Steroid-induced psychosis is a rare but serious side effect of steroid treatment that tends to be seen in patients who are given their medication in high oral or intravenous doses (into their veins). It can be incredibly frightening for both patients and their friends and family.
What is psychosis?
Psychosis is an umbrella term for a range of symptoms that involve a disconnection from reality or a tendency to see things differently than they truly are. In the case of steroid-induced psychosis, patients may experience:
Paranoia: This can manifest as a general sense of fear or suspicion. You might feel like everyone around you is a threat or that someone in particular is plotting against you.
Delusions: These are false beliefs that can become fixed in the mind, no matter what the ‘real world’ evidence shows. For example, you may believe that the government is watching you, even though you have no proof of this and no one else around you agrees it’s really happening.
Hallucinations: Hallucinations are when you feel like you’re experiencing something through one of your senses that’s not really there. The most common hallucinations with steroid-induced psychosis are auditory (related to sound). You might hear people talking about you, commenting on your actions, or even engaging in conversations with you that others around you can’t hear. In some cases, hallucinations may be visual (seeing things others cannot), olfactory (smelling things others can't), or involve other senses, but auditory hallucinations are by far the most frequent.
These types of experiences can be deeply frustrating and upsetting because they make it harder for you to trust yourself and others and for you to feel safe. As with many steroid-induced side effects, it can be helpful to understand a bit about why these things may be happening.
Why does the world feel so odd?
Steroids affect brain function, and while the exact mechanism isn’t fully understood, we know they can alter your mood and the way you see things. The brain is a delicate organ, and even small changes in how different parts of the brain are affected by steroids can lead to a wide range of symptoms. For instance, you might experience paranoia and hallucinations together, or you could start to feel confusion and psychosis at the same time.
Psychosis can be one of the most disruptive side effects of steroid use because it can cause a significant disconnection from reality. A person experiencing psychosis may not trust anyone, including their doctors, nurses or family members. This lack of trust can make treatment very difficult, especially in cases where hospitalization is required. When a patient is severely affected, they may resist treatment altogether, believing that the medications being offered are harmful or unnecessary.
If you’re the friend or relative of a steroid-treated patient, and you see this kind of behavior, this is a moment when you will likely need to step in.
What can family and friends do?
If you’re the person taking steroids, it can be really hard to recognize that you’re experiencing steroid-induced psychosis, particularly if your symptoms come and go. Even if it’s only happened once, if your usual reality feels different, it’s really important that you ask your friends and family to help you work out what’s going on.
If you’re the friend or relative of a steroid-treated patient, this is a moment when you will likely need to step in and make sure the person gets the support they need. This might involve encouraging them to book an appointment as well as attending with them and being prepared to advocate for them (speak on their behalf) as someone who knows their usual baseline of behavior and emotion.
Be sure to inform the doctor about any symptoms of paranoia, delusions or hallucinations you have witnessed or the patient has reported, even if you are not in a position to confirm what was ‘real’ and what was not. The doctor will benefit from your input and then take the lead in identifying what’s going on and be responsible for their care.
How is psychosis treated?
The good news is that steroid-induced psychosis is usually temporary. Once the steroid dose is reduced or stopped altogether, these symptoms usually resolve. Treatment can involve slowly tapering (reducing) the steroid dose, especially if the condition being treated is stable enough to allow for a break.
In severe cases, especially when intravenous (IV) steroids are involved, the risk of psychosis is higher than with oral steroids. However, careful management of the dose and monitoring by the doctor can help mitigate these effects.
Occasionally, short-term use of antipsychotic medications may be necessary to control the symptoms until the steroids are safely reduced.
The bottom line
It is critical to recognize the symptoms of steroid-induced psychosis early and get all parties, including you, your friends or family members, and your medical team, on the same page. By working together, you can reduce the impact of psychosis and look ahead to a fully-supported recovery once your steroids are reduced or stopped.
Remember, always consult your doctor before making any changes to your medication or lifestyle to ensure the best care for your specific health needs.