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Q: Sundowning : Medrol dose pack & Manic Symptoms
Hi.. My daughter has been having psychotic episodes, only at night. Why
are they only at night... I have heard of this being called sundowning.
Also, can a one week Medrol dose pack trigger manic symptoms? (My daughter just
was on this due to antibiotic drug reaction and seems to be more impulsive and
irritable.)
Thanks ... Your Web info is wonderful.
Dear Ms. R' --
Why only at night? Not sure. You may have seen the graphs of the Swiss guy who
cycled every 24 hours? I've had one patient like that myself; she even
scheduled her meetings at work accordingly. So, it could be just her cycle
rate. Otherwise, why night? I'd just be guessing. Haven't seen this reported
in bipolar disorder. Of course she could have something else in addition to
bipolar disorder (or even instead of), like "post-traumatic stress disorder (PTSD),
that can often be worse at night in some cases because of
nightmare/re-experiencing.
Can a Medrol dose-pack trigger manic symptoms. No
doubt. That's probably the most common stimulus, as far as steroid exposure
(from doctors, anyway) goes. I've seen some cases associated with joint
injections but my sense is that this is much less common; whereas the oral
steroid pulse that your daughter received is well-known to be capable of
inducing bipolar symptoms. It's not so bad that someone with bipolar disorder
should never get a steroid pulse, but for people with poorly controlled
symptoms, or any alternatives to the steroids, I pretty much always recommend
avoiding that treatment. This problem is not widely known by primary care doc's
who use that treatment, and get really good and important results (e.g. relief
of severe asthmatic attacks) with it -- so it's not "their fault" that they use
this stuff. It's not standard of care yet to screen for bipolar disorder before
giving an antidepressant, in primary care, so we shouldn't expect them,
yet, to know to screen before giving steroids. But we can keep teaching
them....
Dr. Phelps
Published March, 2004
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