Posted 4/27/2012 9:24 PM (GMT 0)
Dear Machina12,
In response to your questions on what medications are used to manage prednisone withdraw symptoms;
After tapering off pred, abruptly, I was having severe migraines, nausea, bone pain, fatigue, weakness and lethargy. It took two months in bed to figure out what was happening by re-reading the chapter on medications in an IBD specialist's book. I took the book to my PCP who promptly stepped out to call an endocrinologist. I was put back on a dose of prednisone just above where I first developed symptoms of insufficiency (~15 mg). The new taper was unbelievably slow (reduction by 1-1.5 mg every 1-3 months). Symptoms re-emerged at 5 milligrams pred. So the dose was bumped up again; resetting the taper at smaller dose reductions at 1 - 3 month intervals. At 1 or 2 milligrams of prednisone, I was switched to hydrocortisone and continued the slow taper. Every three months I underwent adrenal challenge tests to evaluate adrenal functioning and determine if & how much to taper.
In total it took two years and three taper attempts to get off steroids and restore adequate adrenal function. It then took another 6 months and two attempts to taper off of opiates that were controlling the bone pain and frequent migraines. I used clonazepam to sleep during the opiate withdraw, and continue taking it for sleep. Throughout the pred taper - I couldn't sleep at night and had extreme daytime somnolence, 'sundowner syndrome'. The migraine headaches, bone pain, and extreme lethargy kept me down for two years. The accompanying cognitive fog was like a living in a mental vacuum. Short-term memory was a bit like senile dementia. Phone conversations before noon were completely gone by the time of awakening. Couldn't remember what I had to eat the previous day. Both the adrenal insufficiency and opiates contributed to the cognitive dysfunction and exacerbated the need of prescription stimulants (Ritalin), to get up and function.
The impact of prednisone on my mental health was really profound. While taking 40 mg prednisone ( steroid), I was aggressive & offensive in my social interactions. Grandiosity got ahold too. My OCD escalated & went unchecked for all things in cognitive functioning and personal physical habits - like a runaway train. Way beyond being annoying, even to myself, was terrible anxiety; frequent & powerful spells. In the same week, both my PCP and Psychiatrist suggested I moderate the overdrive with Xanax. Occasionally, I used Ambien if I had no scheduling choice (appointments) and had to get up and function in the mornings.
The entire experience with prednisone, adrenal insufficiency, and medical complications was a time capsule of misery. My underlying chronic depression was exacerbated off the chart. The anxiety grew into an insulation from the world. These, combined with the physical sequela of the insufficiency rendered my existence frozen in time and space, a psycho and somatic paralysis. I don't recommend it.
For myself, I have vowed to never take steroids again unless it is given down an ET tube as a life saving measure. However, for anyone who asks about the use and discontinuance of prednisone; My advice is 1) Avoid it if you have options, and 2) Insist on a very slow & lengthy taper. This means smaller dose reductions over longer intervals. Stay at a dose longer if symptoms begin to emerge. If the GI discounts your symptoms, insist on blood work to evaluate adrenal function; and while you are there asking - include a thyroid panel and B12 level, Calcium & D3 levels, a comprehensive chem screen, a complete blood count, and any relevant inflammatory marker. Blood work is awesome science, and exponentially cheaper than scopes & scans.
Hope this information helps & not TMI.
Ciao Denny Rae