What's the connection: Corticosteroids and behavior?

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Mo, my six year old son, has an attachment disorder. One of the hallmarks of this disorder is increased levels of cortisol - a hormone involved in the body's stress response.

He also has asthma which is occassionally treated with steroids - corticosteroids.

On the occassions that he is treated with steroids he is completely batshit crazy: raging, crying, overwhelmed, incredibly emotional.

The package insert for his latest prescription mentions (any spelling errors mine) :

Quote:

Adverse Event Reports From Other Sources

......<blahblahblah>.....psychiatric symptoms including depression, aggressive reactions, irritablility, anxiety and psychosis......

Here are my questions:

1. Are cortisol and cortiosteroids the same? If you have naturally eleveated levels of cortisol and you take cortiosteroids are you creating a monster?

2. What might be the "other sources" reporting adverse events and where do I find them?

3. What alternatives are out there for people who can't take cortiosteroids without becoming psychotic?

I have tried to research this myself. Really I have. I've waded through a lot of information without getting anywhere. I am hoping that you might know or know where to look for such information.

Any help appreciated.

Thanks!

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How bad is his asthma? This article indicates that mild cases could be handled without steroids. http://www.bmj.com/cgi/content/full/330/7496/864-d

My son used to take theophyline. It was an over-the-counter medication back then. Don't know if it still is. http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a681006.html

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Thanks, Swimpy.

He doesn't take steroids every day. He doesn't even have to use his inhaler doohickey every day.

This is the second time he's been given a two week course of steroids over the last year and a half. Last time he was given liquid prednisone (spelling?), this thime he was given Pulmicort -- which the doctor said didn't cause as many problems.

It seems to be causing an equal amount, or maybe worse, problems to me though.

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Let the doctor know that he's having these reactions. His asthma sounds like it can get pretty bad. Prednisone is known to cause mood swings in some people. This is from Medline.com

Quote:

Mood Swings/Insomnia
Many patients find it difficult to sleep when taking high doses of steroids. Many also find that they are more irritable than usual. Steroids sometimes even induce depression, which improves when the drug is decreased or discontinued.

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Here's the link http://vasculitis.med.jhu.edu/treatments/prednisone.html#mood

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He's not on prednisone this time -- it's budesonide.

I told the (new) doctor that the prednisone had made him nutty and she thought this might be better.

Everything I've come across suggests that it is safe and effective - that's why I was trying to find out about those "other sources".

These drugs are crazy making. I know he has to breathe. I know I don't want to leave him untreated and run the risk of permanant damage to his lungs. I don't suppose it's a huge deal to keep him home from school for the next couple of weeks while he is on the drugs but that can't be a permanant solution if it turns out he needs to use them more long-term.

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I can't believe I'm asking this, but are there drugs they can give him to help calm him down while is on the steroids? I don't like to give kids any more meds than they need, but if corticosterioids are the only option, then he's got to take them.

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I can't believe I'd consider doing such a thing but I would.

I think I'll call the phamacist -- they might have a good perspective or have heard more feedback than the doctor.

Then I'll call the doctor.

Mo's as miserable about it as I am.

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Prednisone used to turn me into a whole other person. I haven't had to take it in years, but always hated it.

Sorry I don't have any alternatives for you, boomer. Just wanted to commiserate.

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Thanks mac. I accept commiseration.

These are really awful drugs. Really awful.

Effective but awful.

I called the pharmacist and he said that yes, this drug can cause severe mood swing -- especially in young boys (Huh?)

So I just left a message with the doctor seeing if there might be an alternative or even if perhaps changing the dosage might help.

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I can't handle the puffers - they make me twitchy-crazy. Steroids, other than topical, I can't do - make me horrible horrible.

~~~~~

Is there something the doc and pharmacist can work out together to get Mo through the current episode - and simultaneously work on figuring out a way to prevent the asthma from escalating to the point of requiring the additional horror-meds.

That's the route I've had to take - become vigilant at the early stages of anything that hinted at turning into an asthmatic episode - extra zinc when anyone near has a ticklish throat ... whatever the signals are.

You don't want Mo to become a hypochondriac in terms of watching for/reporting symptoms - but encouraging him to let you know how he's feeling physically might also help him feel like he's got some control over this (and part of the bad part of an asthma attack is the feeling of lack of control).

Heightened stress can (for some people) set off the asthma - so the cortisol/corticosteroid vortex is just evil. Poor kid.