Synthetic Glucocorticoids use tied to Neuropsychiatric Effects, depression and mania most common

The comprehensive analysis involved 49 studies, encompassing various patient populations, types, doses, and durations of synthetic glucocorticoid use. Here are the significant findings regarding neuropsychiatric adverse effects among glucocorticoid users:

• Depression (22%): The proportion of patients experiencing depression following glucocorticoid use was reported at 22% (95%CI 14%-33%).
• Mania (11%): Neuropsychiatric effects extended to mania, with an 11% prevalence (95%CI 2%-46%) observed among users.
• Anxiety (8%): Approximately 8% of patients reported anxiety (95%CI 2%-25%) as an adverse effect.
• Delirium (16%): Delirium was noted in 16% of cases (95%CI 6%-36%).
• Behavioural Changes (52%): A substantial 52% of users reported experiencing behavioural changes (95%CI 42%-61%).

Psychiatric Scores:

Further analysis evaluated questionnaire scores between glucocorticoid users and non-users:

• Depression (SMD 0.80): Glucocorticoid users showed higher scores for depression (SMD of 0.80 (95%CI 0.35-1.26)), suggesting a greater incidence of depressive symptoms.
• Mania (SMD 0.78): Similarly, mania scores were elevated in users (SMD of 0.78 (95%CI 0.14-1.42)), indicating increased manic symptoms post glucocorticoid use.

The study underscores the substantial neuropsychiatric adverse effects associated with synthetic glucocorticoid use. Notably, depression and mania demonstrated the most pronounced associations with glucocorticoid treatment. Researchers emphasize the critical need for awareness among healthcare professionals and patients regarding the potential neuropsychiatric side effects upon initiating glucocorticoid therapy. The findings highlight the necessity for more structured investigations into the incidence and underlying pathways of these adverse effects.

Reference:

Koning, A.-S. C. A. M., van der Meulen, M., Schaap, D., Satoer, D. D., Vinkers, C. H., van Rossum, E. F. C., van Furth, W. R., Pereira, A. M., Meijer, O. C., & Dekkers, O. M. Neuropsychiatric adverse effects of synthetic glucocorticoids: a systematic review and meta-analysis. The Journal of Clinical Endocrinology and Metabolism,2023. https://doi.org/10.1210/clinem/dgad701