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Mental Health (Expert Forum)
Medrol (steroids) as Trigger?
Answered by
Roger Gould, M.D. - Mental Health, Wellness
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD), bipolar disorder, dementia, electroconvulsive therapy (ECT), learning disabilities, memory, obsessive compulsive disorder (OCD), panic, personality disorders, phobias, post-traumatic stress disorder (PTSD), schizophrenia, stress, transitions, and work problems.
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Medrol (steroids) as Trigger?
by Strac, Oct 22, 2004 12:00AM
Hi and thanks for reading,
I'm a 44 y/o Police Officer, male, healthy, all of my annual physical blood tests and diagnostics come back within norms. I have experienced intermittent anxiety my whole life. As I look back, I can now see that it had been escalating since 1990. It is expressing as migraines, lightheadedness, stomach pain, difficulty swollowing, a panic attack, etc. I was a caffeine junkie and would suck down 4-6 sodas a day (both fountain and canned).
This last May 2004 I was in the yard clearing out some weeds and got a bad case of poison ivy.I sought medical help and was prescribed a Medrol dosepak (4 mg for 6 days).
No problems with it. I finished the regimen on Monday, June 7. On Wednesday morning, I felt a little sick to my stomach and went to work. Later that evening I experienced a PROFOUND anxiety attack. I was terrified and unable to control my thoughts. I was trembling, scared and couldn't stand still. I was consumed with a desire to confess a 7-year-ago act of infidelity to my wife but didn't.
The anxiety didn't abate in the intervening days and my sleep degraded further. I confessed to my wife that Friday after work. Over the next couple of days I saw increasing improvement until the only thing that was left was a disoriented feeling in my head.
Two weeks later, on Monday, when I was at work the anxiety grew quickly until I couldn't stay there. I then saw my GP (6/29). He prescribed Paxil CR 12.5 mg. I saw minimal improvement with that and my sleep worsened. To combat that he gave me Ambien 10 mg.
On Tuesday, September 14th we finally gave up on the Paxil (couldn't go higher due to side effects) and switched to Effexor XR 37.5 mg. I have seen some small improvement with the Effexor (been on it for about a month now at 37.5) but I'm told I am still sub-therapeutic. My side effects are blurred vision, head pressure, lightheadedness/mild dizziness. I'm also still taking the Buspar and Deseryl.
I have been seeing a cognitive therapist and a psychiatrist to manage this. Am diagnosed with GAD and mild depression. I've obtained a self-help program to augment the therapy, am reading some self-help books and, most importantly, have moved closer to God.
Despite all this, I feel lost. I don't feel like I'm making any progress. I'm tempted to just get off all the meds and try some natural supplementation (5-HTP, Whey Protein, Omega-3, etc). I feel like I've painted myself into a corner by going on all these meds and wonder if someone hasn't missed something.
My questions:
1) Have you ever heard of a course of Medrol (or other short-term steroid therapy) being a trigger for this?
2) What about the Medrol caused me to "tip over" like this? What did it affect in my brain?
3) given the nature of the Medrol trigger, do you think that drugs and cognitive therapy will eventually get me back to my pre-Medrol condition - free of meds?
Thanks for taking the time to read this and for any response.
I'm a 44 y/o Police Officer, male, healthy, all of my annual physical blood tests and diagnostics come back within norms. I have experienced intermittent anxiety my whole life. As I look back, I can now see that it had been escalating since 1990. It is expressing as migraines, lightheadedness, stomach pain, difficulty swollowing, a panic attack, etc. I was a caffeine junkie and would suck down 4-6 sodas a day (both fountain and canned).
This last May 2004 I was in the yard clearing out some weeds and got a bad case of poison ivy.I sought medical help and was prescribed a Medrol dosepak (4 mg for 6 days).
No problems with it. I finished the regimen on Monday, June 7. On Wednesday morning, I felt a little sick to my stomach and went to work. Later that evening I experienced a PROFOUND anxiety attack. I was terrified and unable to control my thoughts. I was trembling, scared and couldn't stand still. I was consumed with a desire to confess a 7-year-ago act of infidelity to my wife but didn't.
The anxiety didn't abate in the intervening days and my sleep degraded further. I confessed to my wife that Friday after work. Over the next couple of days I saw increasing improvement until the only thing that was left was a disoriented feeling in my head.
Two weeks later, on Monday, when I was at work the anxiety grew quickly until I couldn't stay there. I then saw my GP (6/29). He prescribed Paxil CR 12.5 mg. I saw minimal improvement with that and my sleep worsened. To combat that he gave me Ambien 10 mg.
On Tuesday, September 14th we finally gave up on the Paxil (couldn't go higher due to side effects) and switched to Effexor XR 37.5 mg. I have seen some small improvement with the Effexor (been on it for about a month now at 37.5) but I'm told I am still sub-therapeutic. My side effects are blurred vision, head pressure, lightheadedness/mild dizziness. I'm also still taking the Buspar and Deseryl.
I have been seeing a cognitive therapist and a psychiatrist to manage this. Am diagnosed with GAD and mild depression. I've obtained a self-help program to augment the therapy, am reading some self-help books and, most importantly, have moved closer to God.
Despite all this, I feel lost. I don't feel like I'm making any progress. I'm tempted to just get off all the meds and try some natural supplementation (5-HTP, Whey Protein, Omega-3, etc). I feel like I've painted myself into a corner by going on all these meds and wonder if someone hasn't missed something.
My questions:
1) Have you ever heard of a course of Medrol (or other short-term steroid therapy) being a trigger for this?
2) What about the Medrol caused me to "tip over" like this? What did it affect in my brain?
3) given the nature of the Medrol trigger, do you think that drugs and cognitive therapy will eventually get me back to my pre-Medrol condition - free of meds?
Thanks for taking the time to read this and for any response.
Doctor's Answer
by Roger Gould, M.D., Oct 25, 2004 12:00AM
, Oct 25, 2004 12:00AM
You should think about your assumption here which may not be correct. The medrol may not be the culprit, especially since the confession became such a big issue. You are probably look at more like a midlife transition, where being honest, and closer to god, and the softer parts of you, are coming out. That in itself can be causing the anxiety, along with the mortality fears that come with it when you abandon the "strong" man, invulnerable man, shell. Work with your psychiatrist and cognitive therapist on these issues, and yes, try getting off of some of these medications so you can think straight when you can, but don't try the self medication route. Rely on your intelligent mind rather than on drugs.
I have always had a slight grey cloud around me anyway and the combination of emotional stress and the Medrol Dose Pack, I'm convinced, pushed me into a zone I had never been before and was quite concerned with how it all affected me. In fact the same week I went to my GP describing how I felt and we have tried 3 different antidepressants to clear up this sudden onset of significant grief. It is clearing but I feel the steroid provided the final push.
In an effort to determine if anything I was taking could have contributed to my overreaction and sadness, I did some web searching looking for negative side effects of the various things I'd recently taken. Since I take a lot of supplements to help with general health and fitness performance I felt maybe one or a combination of these was the culprit. I didn't even think of the Medrol as a contributing factor because I had taken it 2-3 times previously with incident. I also take a prescription testosterone supplement. Common for 50 year olds and older.
Boy was I surprised. I could not find any incriminating info on the supplements I was taking but I did find a number or information sources on Medrol indicating that in infrequent to rare instances Medrol can have significant emotional side effects. I've included some excepts from these sites at the bottom of this message along with the web addresses where I remembered to copy them.
Any significant emotional issue, e.g., infidelity death, guilt, I feel could easily set one up emotionally for the final push. As the info indicates Medrol can provide the push. Remember, rare does not mean impossible. It happens enough or they wouldn't mention it. Hope this info is useful.
Don't discount the advise for counseling or therapy. It can be the most expedient way to resolve emotional issues and may be the only way, in my unqualified opinion.
=================================================
Medrol (Methylprednisolone)
Manufacturer:
Pfizer
Side Effects:
SIDE EFFECTS, that may go away during treatment, include difficulty sleeping, mood changes, nervousness, increased appetite, or indigestion…………………...
--------------------------------------------------------------
Drugs & Vitamins
http://www.drugdigest.org/DD/PrintablePages/Monograph/0,7765,440%7CMethylprednisolone%7C,00.htmlMethylprednisolone
Active Ingredients: Methylprednisolone http://www.drugdigest.org/dd/wavfiles/methylprednisolone.wav
Representative Names: Medrol, Meprolone Unipak
Side effects that you should report to your prescriber or health care professional as soon as possible:
•confusion, excitement, restlessness, a false sense of well-being
•irregular heartbeat
•mental depression, mood swings, mistaken feelings of self-importance or of being mistreated
•unusual tiredness or weakness
----------------------------------------------
Methylprednisolone Oral
http://www.nlm.nih.gov/medlineplus/print/druginfo/medmaster/a682795.htmlhttp://www.nlm.nih.gov/cgi/medlineplus/email_request.pl?refPage=http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682795.html&emailTitle=Drug Information: Methylprednisolone Oral(meth ill pred niss' oh lone)
Brand name(s): Medrol
What side effects can this medication cause?
Although side effects from methylprednisolone are not common, they can occur. Tell your doctor if any of these symptoms are severe or do not go away:
• headache
• dizziness
• insomnia
• restlessness
• depression
• anxiety
---------------------------------------------
Corticosteroids Glucocorticoid Effects (Systemic)
http://www.nlm.nih.gov/medlineplus/print/druginfo/uspdi/202018.htmlhttp://www.nlm.nih.gov/cgi/medlineplus/email_request.pl?refPage=http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202018.html&emailTitle=Drug Information: Corticosteroids Glucocorticoid Effects (Systemic)Contents of this page:
Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. When this medicine is used for short periods of time, side effects usually are rare. However, check with your doctor as soon as possible if any of the following side effects occur:
• Rare
_ .... ; confusion; excitement ; false sense of well-being; hallucinations (seeing, hearing, or feeling things that are not there); mental depression; mistaken feelings of self-importance or being mistreated; mood swings (sudden and wide); ...; restlessness ;
----------------------------------
Brand name:
Medrol
Pronounced: MED-rohl
Generic name: Methylprednisolone
What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor immediately. Only your doctor can determine whether it is safe for you to continue taking Medrol.
Special warnings about this medication
This medication may aggravate existing emotional problems or cause new ones. You may experience euphoria (an exaggerated sense of well-being) and difficulty sleeping, mood swings, or mental problems. If you have any changes in mood, contact your doctor.
I appercaiet you taking the time to gather and share it.
David
¥Ê burning sensation under her skin especially in the back,
¥ knee