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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by ben on April 2, 2002, at 12:19:09
How dangerous/safe is it to treat rheumatic diseases with corticosteroids (after failing NSAIDs) like prednisone or dexamethasone in unipolar depression concerning side effects on mood ? I read that corticosteroids can cause psychosis or depression or make them worser in existing psychiatric diseases.
Posted by Dr. Kramer on April 2, 2002, at 20:11:59
In reply to Kramer: corticosteroids and mood, posted by ben on April 2, 2002, at 12:19:09
> How dangerous/safe is it to treat rheumatic diseases with corticosteroids (after failing NSAIDs) like prednisone or dexamethasone in unipolar depression concerning side effects on mood ? I read that corticosteroids can cause psychosis or depression or make them worser in existing psychiatric diseases.
Actually, they are bad for bipolars, but for unipolars they may be somewhat protective. Stopping them may make depresion worse; taper slowly and be on a good dose of an AD.
Posted by OldSchool on April 2, 2002, at 21:09:17
In reply to Re: Kramer: corticosteroids and mood, posted by Dr. Kramer on April 2, 2002, at 20:11:59
> > How dangerous/safe is it to treat rheumatic diseases with corticosteroids (after failing NSAIDs) like prednisone or dexamethasone in unipolar depression concerning side effects on mood ? I read that corticosteroids can cause psychosis or depression or make them worser in existing psychiatric diseases.
>
> Actually, they are bad for bipolars, but for unipolars they may be somewhat protective. Stopping them may make depresion worse; taper slowly and be on a good dose of an AD.
Dr. Kramer, the above is not true. My depression which is severe, was induced by a cycle of prednisone. Corticosteroids can induce unipolar major depression. Corticosteroids can cause mania, depression, psychosis. They can cause ANY mood disorder. The reaction a person gets to corticosteroids is highly unpredictable. One person might get irritable and angry, manic or hypomanic. Another might get weepy and sad. Another might get a mild antidepressant effect, almost a buzz from prednisone.Corticosteroids are dangerous drugs when it comes to inducing mood disorders in susceptible individuals. Unipolar and bipolar.
Old School
Posted by ben on April 3, 2002, at 6:48:23
In reply to Re: Kramer: corticosteroids and mood, posted by Dr. Kramer on April 2, 2002, at 20:11:59
> > How dangerous/safe is it to treat rheumatic diseases with corticosteroids (after failing NSAIDs) like prednisone or dexamethasone in unipolar depression concerning side effects on mood ? I read that corticosteroids can cause psychosis or depression or make them worser in existing psychiatric diseases.
>
> Actually, they are bad for bipolars, but for unipolars they may be somewhat protective. Stopping them may make depresion worse; taper slowly and be on a good dose of an AD.
Dear Dr. Kramer
So what is right now ?
Ido not take any corticosteroids but I thought about a trial because I have chronic pain not responsive to any NSAIDs.
Thanks
Posted by Dr. Kramer on April 3, 2002, at 20:37:06
In reply to Re: Kramer: whats right now ?, posted by ben on April 3, 2002, at 6:48:23
Between you and your doc. All I'm saying is that the risks are small if you're certain you are unipolar.
Be well.
Posted by OldSchool on April 3, 2002, at 21:10:08
In reply to Re: Kramer: whats right now ?, posted by Dr. Kramer on April 3, 2002, at 20:37:06
> Between you and your doc. All I'm saying is that the risks are small if you're certain you are unipolar.
>
> Be well.
Prednisone causes major depression Dr. Kramer. My dx is unipolar major depression...severe melancholia. It was induced by prednisone. You do not know what you are talking about.Old School
Posted by pharmer on April 3, 2002, at 21:43:43
In reply to Re: Kramer: whats right now ?, posted by OldSchool on April 3, 2002, at 21:10:08
carefull oldschool,sounds like you graduated from the same "school" as dr.tye
Posted by OldSchool on April 3, 2002, at 22:51:58
In reply to Re: Kramer: whats right now ?, posted by pharmer on April 3, 2002, at 21:43:43
> carefull oldschool,sounds like you graduated from the same "school" as dr.tye
HUH? Look I am being very straightforward and direct here. Prednisone causes mood disorders in susceptible individuals. It caused unipolar major depression in myself. I dont appreciate some incompetent doctor coming on here and telling people that corticosteroids is "OK" for unipolar depression. Thats wrong...its incompetent and technically unaccurate and morally wrong to tell someone that corticosteroids is OK for unipolar depression.I didnt graduate from any medical school and Id be insulted to even be called a psychiatrist or psychologist. My knowledge comes from personal experience and the school of hard knocks. And plenty of reading and self education. I think the whole thing is a great big sham and needs to be abolished and the duties of psychiatrists needs to be formally taken over by Neurology. A lot of people think psychiatry is bullshit, not just me. There are no medical tests available in psychiatry and there ought to be some tests.
Psychiatry is bullshit, psychiatrists are full of shit.
Old School
Posted by pharmer on April 3, 2002, at 23:43:52
In reply to Re: Kramer: whats right now ?, posted by OldSchool on April 3, 2002, at 22:51:58
Sorry you feel that way about psychiatry and those that practice it. I believe any medicine can cause disorders in any "susceptible person",not just the field of psychiatry. Unfortunately,many mentally ill people feel they can just open their pill bottle,swallow the pill and presto- up from the depth of hell they will rise.I've learned that to climb up and out,we may have to put some of our own beliefs and past experience's into our emotional recovery. It's tempting to keep riding the elevator to try and get up and out-- but unfortunately we must learn to use the stairs !!
Posted by Dr. Bob on April 4, 2002, at 0:09:07
In reply to Re: Kramer: whats right now ?, posted by OldSchool on April 3, 2002, at 22:51:58
> I dont appreciate some incompetent doctor coming on here...
>
> Psychiatry is bullshit, psychiatrists are full of shit.Please don't post anything that others could take as accusatory, put others down, or exaggerate or overgeneralize.
Bob
PS: Follow-ups regarding posting policies, or complaints about posts, should be redirected to Psycho-Babble Administration, thanks.
Posted by Oracle on April 4, 2002, at 2:25:17
In reply to Kramer: corticosteroids and mood, posted by ben on April 2, 2002, at 12:19:09
Oracle is dismayed by the unkind words expressed on this thread. The Dr. is most kind with his time. My experiences with major depression and cortisone over 20 years are considerable. On doses, by mouth, up to 90 mgs/day (prednisone) for a week or long acting injection (Decadron LA or Kenalog) every month, 6 months running have never caused any problems, mood wise. There is no question in some, with or without mental illness, cortisone has adverse reactions. Nor is there question of the long term effects if the dose is significant. I moved away from my allergies and most of the asthma, but do go home from time to time. This requires predisone, as much as needed and the a step down when I return. I get down to 5-10 mgs/day and am stuck there for 1 to 2 months. At this level, I can see how it could have significant anti depressive effect for some. For me, a traditional AD is better. Prednisone is not as good a "fit" as my current AD. I have also taken way too much in past and will have to from time to time now, so it is not a choice. Higher doses make me very happy, I always reduce my AD dosage. Really too happy.
Oracle is fully aware of the danger of cortisone, I did a geographic (relocation) to get off daily cortisone. I was in real danger of loss of bone and optic nerve damage, and others. Today both are fine. I have a history of life threatening asthma attacks, so I do take 5-10 mgs of cortisone a few times a month. My allergist, who is also an osteopath, and the eye doc indicate this dose is very unlikely to cause problems. I do not know what dose cortisone would be used for in depression. On 5-10 mgs of cortisone I show no depression of endogenous steroid levels.
Oracle
"There is no spoon"
Posted by Elizabeth on April 4, 2002, at 23:05:46
In reply to Re: Kramer: whats right now ?, posted by OldSchool on April 3, 2002, at 21:10:08
> Prednisone causes major depression Dr. Kramer. My dx is unipolar major depression...severe melancholia. It was induced by prednisone. You do not know what you are talking about.
Steroids have unpredictable mood effects, and different people with depression can have different types of endocrine abnormalities. But anyway, is it possible that your depression was triggered by withdrawal from prednisone? (Just curious.) Also, have you ever taken any of the various neuroendocrine tests that are sometimes used in depression? I wonder if ketoconazole -- a glucocorticoid antagonist -- might help you.
My understanding is that steroids are more likely to trigger manic, hypomanic, or mixed mood states than pure depression, but either is possible. Personally, I've only ever observed steroid-induced mania (the mixed/dysphoric/irritable type), never depression (haven't had the pleasure of trying them myself).
One last note: my recollection is that you've said you'd only been diagnosed with MDD, not melancholic features, and that at least one doctor identified mood-reactivity (which precludes melancholia). You've also described your depression and it didn't sound like melancholia to me. It's not a good idea to specify a diagnostic subtype that isn't really applicable; even though this forum is informal, you could easily end up getting advice or suggestions that aren't appropriate to your situation if people are misinformed as to what condition you suffer from. Much of the research on depression has distinguished melancholic and nonmelancholic depressions, so this is not a trivial distinction.
best,
-e
This is the end of the thread.
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