Glucocorticoids Linked to Several Psychiatric Disorders

The use of glucocorticoids in the treatment of such medical conditions as chronic obstructive pulmonary disease and infections of the lower respiratory tract is associated with an increased risk of suicidal behavior and neuropsychiatric disorders, finds a new study published online February 17 in AJP in Advance.

The study evaluated the incidence of and risk for developing depression; mania; delirium, confusion, or disorientation; panic disorder; and suicide or suicide attempt in adults treated with oral glucocorticoids as compared with individuals not taking the medication.

Laurence Fardet, M.D., Ph.D., of the Department of Internal Medicine at Saint-Antoine Hospital in Paris conducted the study with Irene Petersen, Ph.D., and Irwin Nazareth, M.D., Ph.D., both of the University College London’s Research Department of Primary Care and Population Health.

The researchers pooled data from The Health Improvement Network (THIN), a database of electronic medical records collected at primary care practices throughout the United Kingdom. The study examined the records of patients over age 18 who were registered in the database between 1990 and 2008.

Individuals receiving at least one prescription for an oral glucocorticoid comprised the “exposed” group, data from which were compared with those of patients in two “unexposed” control groups—a random sample of patients not receiving glucocorticoid prescriptions and a random sample of patients not taking the medication but who were diagnosed with the same underlying medical disorders as the exposed patients.

During the 18 years in which data were obtained, a total of 786,868 courses of oral glucocorticoids were prescribed for 372,696 patients. Among those receiving glucocorticoids, the researchers identified 6,918 incident cases of depression, 2,030 incident cases of delirium/confusion/disorientation, 898 incident cases of mania, 266 incident cases of panic disorder, 90 incident cases of suicide attempt, 19 incident cases of completed suicide, and 108 incident cases of “psychiatric referral without any details of the symptoms experienced.”

When compared with individuals in both control groups, exposed patients were found to have twice the risk of developing depression, four to five times the risk of developing mania or delirium/confusion/disorientation, and five to seven times the risk of attempting or completing suicide. The researchers noted, however, that the overall risk for suicidal behavior among those taking glucocorticoids remained low.

When considering such factors as age, sex, and medical history, the researchers observed that the risk for depression, mania, and delirium/confusion/disorientation increased with age, while the risk for suicidal behavior and panic disorder decreased as patients got older.

Men were found more likely than women to develop mania or delirium/confusion/disorientation following exposure to glucocorticoids, while women taking the medication carried a greater risk for depression than men.

The researchers reported that larger daily doses of glucocorticoids and a history of mental illness increased the risk for developing suicidal behavior and further neuropsychiatric disorders, while patients taking glucocorticoids for asthma, polymyalgia rheumatica, or giant-cell arteritis may be less likely than other patients to develop neuropsychiatric disorders.

The study was supported by a grant to Fardet from the French National Society of Internal Medicine and the Public Assistance-Paris Hospitals. Petersen received funding from the U.K. Medical Research Council.

An abstract of “Suicidal Behavior and Severe Neuropsychiatric Disorders Following Glucocorticoid Therapy in Primary Care” is posted at http://ajp.psychiatryonline.org/Article.aspx?ArticleID=519047.