Anxiety attack

Cortisone, dexamethasone, hydrocortisone, methylprednisolone, prednisolone and prednisone are called corticosteroids or glucocorticoids. These drugs dampen an overactive immune reaction. They can soothe a bad poison ivy attack or a severe case of hives. Doctors and patients love these medications. They can reverse a life-threatening inflammatory reaction quite quickly. Despite their tremendous benefits, however, there are some very scary corticosteroid side effects that can occur even after only short-term use.

What’s the Difference Between Corticosteroids & “Steroids”?

Let’s clear one thing up immediately. Although some people refer to corticosteroids as “steroids,” they are totally different from the kinds of anabolic steroids athletes use to build muscles.

A steroid is a compound with a specific chemical structure. Without getting into the chemical weeds, here is a visual representation of the basic corticosteroid structure. What you can see, even if you have forgotten high school biochemistry, is a unique 4-ring structure.

corticosteroid chemical structure

The four rings are common to other steroids including the male hormone testosterone, the female hormones estrogen and progesterone as well as cholesterol. Even vitamin D is considered a steroid of sorts.

How Do Corticosteroids Calm An Overactive Immune System?

Think of inflammation a bit like an avalanche. A pebble falls over a cliff where it hits another pebble, which nudges a little rock that picks up momentum as it falls. Soon you have a bunch of rocks bouncing off each other on their way down the mountainside. Eventually, they turn into a full-blown landslide.

This cascade of events resembles the way inflammation builds in the body. The body has numerous inflammatory genes that make a variety of activator proteins and transcription factors (cytokines, chemokines, enzymes, etc.). These in turn trigger a cascade of events that lead to what we call the inflammatory reaction: redness, swelling, joint pain, flu-like symptoms, fever, headache, etc.

Corticosteroids switch off multiple inflammatory genes and chemical pathways (British Journal of Pharmacology, June, 2006). In other words, drugs like cortisone prevent the first few pebbles from precipitating a rock slide. If you can keep the body from amplifying the initial inflammatory signals, you can suppress the collateral destruction that would occur during a full-blown body avalanche.

Corticosteroid Side Effects Are Serious:

Most people know that cortisone-type drugs are powerful double-edged swords. On one hand, they relieve inflammatory reactions rapidly. That means corticosteroids can be beneficial against severe allergies, asthma, anaphylactic shock, inflammatory bowel disease, traumatic brain injury, rheumatoid arthritis and many other hard-to-treat conditions.

On the other hand, medications like dexamethasone, methylprednisolone and prednisone have a long list of serious side effects. They include fluid retention, hypertension, headache, increased susceptibility to infection, muscle weakness, diabetes, osteoporosis, tendon rupture, glaucoma, cataracts and ulcers. Psychological reactions such as anxiety, irritability, mood swings, insomnia, confusion and psychosis are disorienting at best and disabling at worst.

What is a Steroid Dosepak or Dose Pack Dosage?

Doctors assume that corticosteroid side effects are primarily linked to high-dose, long-term use. That is why short-term tapered “dosepaks” are so popular. Such dosing starts with a relatively high amount of corticosteroid and reduces it steadily over a week or two.

One “recipe” for sinusitis involves prednisone in the following dosages:

  • Three days at 40 mg a day
  • Three days at 30 mg a day
  • Three days at 20 mg a day
  • Three days at 10 mg a day

There are a great many variations on this theme. A survey of ear, nose and throat specialists revealed that doctors prescribe a median starting dose of prednisone of 60 mg (American Journal of Rhinology and Allergy, Jan 1, 2017). The dosage range, however, was from 4 to 80 mg. The length of treatment ranged from 2 days to 28 days. By the way, the Cochrane Database of Systematic Reviews (March 25, 2014) analyzed the available research and concluded that treating sinusitis with corticosteroids was ineffective. When combined with antibiotics, corticosteroids “…may be modestly beneficial for short-term relief of symptoms in acute sinusitis…”

Methylprednisolone (Medrol Dosepak)

One of the most commonly prescribed dose packs involves a potent corticosteroid called methylprednisolone. It is “stronger” than prednisone in that a smaller dose packs a bigger punch. Not all corticosteroids are created equal. Cortisone is the weakest and shortest acting. Prednisone is roughly five times more potent than cortisone.

Methylprednisolone Dose Pack recommendations for serious allergy symptoms:

  • First day: 8 mg prior to breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg before bed
  • 2nd day: 4 mg prior to breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg before bed
  • 3rd day: 4 mg prior to breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg before bed
  • 4th day: 4 mg prior to breakfast; 4 mg after lunch; 4 mg before bed
  • 5th day: 4 mg prior to breakfast; 4 mg before bed
  • 6th day: 4 mg before breakfast

Some doctors continue to slowly taper the dose over the next week.

Short-Term Treatment CAN Cause Corticosteroid Side Effects:

Many physicians have been led to believe that a week or two of a drug like prednisone poses very little risk. That is why they are often quite reassuring to patients who may worry about corticosteroid side effects.

A new study reveals that even short-term steroid use can trigger dangerous side effects (BMJ, April 12, 2017).  The researchers reviewed insurance-claims data for more than 1.5 million adults over two years, with special attention to those who took steroid pills for less than a month. They were more likely during that month and the five months following to suffer blood infections, blood clots and broken bones. These are serious complications, underscoring the need to make sure steroids are prescribed only when they are truly needed.

The Authors’ Conclusions:

“Oral corticosteroids are frequently prescribed for short term use in the US for a variety of common conditions and by numerous provider specialties. Over a three year period, approximately one in five American adults in a commercially insured plan used oral corticosteroids for less than 30 days. The short term use of these drugs was associated with increased rates of sepsis, venous thromboembolism, and fracture; even at relatively low doses.”

A Freak-Out Story From a Reader:

The study authors did not include data on patients who were already using inhaled steroids for asthma or chronic obstructive pulmonary disease (COPD). But adding oral steroids could cause difficulties, as it did for one reader. Here is her story:

“My doctor prescribed Medrol (methylprednisolone) for six days to treat bronchitis. I took it for the first two days and wasn’t getting much relief. I asked the doctor to call in an inhaler in the hope that it would help open up my lungs.

“Apparently the inhaler had more steroid in it and within a few minutes I started to feel really strange. I wanted to jump out of my own skin! Shortly after that I became manic.

“I don’t remember what followed, but my boyfriend says I flew into a rage, locked myself in my bedroom and refused to let him in. When I finally did, he said I was writing suicide notes and had several old bottles of pain meds out on the bathroom counter. He called 911 when I became very sleepy and disoriented.

“Thank God he did. It seems I had taken several pain pills and overdosed. I spent three days in the hospital on suicide watch and I don’t even remember doing anything. I will never take that stuff again!”

Psychiatric Corticosteroid Side Effects:

The psychiatric reactions to high-dose steroids are often under-appreciated, but they are not rare. Severe anxiety and insomnia, mood disorders including psychosis, delirium and even dementia are all possible (Psychiatry and Clinical Neurosciences, Oct. 2011).

Patients should be warned of this possibility before they begin taking corticosteroid drugs, whether short or long term. Prescribers also need to be aware of the potential for additive effects from various forms of steroid medicines, including inhalers as well as pills.

More Reader Stories:

This comes from “anonymous:”

“My 16-year-old family member recently had a psychotic reaction to prednisone. The drug was prescribed for a week to treat an asthma attack. His inhaler also had a steroid, which he used as needed.

“He ended up confined to a psychiatric ward for seven days. Upon release he had to be followed up with psychotherapy and anti-psychotic drugs for weeks. How can something like this happen if pediatric doctors are doing their job to follow up their patients?”

Frank in Vancouver, Canada, shares this:

“Prednisone worked well for controlling my Crohn’s flare up. As the dose was slowly reduced I experienced some rather concerning side affects. First was moodiness. Then bouts of anger.

“The worst was the extreme anxiety. At one point I didn’t leave the house for five days. Once I got down to 5 mg I started to get short of breath. After about twenty steps I would start gasping for air like a fish out of water. It was very scary.

“Once I stopped taking prednisone it took about a week to get back to normal. The dose was 40mg the first week and then 5mg less every week after until I reached 20 mg. Then less 2.5 mg a week until I finished. I will never use a steroid again.”

Kelly in New York had a psychotic break on prednisone:

“Ten mg of prednisone daily brought on a severe psychotic reaction. By the 3rd day I was totally paranoid and thought my Facebook friends were conspiring against me. Then I thought God was going to punish me; the police were coming to get me, and on and on and on.

“I ended up in a psych hospital for 3 weeks and was diagnosed, finally, with steroid-induced psychosis. They treated me with two different meds to pull me out of it. I will never take that med again, which sucks because I have ulcerative colitis. Death would be welcomed compared to the hell I endured while on prednisone.”

The Powerful Double-edged Swords:

Corticosteroids save lives! They help people who are having severe allergic symptoms, terrible asthma attacks or uncontrollable inflammatory reactions. But there are many scary corticosteroid side effects. Even short-term treatment can cause complications. Please make sure that your physician describes the pros and cons of steroid use in your particular situation. That way you can evaluate both the benefits and risks of such drugs.

If you found this article helpful please vote on this post at the top of the page.

You can also learn more about prednisone at this link:

Prednisone Side Effects: Deal With The Devil?

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  1. Barbara

    I wonder why the medical profession and the pharmaceutical profession are ALLOWED to prescribe and sell such poison. I don’t wonder why. I know why. If you trust the medical profession, you are ahead of me.

  2. Sarah

    I have just completed a 3 Day prescription on dexamethasone for viral asthma. I’ve had some insane dreams that were so realistic that I woke up thinking I was still in the dream for at least a half hour. I’ve also been very aggressive and do not like who I’ve become. I hope it wears off quick! I will not be taking this again willingly!

  3. Beth

    My 20 year old son was put on 3 days of steroids following a mono diagnosis because his throat was so swollen he could not swallow. Since that time (it is now 4 1/2 months later) he has suffered greatly. He has and is still having waves of paranoia, anxiety, severe depression, suicidal thoughts, started slurring and stuttering, clumsiness, inability to focus or comprehend readings and lectures.

    He has had to drop out of college and is now under the care of a psychiatrist to try to stabilize. Personally, I think steroids are like any other med, if you are allergic to them, you WILL have side effects from them. I am just hoping these aren’t long term side effects….. but it isn’t looking good. I am VERY heartbroken and mad to be honest. UNBELIEVABLE that his life can be changed from this one 3 day dosage?? Well, believe it!!!

  4. Melanie
    New Jersey

    I’ve been on prednisone off & on for 10 yrs for my Chrohns / Colitis. Always helped over months of use to calm the flare. My flares have been lasting longer as the yrs pass. 2015 it lasted about 10 months. This one began about February & I started on 40 mg a day & then over months tapered down slowly. Around End March beginning of April I began to feel fearful & then paranoia.

    At first I thought it was 2 fairly new antidepressants I was on. Talked to my Psychiatrist & went off one then still was no better & went off 2nd one. Went to my family dr. & he immediately diognosed me with steroid induced psychosis. He & my Gastronologist began to slowly ween me off of that awlful drug. I just finished them this past Saturday! Ugh! Having to continue taking the steroids everyday for all these months made me feel like I was swallowing poison everday! I cried everyday taking them, continuing with unbelievable aniexy, paranoia & feeling so scared & lost is horrific. I’m still not doing well.

    Everyday, I pray to feel better soon. I fear I’m going to stay this way although the dr. says it will take time to clean out. I hope so but I’m not feeling it, I feel like I’m not going to get back to myself & it scares the living daylights out of me. Not many people get it. My uncontrollable crying, fear, sadness & feeling so lost haunt me everyday. I try hard to push myself to work, to go to the store, to eat, be around people, drive, etc. I see a therapist but nothing seems to help. My mind is full of terrible thoughts. I can’t stand it. Prednisone was such a great med for 10 yrs & I never knew anything like this could happen from them! I’ll never touch them again!! I pray it all passes & I can heal.

    • Cindy

      Hello, my name is Cindy, I am 50 years old , I have had and still having same reaction to prednisone as you did! How are you doing now ?? I am so afraid I will never be normal again ! ?

      I only took a small oral dose then ER doctor gave me a larger dose in my IV the started me on a high dose the day after the IV dose , I started to feel the effects so I stopped cold taking the evil drug ,long story short I am still feeling not right only have been off the drug for three weeks please someone tell me this will go away !!!! Or what or where to get help

  5. Ed J
    Stoke-on-Trent UK

    She said to me, “They are going to kill me, Yes they are I heard the doctors say that!” The head nurse (our friend) came to reassure her all was well but I was not told steroids can give you paranoia. She came off them but whilst nursing her at home they decided to put her back on steroids to give her some additional weeks.

    Whilst back on them she said to me the most painful thing in our 40 years of marriage bliss. “You are only looking after me because people are watching you!” I was tormented for about 2 years because of hearing that until I realised she had been put back on steroids at that time. I feel to share this with everyone to spare you the evil steroids can sometimes be to a happy couple. God bless.

  6. Sarah B.

    I, like the poster above, suffered steroid-induced psychosis from 10mg a day of Prednisone. I started feeling quite mentally strange on around the 4th day of use, and by the 9th day was totally delusional, paranoid, etc. I also suffered physical side effects, such as severe bruising, sweating and total insomnia. I was given the Prednisone to help treat Inflammatory Bowel Disease. On the 10th day my family rushed me to the ER where, from there I was sent to psychiatric care. I was diagnosed with steroid psychosis and treated accordingly. I now wear a medical alert bracelet, and all of my medical charts state that I can never have any kind of steroid again. This experience has been horrible for both me and my family. I am asking everyone to thoroughly do their homework before taking steroids.
    Thank you.

  7. Susan

    I am undergoing chemotherapy for Stage 4 Colon cancer that has moved to my lungs. I am told the dexamethasone is needed to combat nausea. I have never had any nausea with chemo, but they are given to me at the beginning of my chemo session anyway. I have type 2 diabetes. My blood sugars go up to high 400’s. I sometimes have to urinate every 30 minutes because of this. It takes a few days to get my numbers back down. On the positive side: for about 4 days afterwards I do not suffer from inflammatory issues! I can walk with a lot less pain.

  8. Stephanie

    These drugs can be lifesaving, however, to use them for sinusitis or sinus infection is not the real answer. Years ago Mayo Clinic found that most sinus infections come from fungal infections, Not bacterial. It comes down to researching your condition and then discussing your situation with your GP. You have to be your own advocate to save you from side effects.

  9. Abigail

    You mention Hydrocortisone at the topof the article. My doctor suggested Hydrocortisone 1% , a cream that is available OTC, for a skin irritation. Is this cream putting me at risk for these or other side effects?

  10. Aleksu

    A number of years ago I had a hand injury, pulled tendon or ligament, never got a clear answer; the doctor gave me an injection into the affected area since it was weak and unusable, but didn’t tell me what medication he was using. A few hours later my hand was in excruciating pain, and couldn’t be moved or touched even the slightest. When I called the doctor he indicated this was sometimes a reaction to a corticosteroid. I vowed never to allow myself to be given this kind of medication again. Unfortunately, I didn’t read the package insert for a Flonase prescription a while back, and had a horrible reaction to this common allergy medication, in which every joint in my body became excruciatingly painful for hours. The insert acknowledges that some people have this as an initial reaction to corticosteroids, and suggests that it will go away with continued use. Anything that causes that much inflammation can trigger all kinds of ill effects, since inflammation is the root of most illnesses, including cancers and autoimmunity. Inflammation in the brain can trigger depression and vomiting. It is considered a bad idea to take these meds when you have Lyme Disease due to the inflammatory issues and messing with the immune system. When the vet prescribed prednisone for my terminally ill dog, he stated that it would not be prescribed for long-term use in a healthy dog because it could cause injury and death, but prescribed it for my dog since she was already dying as mercy pain management. In other words, a medication of last resort. This is one medication that people doctors should definitely discuss side effects with their patients before prescribing.

  11. Therese Melancon

    I was told to take a low dose (5 mg) of cortisol (hydrocortisone) for adrenal fatigue. I took 3 a day for about 5 months. That sounds like a long time to me, but was told since it was low dose it was okay. What do you think? Should I continue taking it? I stopped for awhile and was really tired when I don’t take it.

  12. Kay

    I’ve taken Medrol dosepaks for rheumatoid arthritis flare ups and found them to be extremely helpful. I’ve not experienced any harmful side effects. I would highly recommend corticosteroids to anyone dealing with RA flare ups, and I will take them again if needed. I’m very grateful for prednisone.

  13. Dallee

    Steroids can raise blood glucose readings to a very high level. Mine goes up to 400 from one pill.

    I am a Type 2 diabetic. After a course of them for lung congestion several years ago, my readings departed from their normally well controlled level (82 to 103) and no pattern of medication has worked to get me back to those levels.

  14. dand e
    south africa

    Two years ago my husband had bronchospasm and even though I told the admitting doctor he had hallucinations etc with prednisone, they gave him steroids which sent him quite crazy and had to be tied down and does not remember the week or so in ICU. He has since then got dementia brought on by this episode. Our lives are forever a struggle and we don’t trust doctors or hospitals anymore.

  15. Phyllis

    Several years ago I took the “steroid” pack for severe poison ivy which was spreading. Big mistake! I was totally manic for the week I was taking the pills – and then went into a deep depression for over three months. I have never experienced anything like it and never want to again. These drugs so easily prescribed over the phone can have long-term devastating side-effects. Months later I found out that washing the affected area with Fels Naptha bar soap suds and applying calamine lotion works just fine with even big poison ivy outbreaks. Dries out the skin but it doesn’t cause depression.

    • Rick

      Never allow a Doctor to prescribe ciprofloxin a toxic antibiotic that is on the list of essential medications in a basic health care system. This drug can cause more damage than the bacteria it is supposed to inhibit.The list of secondary injuries is to long to publish here but lets just say it can kill you.

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