Adverse psychiatric effects of systemic glucocorticoid therapy

Glucocorticoid therapy causes psychiatric side effects in many patients. Although psychiatric side effects occur most commonly in women and middle-aged patients, no clinical features have been identified to predict which patients are at risk. The most frequent side effects are mood changes ranging from mild euphoria to hypomania, but other reactions, including depression, dementia and psychosis, are possible. The incidence of psychiatric side effects is directly related to dosage. The mechanism by which glucocorticoids produce psychiatric symptoms is probably multifactorial, including both direct and indirect effects on the brain. Psychiatric symptoms usually resolve with dosage reduction or controlled withdrawal of glucocorticoids, but antipsychotic medication may be indicated if symptoms are severe or prolonged.