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Q:  Prednisone

I had some sx typical of hypomanic state from prednisone last year.  However prednisone also induced a wind-up state and myasthenia syndrome state even more prominantly.  Had sleep disturbance with ~3-4 hours of sleep, and PAIN was the limiting factor.  Had widespread body pain such that it hurt to lie on bed.  The worst sx was a feeling similar to that which occurs just before calf muscle cramp, but which was continuous.  Treatment with quinine decreased the cramp sensation but at any dose caused profound weakness.  Dilantin liquid =25mg dosage decreased the cramp but also induced weakness.  Trileptal (1/4 of smallest available size, liquid was not yet available) also caused profound weakness.  I do tolerate Tegretol however without weakness and with resolution of wind-up.


Prednisone induced identical sx to those I experienced on two separate attempts to use Li for augmentation in 1986 and 1987.  Both times, within days of beginning 300mg Lithobid I had widespread body pain and weakness which was labeled a myasthenia syndrome response.  I happen to have writing that I did in 86 &87 describing the Li reaction - and it matched the description of last year's experience exactly. (Li worked well in 86 within one week as an augmenting agent, but could not continue due to pain.  The pain last 4-5 weeks after discontinuing.  First  similar experience occurred with  succynlcholine duing anesthesia in 85.)   RELATED TO MY PRECEEDING COMMENT AND QUESTION ABOUT LAMICTAL REACTION/RASH  Lamictal also has caused the "precramp" sensation in the legs, when I got up up 125 bid dosage, and very prominant at the 150mg dosage.

Dear Ms. L'
Your letter here illustrates several issues of potential interest to others; though unfortunately I have little here to offer of direct use to you. 

First, your description is an example of prednisone (one of a family of medications called "steroids", which happen also to include hormones like estrogen; which is rather full of implications in itself; since obviously there are mood effects from estrogen) having extreme mood effects in someone with (probable) bipolar disorder.  I have not seen an estimate on how frequently this happens; my medicine colleagues who use it a lot say they think this might happen to about 1 person in 100 who gets prednisone, which interestingly roughly matches the common estimates for the frequency of bipolar disorder in the general population, about 1 person in 100 for the more readily diagnosable versions of bipolar disorder. 

Secondly, your story reinforces my impression that somehow there is a direct relationship between pain syndromes like "fibromyalgia" and bipolar disorder, although I am stunned by the reaction you describe to lithium: I've never seen anything like that.  Always good to know about these extreme reactions.  Perhaps there was something like that going on in one recent patient in whom lithium induced some mild back pain, seemingly, gone quickly after stopping it. 

Dr. Phelps

Published September, 2002


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