Psychiatric disturbances and corticosteroids

There doesn’t seem to be all that much in the literature about psychiatric disturbances caused by corticosteroids, but here is a good overview I found:
http://williams.medicine.wisc.edu/steroid_psych_effects.pdf
In the following, I will make some short quotes from the article and respond to them based on my personal experience.

The most frequently identified symptoms include agitation, anxiety, distractibility, fear, hypomania, indifference, insomnia, irritability, lethargy, labile mood, pressured speech, restlessness, and tearfulness.

I’ve probably had all of those at some point. I’ve been on corticosteroids for about 10 years now. I tend to divide that 10 year period into two distinct portions: the first 9 years, where I was severely depressed, often unable to leave my room (causing me to drop out of college), severely indifferent, anhedonia, tearfulness (there were times I cried about things like pizza toppings), insomnia. Then a few years when by in which I was so apathetic I couldn’t cry about anything.

The second portion began in August 2015 with what seemed to be a rather severe psychotic manic episode. The first thing I did was stop seeing my therapist. This episode wound down after about a week and a half, but continues to this day. It would probably fall under the category of a “mixed episode” now, with symptoms of mania and depression at the same time. Overall though, I am much more energetic, I have trouble sleeping, I have a disturbing and constant desire for drugs and alcohol, suicidal ideations, irritability, I cry all the time, I spend too much money (spending money makes me feel good for 10 minutes or so). The major differences are the energy and the ability to enjoy things, though. I am now more or less able to enjoy some things some of the time.

The most commonly reported corticosteroid-induced psychiatric disturbances are affective, including mania, depression, or mixed states.
Most often, patients receiving short-term corticosteroid therapy present with euphoria or hypomania, whereas longterm therapy tends to engender depressive symptoms.

This fits with my experience.

An overly stimulating environment can exacerbate a patient’s condition.

This is why I am largely avoiding Facebook. It’s a constant, overstimulating, unpredictable stream of unrelated nonsense. There is too much going on. Everyone uses it for a different reason. It’s complete chaos. On a related note, this is probably why I can’t stand going to bars anymore. Too noisy, too many people, chaotic.

Among patients with corticosteroid-induced psychosis, as many as 33% experience suicidal ideation.

I am not surprised, and I fall within that 33%, without a doubt. I have spent many, many hours thinking about killing myself. There was only one time I think that I really intended to do it right at that moment, but certainly I’ve done a lot of things that could have killed me, also, and spent a lot of time thinking about how much I want to die. On wikipedia’s page on suicidal ideation, there is also mention of role-playing: I actually purchased an air gun that looks reasonably similar to a real gun, and I keep it in my desk so I can take it out periodically, point it at my head, and pull the trigger. It’s never been loaded with anything and only takes plastic BBs anyway, but that’s not the point; the point is that I like to point a fake gun at my head and pull the trigger. It’s worth mentioning that, before being on steroids, I never had a suicidal thought in my entire life.

While the article says that some people respond to antipsychotics and antidepressants, it also notes that treatment success can be unpredictable. I have not had any success with various mood stabilizers and antidepressants. Due to adrenal insufficiency, my steroids cannot be stopped. At this point, I am not seeing any options other than learning to deal with it on my own, since drugs and therapy haven’t helped, and I can’t afford to just keep throwing hundreds of dollars at the problem anymore.

Medications and suicidal thoughts

My dermatologist has increased my mycophenolate, will need more bloodtests to make sure that isn’t killing me. They don’t want to change the prednisone yet because they don’t want me to end up in the hospital. That’s all well and good except being on this high a dose of prednisone makes me want to die about 8 hours a day. The rest of the hours I mostly stare into space. I have found myself in a sort of shitty situation where I will die without the medications, but the medications make me want to die.

Thoughts on relationships and my mental illnesses

Mental illnesses report:
My last post got me thinking about marginally-related things. I had a “best friend,” OC people will know who I mean, who constantly put me down and insulted me since the early 90s. But I didn’t tell her to piss off until 2011 because I always figured if I got rid of her, I wouldn’t be able to make new friends. And I suppose I made a couple, but not many I have been very close to.

Regarding boyfriends, there was the guy I met in the mental hospital when I was in high school, but, in addition to the fact that, the more I got to know him, the less I liked him, and that I only saw him a couple times a year, and that he was an alcoholic, he was cheating on me the entire time. In fact, I was so aware of this I’m hesitant to call it “cheating,” more like an unspoken open relationship, but only open on one side. But I stayed with him for several years because (as a parallel to the “best friend” situation) I figured if I got rid of him, I’d never find another boyfriend. [And I was right.] He occasionally re-friends me on Facebook and then unfriends me if I don’t reply to his messages immediately. One time his wife started sending me nasty messages, apparently thinking I was the one who friended him.

Eventually though, I figured that if I didn’t have a bf/gf and didn’t have friends, I could deal with that, and that it would be better than having the BF and [some of] the friends I had. There were times back then that I wished I had people to talk to about things but then I started writing a journal again and that helped and I more or less got over the emotional need to have other people around and to talk to people (most of the time when I tried to talk to people about anything emotionally-related in the past, I felt ignored or was quite blatantly ignored anyway, so talking to people never seemed to help). I got new hobbies, exercised compulsively, learned some new languages, etc. And I suppose some people have offered to listen, but I think I am so emotionally closed off that I am unable to have a dialogue about myself, I can only make posts which are written as a monologue. Possibly also why I’ve never really been able to open up to therapists; they are another person in the room who might potentially say something and that scares the shit out of me and I go mute.

Eventually I was on enough medication that my emotional state was completely numbed to the extent that nothing bothered me, so it was quite traumatic for me when that numbness disappeared recently and I am still working through that. Posting on FB helps. If my posts bother you, though, I ask that you unfriend me rather than just hiding my posts from your timeline (assuming anyone who wants to hide my posts from their timeline would actually be reading this, of course). I really don’t mind it when people unfriend me here. I think it is possible that, with a change of medication or a reduction of medication, my problematic emotional states will resolve or become more stable. In the meantime, I will probably continue the posts because, as stated before, this helps me to organize my thoughts.

I wish I didn’t have a sex drive

[Forum post plus some discussion from other people]

I’m not sure where I am at. I’m comfortable for now not talking to people in real life. I no longer get the urge to. There was a time when, if I felt bad or whatever, I would have an urge to talk to people in real life and have a conversation. That’s gone now.

Mainly these days I just wish my sex drive would go away. It’s especially upsetting because, due to medications, I thought it had gone away forever and I was very disappointed and disturbed when it came back (common symptom of bipolar mania: “hypersexuality”).

Here’s your TMI for the day:

Despite, after many years, getting over the Catholic guilt concerning masturbation, it doesn’t really help me much because (1) it seems a bit second-rate, and (2) it occasionally makes me cry, which makes it especially unpleasant and unhelpful. It’s not that I’m not good at it, I think I’m pretty good at it, it just seems like I’m lacking something I guess. It has diminished slightly since the psychotic episode last summer, though, but it’s still there.

So, not really sure where to go with that. If you’re horny and haven’t had any success having sex with other people, masturbation would be the obvious way to go, but it doesn’t seem to help me much. I guess I’m just waiting for menopause now because it’s my understanding that that can help to diminish sex drive.

I used to abuse drugs and alcohol very heavily to reduce or eliminate my sex drive, but it’s my understanding that that isn’t necessarily a healthy thing to do, either.

I don’t have any real hopes of ever being in a real relationship (I assume that would potentially be helpful with the sex drive), because, after 17 years or so, I have gotten discouraged by being rejected by everyone I ever attempted to initiate a relationship with and either (1) I am just not attractive to people in that way, or (2) I am doing something very wrong and I can’t fix it because I don’t know what I’ve been doing wrong.

There has never been a time where someone wanted to start something up with you, where they initiated the potential relationship?

No. I mean, not since like 1996, and he was cheating on me since the very beginning. So I always figured it was up to me to make the first move, but that always ended up leading to rejection and/or losing friends. I don’t think I’m creepy or anything, and the most I ever did was suggest that me and another person hang out (alone, without other friends), and I never even got that far* with people I normally hung out with (around other people), I would either be told they weren’t interested or they’d agree to hang out or go somewhere and then never show up, and then never talk to me again because apparently that made it weird. I also never considered myself anything worse than average looking, so I don’t think that’s it, and I had great tits in college.

*Not counting some drunken messing around with some women when i was 18 or 19, but that was more in the realm of 1 night stands and not potential relationships.

On involuntary celibacy

[This was a discussion of a post on Facebook which I can’t find to quote right not]

It’s interesting to read people’s thoughts on this; this guy is obviously angry. The culture in general is often judgmental toward people who don’t have sex, though, which probably doesn’t help and just causes more hatred and lashing out.

I disagree that it’s a male problem, though. I mean, I tried during the entirely of my 20s to have sex and relationships without any success at all (haven’t even kissed anyone since I was a teenager, probably wouldn’t remember how; by the time I was in my 30s I’d given up), and I do get resentful when people suggest that any woman can just go out and get all the sex she wants, whenever she wants, just because she has a vagina.

I do think discussion is helpful though. People can get really uncomfortable if you start talking about anything other than a normal sex life. I think there is some overlap with the way people respond to people talking about mental illness, many people don’t know how to deal with the discussion and try to avoid it, but I think talking about it helps people understand each other and should be encouraged. I also refuse to censor what I say regarding things like mental illness and sex to make the people around me comfortable, because (1) no one has the right to never be upset, and (2) if other people can talk about sex and relationships and that’s socially ok, I feel like I should be able to talk about what it’s like to not have those things.

I got irrationally upset one time when I was talking about a back tattoo I considered getting and some guy said guys would appreciate it. I said no guys other than my dermatologist ever see my naked back! (I have several tattoos no one has ever seen, for that matter.) And I realize now I was just lashing out because he just assumed I had sex with people because most people do and I shouldn’t have gotten angry with him.
Also probably why it bothers me if people ask if I have children. I never had a chance to make a decision to have children or not. As a kid, I always said I didn’t want any, but that’s not the same thing and thinking it over and being able to decide on the matter.

The worst thing about being bipolar and having severe mania at times is having a sex drive, for me, anyway. It’s the most unpleasant and unwanted symptom, and harder to deal with even than suicidal thoughts, which I also have a lot of while manic. The only good thing about the medication induced depression I was in for several years there, IMO, was complete lack of a sex drive. I thought maybe it would stay that way forever.

People who say suicide is cowardly

I’d like to extend a sincere “fuck you” to everyone who posts shit calling suicidal people “cowards,” saying they’re “taking the easy way out,” or that it “doesn’t end the pain, it just gives it to someone else.” [Last one is the actual meme I just saw that inspired this post.] When Robin Williams died, Henry Rollins posted an assholish rant somewhere and that pissed me off immensely also, along with all the people who commented in agreement with it.

You don’t get to judge a suicidal person’s pain and decide your imaginary right to not grieve is more important than whatever they’re going through. This type of shit just strikes me as selfish as fuck, like you’re willing to let your loved ones suffer whatever just because you don’t want them to hurt you. There is no guarantee in life that you’ll never get hurt, and I doubt any suicidal people are going around thinking “gee, I’d sure love to hurt everyone that loves me!” No, they are thinking that they can’t deal with continuing to live. I agree with promoting and sharing things like suicide hotlines, but I cannot, CANNOT deal with the idea of suicidal people just “taking the easy way out” or being “cowards.” If you think that, I imagine you’ve never had a suicidal thought in your life or that you are severely lacking in empathy or you wouldn’t say such assholish things.