Treatment of Corticosteroid-Induced Mood Changes With Olanzapine

Ms. A was a 21-year-old woman with no personal or family history of mood disorders who, at presentation, had received 3 months of prednisolone therapy (30 mg/day) for severe asthma. Other medications in her regimen included inhaled steroids and β-agonists. A psychiatric consultation was requested by her allergist.

Ms. A reported a depressed mood, mood swings, crying spells two to three times daily, suicidal ideation, anxiety, and insomnia beginning within days of starting chronic corticosteroid therapy. She had rapid speech and prominent affective lability ranging from smiles to tears during the interview. Her scores on the 28-item Hamilton Depression Rating Scale, Young Mania Scale, and Brief Psychiatric Rating Scale (18-item, 1–7 scale) were 33, 9, and 31, respectively.

A regimen of olanzapine, 2.5 mg at night, was started. Three weeks later, Ms. A reported the “medicine really, really helped.” The crying spells had decreased to about one each week, while mood swings and suicidal ideation had subsided. The only side effect was mild sedation at bedtime, which she felt improved her sleep. During the interview, her affect was stable and euthymic. Her Hamilton rating scale, Young Mania Scale, and Brief Psychiatric Rating Scale scores decreased to 3, 0, and 19, respectively. After 5 months of olanzapine therapy, she remained free of mood symptoms, despite the continuing use of corticosteroids, and was tolerating the medication well.