Steroid-Induced Mania Treated with Aripiprazole

Abstract

Brown and Chandler reviewed the literature on significant psychiatric side effects of corticosteroids, noting presentations of depression, mania, psychosis, and memory deficits. Naber et al. followed a prospective, uncontrolled cohort of 50 patients on methylprednisolone or fluocortolone, at initial doses of 119 41 mg/d, and tapered to 75 22 mg/d over 8 days. They found that “manic-type” symptoms were reported by 26% of the participants, most of which began in the first 3 days of treatment and continued, despite the taper, over the 8 days of the study. If possible, removing the offending steroid is desirable when patients present with psychiatric side effects. However, if the steroid-induced behavior puts the patient at significant risk of morbidity and mortality, adjunctive use of an anti-manic medication may also be warranted. The data for pharmacologic intervention in steroid-induced mania is limited in scope and study design. Among the classic mood stabilizers, lithium has the most evidence in steroid-induced mania, with a 71-patient, retrospective report. There is a positive case report regarding the use of valproic acid. Amongst the antipsychotics, the use of phenothiazines is supported by a 14-patient case series. Haloperidol and quetiapine have positive case reports. Olanzapine use is supported by an open-label trial in 12 patients. Risperidone has recent pediatric case reports.