Brown E Sherwood
Psychoneuroendocrine Research Program, Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
Ann N Y Acad Sci. 2009 Oct;1179:41-55. doi: 10.1111/j.1749-6632.2009.04981.x.
Corticosteroids, such as prednisone and dexamethasone, are commonly prescribed medications that suppress the immune system and decrease inflammation. Common side effects of long-term treatment with corticosteroids include weight gain, osteoporosis, and diabetes mellitus. This paper reviews the literature on psychiatric and cognitive changes during corticosteroid therapy and potential treatment options. Hypomania and mania are the most common mood changes during acute corticosteroid therapy, although depression has also been reported. However, depression is reported to be more common than mania during long-term treatment with corticosteroids. A decline in declarative and working memory is also reported during corticosteroid therapy. Corticosteroids are associated with changes in the temporal lobe, detected by structural, functional, and spectroscopic imaging. The mood and cognitive symptoms are dose dependent and frequently occur during the first few weeks of therapy. Other risk factors are not well characterized. Controlled trials suggest that lithium and phenytoin can prevent mood symptoms associated with corticosteroids. Lamotrigine and memantine also have been shown to reverse, at least partially, the declarative memory effects of corticosteroids. Uncontrolled trials suggest that antipsychotics, anti-seizure medications, and perhaps some antidepressants can also be useful for normalizing mood changes associated with corticosteroids. Thus, both the symptoms and treatment response are similar to those of bipolar disorder. Moreover, corticosteroid-induced mood and cognitive alterations have been shown to be reversible with dose reduction or discontinuation of treatment.
皮质类固醇，如泼尼松和地塞米松，是常用的处方药，可抑制免疫系统并减轻炎症。长期使用皮质类固醇治疗的常见副作用包括体重增加、骨质疏松和糖尿病。本文综述了关于皮质类固醇治疗期间精神和认知变化以及潜在治疗选择的文献。轻躁狂和躁狂是急性皮质类固醇治疗期间最常见的情绪变化，不过也有抑郁症的报告。然而，据报道，在长期使用皮质类固醇治疗期间，抑郁症比躁狂症更常见。在皮质类固醇治疗期间，也有陈述性记忆和工作记忆下降的报告。皮质类固醇与颞叶变化有关，可通过结构、功能和光谱成像检测到。情绪和认知症状与剂量有关，且常在治疗的最初几周出现。其他风险因素尚不明确。对照试验表明，锂盐和苯妥英钠可预防与皮质类固醇相关的情绪症状。拉莫三嗪和美金刚也已被证明至少可部分逆转皮质类固醇对陈述性记忆的影响。非对照试验表明，抗精神病药物、抗癫痫药物，或许还有一些抗抑郁药物，也可用于使与皮质类固醇相关的情绪变化恢复正常。因此，症状和治疗反应与双相情感障碍相似。此外，已证明皮质类固醇引起的情绪和认知改变可随着剂量减少或停药而逆转。
