Glucocorticoid treatment carries risk of adverse psychiatric outcomes

Treatment with oral glucocorticoids may contribute to elevated risks of adverse psychiatric outcomes, including the onset and relapse of common psychiatric disorders, as shown in a population-based cohort study.

Researchers used Swedish population registers and identified 1,105,964 individuals aged 15–54 years who had dispensed glucocorticoid prescription in oral form. Outcomes included unplanned specialist healthcare contacts due to depressive, bipolar, anxiety, or schizophrenia-spectrum disorders and deaths by suicide or unplanned specialist healthcare contacts due to self-harm.

Over a mean follow-up of 12 years, between 0.6 percent and 6.9 percent of the cohort had unplanned specialist healthcare contacts for anxiety disorder (6.9 percent), bipolar disorder (0.8 percent), depressive disorder (3.9 percent), schizophrenia-spectrum disorder (0.6 percent), and suicidal behaviour (2.6 percent). These proportions were similar between men and women.

Compared with untreated period, oral glucocorticoid treatment period was associated with increased risks of depressive disorders (hazard ratio [HR], 1.08, 95 percent confidence interval [CI], 1.00–1.16), bipolar disorder (HR, 1.23, 95 percent CI, 1.12–1.36), and anxiety (HR, 1.25, 95 percent CI, 1.20–1.31). There was no clear association observed for suicidal behaviour (HR, 1.06, 95 percent CI, 0.96–1.17).

Findings did not differ by age and gender.

These data highlight the need for additional monitoring during glucocorticoid treatment for individuals with psychiatric histories, according to the researchers.