Q:  Connection Between BP & Prednisone

Dr., Thank you for the time you sacrifice from your life to help others. I am just writing to comment on the Prednisone/BP connection. I was first introduced to Prednisone in the early 1980's for severe asthma and allergies. This drug was prescribed for me numerous times throughout my childhood and adolesence. Prior to taking Prednisone, I had no mental health issues. While taking the drug, I became extremely nervous, developed a tic syndrome, felt enraged at times and became violent. It was again prescribed for me several times for a mysterious rash, which I now believe came from the drug itself. The bottom line is that of course I have swore off Prednisone, but now in adulthood, I have been diagnosed with BP1, Tic Syndrome, and OCD. Maybe coincidence but I wouldn't want anyone else to take the chance. I went from being the best in my business and well reknoned to now barely being able to hold onto my job. Perhaps this may help someone else make a decision or may be add to your own research.

Best Regards, 
Kevin
 

Dear Kevin -- 
Thanks for your note. Other readers who are not familiar with the connection between prednisone -- a steroid medication used to treat inflammation conditions -- and bipolar disorder may be interested in my webpage and three, "are steroids really bad?"

The connection is clear. But what Kevin describes, the possibility of bipolar disorder precipitated by the use of prednisone, is not clear. Unfortunately, making a causal connection between the two is difficult. You used the prednisone through adolescence. The typical age of onset of bipolar disorder is during adolescence. Even though you did not have symptoms before starting the medication, and have been continuing after using the medication, we cannot be sure that you would not have developed bipolar disorder during adolescence regardless of taking or not taking prednisone.

We have the same challenge trying to determine whether antidepressants can "cause" a person to have bipolar disorder who might not otherwise have had it. You can read some examples which I think are strongly suggestive, similar to your experience with prednisone, on my page about antidepressant controversies, and the "kindling" concept.

It would be useful to know how many people take prednisone and do not develop anything that looks like bipolar disorder. On that webpage of mine about steroids, you'll note that the figure we have for this right now appears to be about 98 % of all those who take prednisone -- in other words, of all those starting this medication, only about 2% develop psychiatric symptoms while taking it (we do not have information about what happens to them later) (the figure was higher when high-dose steroids were used).

However, your experience does demonstrate that for people with a family history of the problems suggestive of bipolar disorder, taking prednisone carries a risk. If it can possibly be avoided, that is probably wise for such individuals. On the other hand, this medication is generally used when symptoms are quite severe and few alternatives are available. Nevertheless, using it for a mild to moderate case of poison oak may not be worth it if you know that you have a mood risk based on your family history, or your personal experience.

Thank you for using your experience to try to help others.

Dr. Phelps