Drug dependence involving prednisone: two cases and a review of the literature.
Dependence is an unusual, but potentially serious complication of corticosteroid use. Two cases of prednisone dependence are reviewed; the first involving a patient with inflammatory orbital pseudotumor who developed a dependent pattern of prednisone use that persisted years after the resolution of the acute episode. The second case involves a patient with factitious disorder who attempted to obtain corticosteroids from multiple clinicians, despite the absence of any clinical indication for them, manipulating elements of her medical history to influence the prescription of corticosteroids. Both patients exhibited tolerance and withdrawal symptoms, and both developed serious systemic effects from the corticosteroids, including cataracts, diabetes mellitus, and cushingoid signs. Both patients also exhibited dependence upon other substances. A MEDLINE search was conducted, and the case literature regarding corticosteroid dependence was reviewed. Twenty-six cases of potential corticosteroid dependence were identified, and 22/26 (85%), retrospectively, met criteria for DSM-IV substance dependence involving corticosteroids. Prednisone was the most frequently implicated corticosteroid, but cases involving ACTH, cortisone, and high-dose inhaled dexamethasone and beclomethasone were also identified. Asthma was the most common underlying medical condition for which the corticosteroids were prescribed, but a variety of allergic and inflammatory conditions were also reported. Corticosteroids may induce dependence based on their propensity to induce euphoria as well as a characteristic withdrawal syndrome, in addition to directly influencing reward circuitry. Clinicians should be aware of the possibility of prednisone dependence when confronted with patients who exhibit vigorous insistence on corticosteroids out of proportion to objective signs and symptoms of inflammation.
Anfinson
Theodore J
TJ
Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA. Theodore@dekcsb.org
Channappa
Chaitra
C
Vo
Huyen-Trang Ngoc
HT
D000328:Adult; D005260:Female; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000502:physiology; D011241:Prednisone / Q000009:adverse effects*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy; D019966:Substance-Related Disorders / Q000209:etiology*
D011241:Prednisone