to reconcile his behavior and how I feel about it - and feeling horrible that I may have been selfish when I should have been understanding, that he really might not have been able to control it. Had no idea this could be like this, the doctor and prescription label made it sound mild and minimal, but what I'm reading all points to the possibility of them being very severe. I wish I had been prepared!

it is awful

as he tapers it will be awful again

my son has spent most of his life on these drugs

I am on 40 mg of prednisolone just now and cannot control my temper. Something happens to frustrate me and I will shout, scream and swear before I even realise I am doing it, never mind being able to stop before I lose my temper.

If your dh has sarcoidosis that can also affect temper. I have neurosarcoidosis and it has affected my frontal lobes, which can cause irritability and short temper. This should be temporary and he should recover with treatment.

There are other corticosteroids he can take, I hope he can speak to his neurologist and explain the side effects are too severe to live with and he needs an alternative. I've been offered an immunosuppresant after my latest heavy dose of steroids to try to taper them down or come off them altogether, so he could also ask about that.

Hope he gets better soon, and I hope you are OK. I can assure you your dh loves you very, very much, as I do my dh, and all of his bad temper is due to the medication. It is really horrible to be hurting the people you love like this, and it really is uncontrollable. If he is like me he will be feeling very guilty but completely unable to stop, but he will get better once he is off steroids.

Thank you merci and coffee. I had no idea what to expect, and it's very reassuring to hear these experiences, though I'm sorry you've been through this as well. To update my original post, it was prednisone 40mg.

Hopefully things will look better on his next chest scan, and otherwise he can talk about a different prescription. I feel much more prepared now.

It worries me a bit that your dh has lost his prednisolone tablets. Normally if I am on high dose pred for more than 3-4 weeks I have to reduce the dose slowly over a few days/weeks. I'm not sure exactly why (to do with the bodies own cortisol production being suppressed during corticosteroid medication) but I wonder if that could have added to the problem?
And yes they make me moody too.

Magso is correct, lost tablets are a red flag because just stopping pred risks a crisis. The pred sits on cortisol production and your body has to be gradually coaxed into restarting. I've heard accounts of the tapering time as being the hardest time for side effects. Please see your GP for advice.

usually they are tapered and it is not a good idea to just stop them
when was he supposed to stop them?
40mg daily is high dose and presumably necessary so he needs to get medical advice about restarting if necessary

I'm worried too, but I think he may have hit the window where it was ok to stop. I thought this round had been longer, it was meant to be eight weeks, but he stopped after two. Either way he's now been off for eight days and says he's fine, no withdrawals. I'm still worried about his adrenal gland function but wouldn't that be more apparent by now?

Luckily it's not a case where they are necessary in a life-threatening way. Also, his eight week cycle was meant to be four weeks of 40mg, then four weeks of 20mg, then nothing. From what I'm reading, that seems crazy, shouldnt tapering be more gradual?

I've told him to call his doctor in case he needs more monitoring. But I'm hoping he stopped at an ok time, he'll continue normally, and this nightmare is over for now.

That taper is fine. There are loads of different patterns. Sometimes no taper at all. We do 40 and stop. But tapering is more normal. 2 weeks vs 8 weeks is a big difference though - maybe wont have desired effect. Anyhow fingers crossed it does.

I think stopping after only 2 weeks is OK ( I often have short courses of 1-2 weeks which require no taper). Hope he speaks to the GP though!

Hi OP, sorry to bump this thread after a couple of weeks, but I wanted to let you know that my DH also has sarcoidosis (diagnosed 2 years ago) and suffered awful mood-swings when he started taking a high dose of prednisolone. It made family life dreadful for a while so you have ALL my sympathy!

DH first took pred for 9 months. After 6 months his chest x-ray was completely clear and has remained so. He has now developed a persistent rash though (erythema nodosum) and is back on a low dose of pred, plus methotrexate.

DH has had to learn how to control his temper when he's taking steroids. His consultant has stressed to him that he can't simply use his meds as an excuse for abusive and threatening behaviour, and he has to learn to manage his emotions as part of learning to manage his chronic illness. He doesn't flip out any more - mainly because he has made the connection that his feelings of anger are caused by the drugs, not his family acting like arseholes. Sounds simple, but I can understand it really isn't. I also have a zero tolerance policy in place, and have told him he'll have to leave if he can't keep a grip.

I'll keep my fingers crossed for you and your DH and hope his meds work soon . But as other posters have said - it REALLY isn't a good idea to stop taking pred overnight, it needs to be carefully tapered off. A close friend had a nasty pyschotic episode last year after stopping a 40mg dose overnight.