Crohn's, bipolar and addiction. Oh my

Hi IBDNewbie.

Is the suppository a steroid or mesalazine, do you know? Oral steroids can cause severe psychiatric symptoms, but only in a small minority (the pamphlets claim 5%). I'm not sure if that risk rises for somebody with a pre-existing psychiatric disorder. It might do, but I would have thought if there was a massively increased risk, doctors would be aware of it.

One possibility is to switch from oral prednisone to Entocort. Prednisone is systemic, Entocort is topical - therefore there are far fewer systemic side-effects with Entocort, at least in the short term.

However, your son's Crohn's is being undertreated. The steroids might get things under control for as long as your son is on them, but they have zero lasting effect. And mesalazines (or mesalamines if you're in the US) are virtually useless for Crohn's. Your son should be on an immunesuppressant (6MP or Imuran) minimum, and probably a biologic (Remicade or Humira) as well. Personally I think it's better to get on a biologic as early as possible, since if the disease gets too out of control, not even the biologics might work.

As for pain meds, they treat pain but don't touch the underlying disease (a bit like steroids!)

Thank you for your thoughtful responses and kind words, NCOT and scifigal2K. To answer your question, NCOT, he's on Uceris (oral steroid) and Canasa (mesalazine suppository). I believe the doctor's plan for him is to resolve the acute bleeding and inflammation issue with the steroids short term and then move to Humira or Remicade for the longer term. Up to this point, he had a mild case compared to others with whom he's spoken (he volunteered at a Crohn's camp for kids over the summer and met a lot of folks with varying degrees of CD). When he was first diagnosed, his GI wanted to put him on steroids but because of his bipolar issue, the doc went to Lialda instead. Maybe it was the drug or maybe it was just the unpredictable course of the disease, he stayed pretty stable until last month, when all hell broke loose. I guess there was little choice other than a steroid at that point, but I'm keeping fingers crossed and eyes wide open until he can get off of them. I will definitely talk to the doc about the immunosuppressant and the next steps.
Again, thank you very much for your advice and input. Hope you get over your "rough" patch and feel better soon, NCOT.