I’m posting this here, in my personal blog, because I’m probably going to edit it from my private email report to Androtics on P135. Feel free to link it in other threads:
The steroid Prednisone has certain “emotional” effects, well known by physicians, but (IMHO) not often sufficiently discussed with patients, and DEFINITELY not with the patient families (similar effects are seen with other related oral/IV steroids and maybe inhalers). It can make pts irritable/unreasonable at as little as 2.5mg (the lowest chronic oral dose). I haven’t seen clear paranoia at doses below 10mg (usu the lowest acute oral dose) but I’ve seen almost comical paranoia (“What is my husband saying about me in the hall? I hear him talking!”) at 10-20mg. Alas when we feel it is necessary to run a short course of prednisone, we may start at a much higher dose (I don’t personally start at anything more than 60mg/dose outpatient, and even then only if the pt’s history indicates that I need to start that high).
I put “emotional” in quotes because it is essential to taper a patient off any dose higher than 20mg/dose, or they may go into frank psychosis, which (if you’ll forgive my candor) ain’t ‘emotional’ , but completely cuckoo-land. I’m morally certain that the medical literature must show some murders committed by patients cold-turkeying off 30mg prednisone without a taper. Maybe even rare cases at 20mg.
I’m telling you this because someone you love will probably be prescribed prednisone or a similar oral steroid in the next decade. Aspirin, ibuprofen, etc. are commonly called “NSAIDs” (Non-Steroidal Anti-Inflammatory Drugs), which tells you that the Big Dogs are Steroidal Anti Inflammatory Drugs. Steroids are also used as “maintenance inhalers” for asthma (there are other categories of maintenance inhalers, and critical RESCUE inhalers, but this isn’t a clinical symposium on management), and may have emotional effects. Those of you dating asthmatics can report on how that affect pheros. Physicians have been debating for decades if there is a truly statistical “Asthmatic Personality” caused by the disease, the attacks/resulting anxiety or the medication.
Try to be understanding of affected relatives, friends, colleagues. It may not be “them”, but their medication, talking. It’ll make you life easier
Also, be aware that steroids may alter their reaction to pheros that you happen to be wearing when you visit or run into them.
Finally I’d be curious to hear any phero reports about asthmatics. That’s an issue that affects all ages, but is treated with lower steroid doses long-term (high doses in the Emergency Department)
[Edited to add: Steroids like prednisone are safe, very effective, and I’d recommend/administer them to my loved ones --and have, to parents, siblings, my kids, friends. They just have some odd effects on emotions and may require step-down dosing AFTER they save your life]