Is prednisone making me crazy?
September 11, 2015 8:16 PM   Subscribe

I have been taking prednisone for several weeks and will be for at least several more (thanks, Crohn's), in doses from 60 mg on down. I am worried I am slowly going crazy without realizing it.

YANAD, etc, etc. Just looking for insight.

It HAS helped my GI symptoms immensely, and I haven't experienced the fabled side effects yet - moon face, acne, etc. In fact, I barely have an appetite and have certainly not gained any weight... maybe even lost some.

My sleep is way out of whack, which is where I fear the crazy. Last weekend I stayed up until 5:30 am one day which is hugely out of character for me. And not only did I stay up, I got insanely productive amounts of work done in the wee hours of the night. I've had lesser insomnia since there, where I can't really sleep but also don't really WANT to sleep. That's kind of a scary feeling?

I've dealt with anxiety and depression in the past and am also taking 20 mg of escitalopram which works extremely well for me. But since starting the pred I have felt kind of amazing in some ways emotionally - much calmer, less anxious, less stressed, and more focused than usual.

However, I'm also absent minded from lack of sleep (I don't feel particularly tired during the day but I am constantly losing things and forgetting words), am aware that I've been talking really fast lately, and feel kind of emotionally chilled out/distant as part of my calmness. This is making my marriage weird too.

Should I be scared that these small, and not necessarily terrible, personality changes are going to build to some big psychotic break? I should clarify that in no way do I feel manic or out of control - just not myself, and kind of speedy.

I have only mentioned the sleeping problems to my GI, but he suggested Ambien which has done scary things to me in the past. He also said I could start tapering my dose down to 40 mg for now. My GP is the prescriber of my anxiety meds but I haven't talked to her since starting pred. I do not want to stop the prednisone if I don't have to, because it is clearly healing my physical body, but I also don't want to lose my mind!
posted by raspberrE to Health & Fitness (25 answers total) 2 users marked this as a favorite
I haven't taken prednisone myself but my daughter has been on it on and off, and it noticeably affects her sleep and her personality (she also got the moon face). The side effects went away when she stopped the medication, and started up again when she went back on it.

I wouldn't be worried about these changes being permanent, but I would start tapering down if the doc has given you the okay. Keep an eye on how you're feeling and ask for reality checks from people who know you, and keep your doctors in the loop. Good luck!
posted by peanut_mcgillicuty at 8:22 PM on September 11, 2015

I have "cannot take prednisone or any steroids" in large red letters on all my medical charts, because it makes me that crazy. I believe that people with mood disorders are especially sensitive to it.
posted by intrepid_simpleton at 8:23 PM on September 11, 2015

This dose of prednisone made me crazy too -- your description of it sounds verrrry familiar. I believe that is a common and known side effect. I also had an insane appetite that made me gain weight.

Like the previous poster, I can say that these kinds of side effects went away rapidly when I stopped taking the drug (or reduced it below a certain level); they never really eased up during a month of this dose though. Please don't stop taking it without tapering though.
posted by Tandem Affinity at 8:25 PM on September 11, 2015

It makes me sleep much much less, gives me crazy energy, and at high doses like you're taking now also makes me really really angry. The side effects calm down after you've been on it for awhile and especially if you're tapering down. The weight gain and moon face hang around for a long time, though. I personally wouldn't add other drugs on top to deal with the symptoms. The sleep disturbances tend to be more at the beginning of the course of treatment so you're not really looking at weeks of no sleep.
posted by MsMolly at 8:30 PM on September 11, 2015

I think you should talk to whoever is in charge of your psychiatric drugs about the prednisone, and make sure she considers the dose and gives the ok on it. Prednisone side effects are strong and yeah they can include sleeplessness, anger, mania.... I've had all those, and I've only taken it a couple times for short stints; I imagine long stints could be quite problematic.
posted by fingersandtoes at 8:35 PM on September 11, 2015

My dad's got Crohn's, diagnosed when I was a young kid, and I vividly remember when he started prednisone and every dosage change he had throughout the years because he fucking went nuts. In addition to his sleep being all out of whack, he went into rages with zero provocation. He absolutely got hit hard with the mood altering side effects of the steroid. But eventually, after several weeks of being at a steady dosage, he'd mostly go back to normal, just with a tendency to really lose his temper from time to time. The mood side effects of the drug are very real.

I don't know what to tell you to answer your specific questions, but it's good that you're paying attention to this. Definitely bring your concerns up with your doctor so you can both keep tabs on it.
posted by phunniemee at 8:39 PM on September 11, 2015

IANAD, but I don't think you're going to have a psychotic break. This is a totally common reaction to Prednisone. The stuff made my heart pound out of my chest. I can tell when my mom's been taking it because she sounds quite manic on the phone. phunnieemee reminded me that my dad got really ragey when he took it once when I was a kid.

Talk to your doctor. Ask about something like melatonin for sleep (I thought it was BS until I started taking it a few weeks ago...the stuff works!).

I had a cortisone shot in my spine on Wednesday and it's giving me similar insomnia. I feel you!
posted by radioamy at 8:42 PM on September 11, 2015

Unfortunately, these are common side effects of prednisone. You should tell your doctor about them in more detail.

At one time in my teens when I was just diagnosed with a chronic illness, I weighed about 72 pounds or so and was frail as all get out. I was also on large amounts of prednisone. I got upset about something long-forgotten, something minor, and proceeded to hulk out and rip the doors off two of the cabinets in the kitchen straight from their hinges.

This drug has serious impacts on mood and behavior. What you are going through is a normal response to the medication. This is one of the many reasons that long-term prednisone use is not advisable, and is why it is necessary to taper, which you are doing. You should not stop taking it outright; that's not safe, either. Your doctor said you could start tapering now, so you may want to heed that advice, or you can try to wait and go with the tapering plan as originally outlined. Talk to them again and be more specific; tell them the mood stuff as well.

Try to take care, remind yourself that this is temporary and is a result of the medication, and be as kind as possible to yourself right now because dealing with a chronic illness is really hard ,and doing it while on massive amounts of prednisone is even more difficult.
posted by sockermom at 8:44 PM on September 11, 2015

My understanding of prednisone (I say this having been prescribed it six or eight times now) was that the big doses tapering off gradually were out of fashion and current medical thought was the pulse dose: a course of huge amounts but over and done in three days. My neurologist suggested this reduced the worst effects of it.

The first time I was prescribed a pulse dose, the pharmacist explained the usual expected side effects of corticosteroids (irritability, sleeplessness, heartburn) then paused and said, "You seem like a level-headed fellow, but this much prednisone will make you into The Incredible Hulk for a few days. So if you feel really pissed off at everyone and everything, this will be why." And sure enough, a couple of nights later I lay staring at the ceiling at 4:00 AM, fuming about some colleague's ridiculous stance on whatever, my esophagus seemingly filled with lava, restraining myself by sheer force of will from climbing out of bed and writing a regrettable e-mail.

I would be very careful about mixing the meds. I am neither doctor nor pharmacist, but you might want to talk to one of these two about the possibilities of a bad mix of chemistry. Prednisone, alas, affects your thinking in disturbing ways and an outside view would be helpful.
posted by ricochet biscuit at 9:02 PM on September 11, 2015

What you are describing is very similar to what my mom experiences on Prednisone. She gets very calm and focused and is full of energy. I also get full of energy but I want to punch walls and I hate everyone. So congratulations to you for getting the better end of the deal! It often makes people gain weight but some people lose weight, including my mom and myself (I lost 10 pounds in a week and my mom loses weight even more quickly - unfortunately for both of us, it comes back after we go off steroids and brings some friends along).
posted by rednikki at 9:04 PM on September 11, 2015

My husband did a very similar protocol due to his Crohn's and he was pretty much a nut job for a period of time. Nothing bad happened though-just some really really excited late night conversation about-no joke-the AMAZING BEE KEEPER'S ASSOCIATION MEETING I JUST WENT TO!!!! and rewiringg of the garage at 2 am. Basically, meth without the aggression.
posted by purenitrous at 9:36 PM on September 11, 2015

I know you'll still have to taper off the prednisone but ask your dr about whether Entocort might be appropriate instead. I found that much easier to deal with when I was last flaring.
posted by stefnet at 10:03 PM on September 11, 2015

In addition to talking to your GP about mixing the meds, talk to your pharmacist, who is likely to have the most up to date information on prescriptions and interactions.

I've been on serious doses of prednisone for allergic reactions (chronic immune system diseases suck, yeah) and nthing that they totally mess me up moodwise. Even taking prolonged doses of prednisone eye drops for irises can make me super-grumpy. Good luck with the tapering and I hope you're better soon.
posted by immlass at 10:05 PM on September 11, 2015

Yes to all the above good advice, and perhaps look into alternative methods to help with the GI issues.
Fermented saurkraut, kefir, etc. Try an Yahoo or google group for others suffering from your condition for some dietary advice.
posted by TenaciousB at 10:20 PM on September 11, 2015

Don't take melatonin unless you've cleared it with your doctor first; it can interfere with the prednisone's ability to do its job.

Yes, to echo everyone else, these are common side effects of prednisone and ones I have experienced when on it. I hate hate hate that drug, but sometimes it's the only way to control inflammation. I don't think you need to worry about a big psychotic break, but do keep aware of any mood or thought changes and let your doctor know if they occur.

The euphoria/energy combined with insomnia can really exhaust you over time. Talk to your docs; they should be able to give you something that isn't Ambien. Tapering could certainly help too.
posted by thetortoise at 12:08 AM on September 12, 2015

In my experience, the steroid induced mania only lasts for the first few weeks of treatment. I wrote all my grad school applications in one afternoon on prednisone, but after a few months of steroid treatment, I was back to 'normal' and felt as tired as one would expect.

Make sure you're taking your prednisone in the morning. It might make overnight IBD symptoms worse, but it's the only chance you'll get for normalizing sleep, so pick your poison.
posted by telegraph at 5:14 AM on September 12, 2015

Prednisone turns me into a twitching, shuddering, sleepless, irrationally aggressive rage monster who cannot deal with the nauseous anxiety and paranoia clawing its way through her belly and up her throat to emerge aiming straight for anyone in her eye-line.
To get me to take prednisone, doctors have to convince me that the choice is "prednisone or you will literally die, tonight" and even then I will ask for second and third opinions and my husband, who wants nothing more than my continued existence at his side, will nod and ask for contingency plans.

My mum, has several times been prescribed prednisone long-term. Like you, she could see and feel it healing her body, and she stuck it as long as she could - to the 'first fix' stage, in her case - but for her, the side-effects ultimately outweighed the physical improvements and she no longer takes it, choosing to work with less aggressive (and less effective, unfortunately) alternatives than become the "prednisone-person."

It sounds as if your course of treatment has a fixed end point, and if you're willing and able to process the side effects as a routine temporary state, that's great, and it is seriously wonderful and that you've found a drug that's working for you.

When your course of treatment is over, be aware of the possibility of steroid withdrawal symptoms. Tapering off sensibly (as your doctor is clearly planning) will help with or even eliminate this, but with the huge range in sensibilities and drug tolerances in human bodies, keep a look out for it so that you can process it the same way as you are processing the side effects right now. You're not going mad, you're not getting worse and the changes are temporary. It's just another stage of the drug.
posted by tabubilgirl at 5:26 AM on September 12, 2015

Thanks for all the reassurance. Someone above described it as "meth without the aggression" and that pretty much sums up how I'm feeling.

Thanks also for the reminder to be kind to myself! Illness does suck and crazy drugs don't make me feel any better about myself.

And I was wondering about what thetortoise mentioned... if the euphoria/energy combined with the insomnia is going to eventually exhaust me or lead to a crash and burn. I'm trying to get as much sleep as possible this weekend. Thanks.

Side note, I did 6 weeks of Entocort before I started the pred and it has zero effect on my symptoms. No side effects either, but didn't help.
posted by raspberrE at 7:22 AM on September 12, 2015

I experienced similar side effects while on prednisone, but they went away after the course was over (for all the courses -- 3 or 4). It really is a wonder drug for my IBD flares. For me, I took advantage of the my altered state, but I didn't crash and burn or anything afterward. I just felt like I used to. Once you start tapering, you'll probably start to notice the side effects lessening. Good luck.
posted by aloysius on the mixing boards at 9:20 AM on September 12, 2015

A coworker of mine has to go on Prednisone periodically and he definitely gets the aggression as part of it, too. You can see him visibly biting his tongue, which is almost more unnerving than if he were to let it out.
posted by small_ruminant at 10:41 AM on September 12, 2015

Yep. Just one more confirmation point. I've gone through several long courses of prednisone as have others in my family. We all get different results. I have to say I'm happier with the manic insomnia than the weepy depression that others get. I was always so wired at the high dose start of a course that a couple of times I really had to explain to people because they thought I was on something recreational. (Especially the time my roommates came home late one night and I was almost finished painting the kitchen ceiling a nice shade of blue.) FWIW, I've learned that I have to taper off very gradually and have a long tail at the end to avoid rebound reactions, YMMV. Good luck with it. The only bright side is that prednisone is good for what ails you. Sometimes it was the only thing that worked, but boy did it ever. Was always glad to have the option.
posted by Gotanda at 5:37 PM on September 12, 2015

Ok, next question if anybody is still reading this -

I stepped down to 40 mg over two days. So after 2 weeks of 60 mg, I did 50 mg for two days, and I'm on day 3 of 40 mg.

The last couple of days I've been kind of weird/off feeling physically - a little headachy, dizzy, light headed, shaky, woozy feeling. Am I imaging it or could it really be that I tapered too fast?
posted by raspberrE at 5:16 PM on September 14, 2015

You should call your doctor and see if there is a nurse on call with whom you can speak. This is not an Internet question, unfortunately.
posted by sockermom at 11:13 AM on September 15, 2015

2nding sockermom-- prednisone messes with your adrenals going on and off it, so there can be a lot of side effects, but if you're in any doubt about severity or anything else, call your doc.
posted by thetortoise at 1:06 PM on September 15, 2015

That sounds like too fast a taper to me. I taper a week at a time, 5 mg at a time, and then depending on how long I've been on it, at the tail end I taper EXTREMELY slowly, like 2.5 mg at a time every other day (a week of 5, 2.5, 5, 2.5, then a week of 2.5, 2.5, 2.5, then a week of 2.5, 0, 2.5). Otherwise I get rebound effect.

On a chronic illness website I frequent, someone described their prednisone side effects in a way that was unforgettable to me because she was describing me. She said, "I knew I was on prednisone when I found myself scrubbing the baseboards of the kitchen at 3 a.m. while crying." Yep. For me, I didn't even realize how bad the side effects were even on a low dose until I did a 14 day silent meditation retreat while tapering prednisone. There's always a little of what they call "vipassana vendetta" so I didn't really think that my anger was anything unusual until I did another 10 day the next year and wasn't angry at all. All of a sudden it all made sense.
posted by janey47 at 6:27 PM on September 17, 2015

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