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.

Download full-text


Available from: E. Sherwood Brown, Jun 03, 2014
  • Source
    • "Biological vulnerability Advancements in neuroscience have promoted the biological vulnerability perspective. Three biological factors of depression have been identified, including abnormal levels of serotonin (Caspi et al., 2003), the brain-derived neurotrophic factor (BDNF) (Martinowich et al., 2007) and corticosteroid (Brown, 2009). Scientists have also made attempts to identify biological vulnerability to depression at a genetic level (e.g. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Depression is a significant mental health issue that many social workers encounter in their practice. There is great deal of theoretical and empirical knowledge concerning depression that stems from different paradigms. In this paper, we argue for the importance of understanding depression from four paradigms, post-positivism, social constructivism, critical theory and Eastern paradigm, and we illuminate how depression would be known and dealt with by these paradigmatic approaches. Given multiple paradigms available in understanding depression, we argue that social workers need to have the ability to appreciate and discern these different paradigms. Such ability can help strengthen social work practice. We further illustrate an eclectic approach that not only allows social workers to recognise the utilities and limitations of different paradigms, but also enables them to be dynamic, effectively addressing a range of issues when working with a service user who has depression.
    Full-text · Article · Dec 2015 · British Journal of Social Work
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To dosimetrically evaluate the effect of reduced margin radiotherapy on hippocampal dose for glioblastoma multiforme (GBM) patients. GBM patients enrolled on the Radiation Therapy Oncology Group (RTOG) 0825 trial at our institution were identified. Standard RTOG 0825 expansions were 2 cm + 3-5 mm from the gross tumor volume (GTV) to the clinical tumor volume (CTV) and from the CTV to the planning tumor volume (PTV), respectively. These same patients also had reduced margin tumor volumes generated with 8 mm (GTV to CTV) + 3 mm (CTV to PTV) expansions. Individual plans were created for both standard and reduced margin structures. The dose-volume histograms were statistically compared with a paired, two-tailed Student's t-test with a significance level of p < 0.05. A total of 16 patients were enrolled on RTOG 0825. The reduced margins resulted in statistically significant reductions in hippocampal dose at all evaluated endpoints. The hippocampal Dmax was reduced from a mean of 61.4 Gy to 56.1 Gy (8.7%), D40% was reduced from 49.9 Gy to 36.5 Gy (26.9%), D60% was reduced from 32.7 Gy to 18.7 Gy (42.9%) and the D80% was reduced from 27.3 Gy to 15.3 Gy (44%). The use of reduced margin PTV expansions in the treatment of GBM patients results in significant reductions in hippocampal dose. Though the exact clinical benefit of this reduction is currently unclear, this study does provide support for a future prospective trial evaluating the neurocognitive benefits of reduced margin tumor volumes in the treatment of GBM patients.
    Full-text · Article · Jan 2014 · Radiation Oncology
  • Source
    • "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 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Although data are mixed, asthma and rheumatologic conditions may be associated with cognitive impairment. Medications may play a role because corticosteroids are associated with memory impairment. Therefore, an easily administered assessment of cognition would be useful in these patients. We assessed relationships between self-rated and clinician-rated cognitive performance and mood in patients with asthma and rheumatologic diseases. Participants included 31adults treated for asthma or rheumatologic disorders (17 receiving chronic prednisone therapy, and 14 not receiving prednisone). An objective assessment of a variety of cognitive domains was administered through clinician and patient-rated assessments of cognition. Composite scores for the objective (Global Clinical Rating [GCR]) and subjective (Neuropsychological Impairment Scale: Global Measure of Impairment [GMI]) measures of cognition were derived. Depression was assessed with the 17-item Hamilton Rating Scale for Depression (HRSD-17). A linear regression was conducted with GMI scores as dependent variable and GCR, HRSD-17 scores, and prednisone-use status, as independent variables. Significant differences between prednisone-treated patients and other patients were observed on the GCR, GMI, and HRSD-17. In the regression analysis, HRSD-17 scores, but not GCR scores, significantly predicted GMI scores. Prednisone-treated patients had higher levels of depressive symptoms and subjective and objective cognitive deficits than those not taking prednisone. In the combined patient groups, subjective cognitive assessment was more strongly related to depressive symptoms than objective cognition. Findings suggest physicians should be aware of the potential for cognitive deficits in patients taking corticosteroids and, when appropriate, should consider the use of objective neurocognitive tests or neuropsychology consultation to better characterize its presence and severity.
    Full-text · Article · Mar 2013 · Allergy and Asthma Proceedings
Show more