Suicide Risk and Glucocorticoids

According to the results of a new study, glucocorticoids increase the risk of suicidal behavior as well as a range of psychiatric disorders. These steroid hormones (such as hydrocortisone) are often prescribed for respiratory problems such as respiratory infections and chronic obstructive pulmonary disease. People treated with glucocorticoids had an almost sevenfold increase in risk of dying by suicide or attempting suicide as people not using these medications. Patients receiving these drugs were twice as likely to experience depression as other people. The authors noted that although the overall risk for suicidal behavior among people taking glucocorticoids is low, these drugs are widely prescribed. At any given time, approximately 1 percent of adults in the United Kingdom (where the study took place) are taking a glucocorticoid. The authors recommend that doctors “exercise caution in administering these drugs” and that physicians, patients, and their families be taught to watch for early indications of adverse side effects.

Compared to patients who had not taken the medication, patients prescribed glucocorticoids were 1.83 times more likely to experience depression; 4.35 times more likely to experience mania; 5.14 times more likely to experience delirium, confusion, or disorientation; and 1.45 times more likely to experience panic disorder. Depression and delirium/confusion/disorientation made up the majority of the neurological disorders experienced by patients in the study.

The greatest risk of adverse side effects was among those who were prescribed larger daily doses and had a prior history of neuropsychiatric disorders. Younger people were more at risk of suicide, suicide attempts, and panic disorders than adults. The risk of depression, mania, and delirium/confusion/disorientation increased with age. However, women were more likely to develop depression than men, while men were more at risk for delirium/confusion/disorientation than women.

People taking glucocorticoids for asthma had a lower risk of neuropsychiatric outcomes, possibly because the low dosage of the inhaled drug protects against side effects if the patients are later prescribed higher doses.

The study used the Health Improvement Network primary care database in which 19 suicides, 80 suicide attempts and 10,220 cases of severe neurological disorders were identified among 372,696 patients 18 and older who had taken oral glucocorticoids in the years 1990-2008. The diseases for which patients were prescribed this class of drug included lower respiratory tract infections, asthma, and chronic obstructive pulmonary disease.

Fardet, T., Petersen, I., Nazareth, I. (2012). Suicidal behavior and severe neuropsychiatric disorders following glucocorticoid therapy in primary care. American Journal of Psychiatry, 169(5), 491-497.