Mixed mood disorder induced by high-dose corticosteroid treatment. A case report

Corticosteroids (CS) are commonly used drugs for the treatment of various diseases. They are related to many adverse effects, among which some are practically manifestations of the whole spectrum of psychiatric symptoms: depression and anxiety, suicidal ideation, mania, cognitive disorders and psychosis. These adverse effects seem to be more common with higher doses and longer duration of treatment with CS, to manifest during the initial days of the treatment and, possibly, to be independent of the route of administration. There do not exist clear risk factors: psychiatric history does not seem to confer additional risk even though women may be more vulnerable. We describe a case of a woman who suffered from a chronic renal disease and received high doses of CS for the treatment of an acute condition. After the first month of treatment with CS, she manifested mild depression but, after the second month, the clinical picture changed dramatically to that of severe mania. She did not comply with the psychiatric advice that was given to her, consequently we are not fully aware of the evolution of the psychiatric disorder. We focus on the need for cooperation between psychiatrists and other physicians in order to achieve timely recognition and treatment of these disorders, on the continuous pharmacovigilance and the proper education of patients and we underlie the need for conducting systematic studies in patients receiving CS.