Prednisone Part One

I envision the "path" from diagnosis of Churg Strauss Syndrome to a return to health as a fairly straight road with many side roads and wrong turns that lead away from the destination that you want to travel. These wrong paths and side roads can many times be prevented, treated or avoided entirely. Addressing many of the side effects of medication used to treat this disease can help get the patient back to health more quickly.

The first thing I would like to address is the series of side effects or unwanted effects of prednisone or steroids. While steroids are a mainstay of the treatment of vasculitis and certainly the "mother of all anti inflammatories," they have many unwanted and unpleasant side effects. One of the most common is mood alteration including agitation, insomnia (very common), depression, euphoria (markedly elevated mood) and emotional lability or major mood swings, and even psychosis. Steroids or prednisone can destabilize a previously controlled mood disorder or provoke one in a person with no prior history of any psychiatric illness. In addition, many people who develop a chronic illness are quite prone to the development of depression. The statistics for the development of depression of chronic illness may go as high as 60-85%. There are some studies that show that depression, left untreated, can over a period of time actually cause changes in the structure of the brain with loss of neurons (nerve cells) and atrophy (shrinkage of brain tissue).

Knowing how frequent depression is in chronic illness and how common it is for steroids to induce mood changes or depression, it is quite reasonable to consider at least a short term treatment with an antidepressant or anti anxiety agent. Sleep medicines may also be needed in order to maintain a normal sleep pattern and to ensure that the person gets a good night’s sleep. I feel that there is no point to have people who cannot rest or sleep due to steroids be left untreated when they might cope on their own by self medicating with alcohol or using their spouse’s medication. This is something that the treating physicians should be aware of and if they don’t ask it should be bought to their attention.

Other treatments for depression that may work with medication include vigorous exercise if possible, sunlight, adequate vitamin B6 if on certain medications that may interfere with its metabolism, and occasionally such herbs as St John’s Wort. The supplementation with estrogen in menopausal women and iron in those who are iron deficient may also be of help.

Lastly, as all of you know, coping with a chronic, mutli-system disease is a major undertaking and involves calling upon spiritual, emotional, physical and psychological reserves. It is quite reasonable to ask your treating physician for some additional help while trying to deal with such major changes in your life. There should be no guilt or shame in how you deal with these issues, or with the use of medication to help. Antidepressants are not habit forming and there is no good evidence to show that the new generation of sleep meds are habit forming either. Good luck and God bless on your road to recovery.

*** None of this information is meant as a substitute for exam and diagnosis and treatment by your physician.

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