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Olanzapine for Corticosteroid-Induced Mood Disorders

TO THE EDITOR: We were delighted to read the article by Larry S. Goldman, M.D., and Joseph Goveas, M.D., in a recent issue of Psychosomatics.¹ We had a similar interesting experience when we used olanzapine to treat corticosteroid-induced hypomania, mania, and psychosis. We treated three patients who all had steroid-induced mania with psychosis; they all required inpatient psychiatry treatment. We used olanzapine for all of our three patients with good results. Our first patient needed only an immediate dose of 5 mg of olanzapine for complete recovery, which is similar to a case described by Drs. Goldman and Goveas. The other patients were asymptomatic 2 to 4 days after starting olanzapine, 15 mg/day; they were advised to continue to take it for 2 weeks, after which it was discontinued.

We entirely agree with Drs. Goldman and Goveas that there is scant literature on the cause, incidence, and treatment of steroid-induced mood disorders. Although there has been an attempt to classify steroid-induced mania and psychosis,² it is vague and clinically cumbersome, in our opinion. Our review of the literature found little information regarding the treatment of these disorders. We were not able to find anything apart from case reports in which chlorpromazine, haloperidol,³ and risperidone⁴ were used.

We do believe that olanzapine is a good first choice for the treatment of steroid-induced mood disorders, especially hypomania and mania with or without psychosis. Further studies must be performed to see if any of the newer atypical antipsychotics are at least as efficacious as olanzapine in the treatment of these disorders.

REFERENCES

1. Goldman LS, Goveas J: Olanzapine treatment of corticosteroid-induced mood disorders. Psychosomatics 2002; 43:495-497[Free Full Text]
2. Rome HP, Braceland FJ: The psychological response to ACTH, hydrocortisone, and related steroid substances. Am J Psychiatry 1952; 108:641-651[Free Full Text]
3. Hall RC, Popkin MK, Stickney SK, Gardner ER: Presentation of the steroid psychoses. J Nerv Ment Dis 1979; 167:229-236[Medline]
4. Kramer JM, Cottingham EM: Risperidone in the treatment of steroid-induced psychosis (letter). J Child Adolesc Psychopharmacol 1999; 9:315-316[Medline]

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