June 1, 2023


What do you do when you’re dealing with the side effects of prednisone that affect your mood how do you deal with roid rage what do you do when the medicine makes you so depressed you don’t want to get out of bed that’s what we’re going to cover today we’re going to talk about how to cope with the psychiatric side effects of prednisone so first of all we’ll talk

About the non prescription strategies things you can do without getting a prescription from your doctor next we’ll talk about examples that worked for me of those non prescription methods and finally we’ll conclude with what you can ask your doctor about getting as far as prescription options and this is based on not only my own experience as a prednisone patient

But also these articles medical reviews and my expertise as a pharmacist and if you haven’t already caught last week’s episode we did the prequel to this this is the second episode about psychiatric side effects so if you’re curious about any of the side effects i’m about to talk about if you check out last week’s then you will understand more of what we’re talking

About okay so what happens when your prescription for prednisone makes you feel so crazy you want to jump off a bridge or run across a busy street or spend all your money or some other really bad side effect that is really worse than the reason you’re taking prednisone so when we talk about prednisone it’s always a risk versus a benefit the risk being the side

Effects and the benefit being your disease being under control so if you’re taking it for something that is just to make you feel better and not necessarily life or death then when you have a really bad side effect it’s not worth it anymore but if you’re taking prednisone because your kidneys are going to fail or for me i could have bled to death then it might be

Worth it and so we’ll have to talk through different scenarios so this scenario the first scenario we’re talking about is if there’s any other possible treatment we could use that would keep you alive then what if you have a bad enough psychiatric side-effect then the goal is to stop taking prednisone and to slowly taper it and to be watched while you’re tapering

To not ever go cold turkey mmm and if that doesn’t work then decreasing the dose so for example if you’re on 40 milligrams going down to 20 milligrams then the second line options are these non prescription coping strategies and then prescription coping strategies so this is the same chart i showed you last week each of these little dots is a psychiatric symptoms

That you might feel so first of all we’ll talk about mood lability and a non prescription way to cope with this and pretty much any there of these is meditation it can help no matter which of these symptoms you are experiencing meditation is a practice so it’s something that you have to do every day and you get better as time goes on i’ll talk about that more in

Detail in a little bit anxiety so if prednisone is giving you anxiety which is pretty common you can learn breathing techniques one that i learned that i found really helpful is called the four six seven where you breathe in on four do hold it four six one two three five six and then out for seven two three four five and then you repeat in hold out in hold out then

There’s the box technique which is in four hold it for four out for four hold it for four in for four and you just draw a box with your fingers and it distracts your brain from thinking about whatever you were anxious about and it calms your heart rate and this is great to use with kids too because it gives them something else to focus on insomnia so this is also

Quite common um the number one complaint that people tweet about when it comes to prednisone is insomnia so if you’re experiencing restless sleep then it’s pretty common don’t feel one thing that really helped me was improving my bedtime routine and one definite big change i made was no screen time before bedtime because that prednisone brain would just go through

Whatever i had just seen online whether it was politics or a friend from high school or some random recipe and it would just go round and around around in my brain all night long and so i learned i had to stop using my screens at least two hours before bedtime and that really helped calm my brain down and then um i’ve done another episode about this it was one of

The first ones i did about sleep so you should check that out and it in depth with some really good tips okay depression so depression is more common at higher doses and when you’ve been on in a longer time and one of the most helpful things for depression is exercise and if you’re taking prednisone for a joint problem or a breathing problem then i can understand

How exercise is definitely going to be a challenge but there are exercises for every level of ability for every impairment level and i encourage you to find one that works for you i really am loving the seven app doing high-intensity interval training so i use that all the time it’s free you do seven minutes of workout and you’re done and i feel so good after okay

Memory a lot of people get brain fog or even dementia when they’re taking prednisone and so doing puzzles and keeping doing as much active things with your brain as possible writing reading just focusing as much as you possibly can mania so if you’re getting this like i got probably hypomania when i started prednisone i just had like a ton of energy i could just

Go so if you have that try to tell yourself to focus it to focus that energy to do good things like meal prepping like going grocery shopping for healthy foods so that your food in your house is good eat for eating when you get the prednisone binging so i the last time i was on a prednisone drug i prepped like for four hours and i had tons of delicious green

Great food to eat so i highly encourage you to use that if you get that um psychosis so people literally feel crazy electroconvulsive therapy can help but that technically is a prescription so these are some things that i found helpful for anxiety insomnia doing meditation so there’s an app called the calm i believe there’s also one called headspace and these

Would get me through some rough nights so if it was two o’clock in the morning and i was like my eyes won’t shut my brain won’t turn off what am i gonna do i would put in a little earbud and i would listen to a calm meditation sleep story whatever another thing i would do is listen to scriptures on the audio just things that um would help me turn off my brain

And think about something more calming was really helpful for me okay so relationships are definitely affected by your partner’s own mood changes you might feel like a different person your family members might feel like where did mom go where did what happened to dad you know what why isn’t he acting the same as he used to or why is it mom is nicest used to why

Can’t mom get off the couch right so we have to help our families know that this is the drug and not us i know it’s hard for everybody to remember when it’s the heat of the moment some things as far as parenting that helped me are there’s a lot of really good parenting apps out i mean books out there and then i was actually taking this aha parenting course while

I was on prednisone and it really helped me to not yell at my kids we’ll just leave it like that to really connect to make connections with my children and so i really recommend that then as far as marriage there are some really good marriage books john gottman is probably like the foremost marriage expert in the world and he wrote this book that i think everyone

Should read it’s relevant whether you’re married or not whatever relationships you’re in this one like it just tells you what not to do and what to do and really makes it doable so the seven principles for making marriage work one of the important principles in here is the four horsemen of the apocalypse slash of like predicting divorce criticism defensive ness

Contempt and stonewalling and i understand when i’m partners on how easy it is to default to these options but we need to find alternatives and so in the blue you can see the terms that they use in this book and so if those terms don’t make sense to you you do that definitely need to read that book it’s really good and i love the bottom one it’s do physiological

Self soothing so just breathing deeply and turning down that hyper reactive state that we’re in one more on prednisone just doing anything you can to slow it down to relax just to breathe breathe and you can not be in that reactive state and locking people the people that you need in your life to care for you so check that book out okay back to this little chart

Of our main psychological symptoms so first of all mood lability so that going up and down with your moods you can do talk therapy and if your mood lability gets so bad that it turns into delirium some drugs called haloperidol is the first generation antipsychotic and then atypical antipsychotics new ones like abilify or zyprexa those ones can help anxiety so

There are a lot of medicines that can help with anxiety some things like zoloft and prozac and we’ll view trin and then if you need something that’s shorter acting and you’ll get the anxiety all the time it’s just once in a while then you could do something like xanax but that’s more addictive and you don’t necessarily want to get something addictive insomnia so

First-line therapy for most people who have insomnia would be to take melatonin and this is especially helpful when you are taking prednisone because prednisone is interfering with your circadian rhythm and melatonin is your circadian rhythm maker and so it’s just giving back what prednisone is blocking and then if that’s not enough and i would start out at 1 2

3 milligrams per day and you could even go up to 20 milligrams but i would go really slowly to get to that point then benadryl is an option over-the-counter diphenhydramine like tylenol pm those things all have that diphenhydramine in it and that’s it’s actually an antihistamine that makes it so you’re not feeling allergic but it can also have the side effect of

Making you feel drowsy and so most people this can be helpful in but some people who shouldn’t use that are people who are old 465 or people who’ve tried it in the past and have the opposite reaction of like being hyper instead of drowsy and finally there are sleep medicines like ambien and lunesta those drugs are really great at helping you fall asleep not

Necessarily keeping you asleep unless you get the extended-release version and they are also not very safe in the elderly so be careful with all of these options always do your homework and make sure that it’s really right for you but if you’re experiencing these things sleep is one of the most important ways to heal from anything and so sleep is important it

Might be worth it to take medicine for it depression okay so zoloft is also good for depression and prozac and paxil all of those drugs are ssris they can help with depression and then lithium so this is an ion that can help to stabilize your brain activity and so it not only helps with depression like major depression but it’ll help with some of these other

Side effects coming up and then one more thing that’s not on here it’s called tricyclic antidepressants and they’re they’ve been shown to not really be as helpful for this type of prednisone causing depression so i would stay away from those unless they already work for you okay memory so if the paradin is own is interfering with your memory there are memory

Medicines like for people who have dementia like namenda and that can be helpful then there’s this seizure medicine called lamictal and it’s actually used for a lot more things than just seizures and so it can help to clear the brain fog and remember a little bit better and then even this blood pressure medicine called propranolol can help from mania when you’re

High as high as a kite and buzzing that these are called mood stabilizers instead of just having your mood way up high it just kind of settles your mood down keeps you mormon in the normal range so lithium that ion olanzapine and other atypical antipsychotics like abilify and then phenytoin and valproic acid are both seizure medicines but are also often used to

Help with mood regulation so if you’re having these problems is probably worth it to be on these medicines alright psychosis they used to have a term for all of these called steroid psychosis and back in the day a lot of these medicines didn’t exist but prednisone did and so they didn’t have many options thankfully we do now we have the atypical antipsychotics

Like praxis abilify we also have lithium and electroconvulsive therapy so back to our discussion of benefit versus risk it’s always what you absolutely need what is worth it so if you’re going to die without the prednisone but the prednisone is causing side effects that are so bad you might need to take this medicine and then it’s worth it all medicines in every

Treatment including water has a side effect so it’s always figuring out what the balance of that is and if it’s worth it so in light of that um the doctors should monitor you i showed this exact same slide last week but no matter what if you have a doctor or you are a doctor we should be asked about these side effects every appointment we should tell our doctor if

Anything is happening that you’re not used to if your mood is getting out of control or you’re feeling suicidal you need to tell your doctor because those medicines can help they can bring you back to feeling more like yourself and it’s really important so you’re worth it is worth getting help and so find that help finally i created this dietary supplement and it

Has several ingredients that can help keep a steady mood and help you sleep more restfully at night i really struggled with sleeplessness when i was on prednisone and so i created this so that when i have to go back on prednisone i’ve got this to fall back on that not only is it helping me feel calmer and more like myself but it’s also giving back the nutrients

That prednisone is feeling in addition to that melatonin and so i would encourage you to check it out at nutria nice calm i will talk to you next week signing out as your prednisone pharmacist dr. megan

Transcribed from video
Prednisone – How to Cope with Mood Changes from Prednisone – Psychiatric Side Effects – Crazy By Dr. Megan – Prednisone Pharmacist