Management of psychiatric side effects associated with corticosteroids

Corticosteroids are given for a wide variety of inflammatory or immune response-related illnesses. Dose-dependent psychiatric symptoms, including mania, depression, cognitive impairment and occasionally psychosis, have been reported during corticosteroid therapy. As many patients require long-term therapy with corticosteroids, treatments for these symptoms are sometimes needed. One small controlled study suggested that lithium prevents psychiatric symptoms with corticosteroids. Case reports suggest the efficacy of several different anticonvulsants and antipsychotics. The anticonvulsant lamotrigine may be useful for depression and cognitive impairment associated with corticosteroid therapy. Literature on antidepressant use is mixed, with reports of symptom worsening with tricyclic antidepressants but improvement with selective serotonin reuptake inhibitors. Larger controlled studies are needed to determine optimal treatment for the psychiatric side effects of corticosteroids.