Effects of Glucocorticoids on Mood, Memory, and the Hippocampus

Psychoneuroendocrine Research Program, Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
Annals of the New York Academy of Sciences (Impact Factor: 4.38). 10/2009; 1179(1):41-55. DOI: 10.1111/j.1749-6632.2009.04981.x
Source: PubMed


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.

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Available from: E. Sherwood Brown, Jun 03, 2014
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    • "Anti-epileptic drug use has been previously implicated in the reduction of most cognitive functions except memory in a recent study on low-grade glioma patients [43]. Conversely, corticosteroids have been demonstrated to directly result in a decline in declarative and working memory [44]. Additionally, corticosteroids have been found to result in decreased hippocampal activity and blood flow [44]. "
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    • "Corticosteroids are associated with a variety of brain effects including mood23,24 and memory changes,5–9 and with chronic exposure, hippocampal atrophy.10 In animal models corticosteroids are associated with increases in glutamate in the hippocampus,25 and histological changes (e.g., dendritic remodeling and even neuronal death) in the hippocampus can be prevented with agents that decrease glutamate release26 or block the N-methyl-d-aspartate receptor.27 "
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    • "A decline in declarative and working memory is also reported during corticosteroid therapy. Lamotrigine and memantine have been shown to reverse, at least partially, the declarative memory effects of corticosteroids [10]. Some studies reported beneficial effects of serotonin reuptake inhibitor but also less documented. "
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