Neuropsychiatric Side Effects of Steroids

Today’s pearl reviews the adverse neuropsychiatric effects associated with the use of steroids.

Can steroids alter mentation? What is the incidence? Are there any risk factors?

Types of neuropsychiatric effects: Depression; mania; panic disorder; suicide or suicide attempt; delirium, confusion, or disorientation; psychosis (Janes 2019); insomnia

Incidence: 15.7 per 100 person-years of glucocorticoid exposure for all glucocorticoid courses (22.2 per 100 person-years at risk for first courses, 14.0 for second courses, and 11.7 for third or later courses) (Judd 2014)

Neuropsychiatric OutcomeAdjusted Hazard Ratio95% CI
Suicide or suicide attempt6.894.52, 10.50
Delirium, confusion, or disorientation5.144.54, 5.82
Mania (nonpsychotic)4.353.67, 5.16
Depression (nonpsychotic)1.831.72, 1.94
Panic disorder1.451.15, 1.85
>5 neuropsychiatric outcomes2.262.15, 2.37
TABLE 1. Risk of Five Severe Neuropsychiatric Outcomes Associated With First Course of Oral Glucocorticoid Prescription, Compared With Unexposed Adult Population Matched for Age, Gender, Practitioner, and Underlying Medical Condition (Judd 2014)

Onset: 3-4 days after initiation (up to 2 weeks)

Duration: Few days to few weeks

Risk Factors: Age, dose, timing/duration of course

Treatment: Dose reduction or discontinuation; medications used for anxiety/depression/mania; close monitoring




Author: Bryan D. Hayes, PharmD

Attending Pharmacist, Emergency Medicine and Toxicology, Massachusetts General Hospital; Assistant Professor of EM, Harvard Medical School

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