The original post these responses were written for some years ago was complaining about lack of enthusiasm and the posts then went on to bring to light concerns about the lack of ability to concentrate, desire to eat, grumpiness and "change in personality". This was written by a clinical healthcare professional.
Cloudgazer wrote:
"Prednisolone on its own affects the cognitive processes that deal with memory, concentration, planning and completion of tasks, multi-tasking, sleep, impulsive reactions, stress management and appetite - and that's before you factor in the effects of the illness itself!
So, don't worry. You haven't permanently turned into a lethargic, quick-tempered, ravenous monster. Things do get better slowly but surely as the steroid dose comes down. It's very disconcerting to find that a medication that is essential is also a truth serum in the midst of what feels like a temper tantrum. I've found it helpful to tell friends and family that I'm having 'a prednisolone day' or 'moment'.
Please don't feel ashamed about your increased appetite; it is very common. It's caused by the prednisolone. You might find it helpful to search on the forum for some of the advice threads on how to manage it. Let me know if you can't find them and I'll find a link for you.
As for the loss of interest in things you normally enjoy, I've found it very strange not be able to read or do even the simplest of things that I usually like doing. You can't do much about it as it's not you failing as a person, it's the drug doing its job.
Rather than fight against it, I have found that it helps to notice that there are good things about having to do one thing at a time. You might also start to notice that there is an hour or so in the day (or night!) when concentration is better. I have a small window of less foggy thinking when I first wake up and then again in the early evening. I think it's related to when the prednisolone is at its lowest effect for me.
The HPA axis (the hypothalamus, pituitary, adrenals plus all the hormones and signalling substances) effects include the ones I've mentioned above, the regulation of certain cognitive functions, such as 'executive' planning, short-term memory, emotional impulses, responses to stress hormones such as adrenaline and cortisol, as well as responding to appetite triggers. So, as the steroid doses reduce the effects on the HPA functions start to become less. In a very basic sense, prednisolone, especially at the high doses, means that we don't switch off or regulate our instinctive impulses as quickly as we would when not taking it. We respond much more quickly and in a more exaggerated way to small triggers.
These effects lessen with the reduction of the prednisolone dose. It may not be immediately noticeable with a gradual reduction plan but it does happen.
As for your question about personality change, well, that's not really to do with a fixed entity that changes with an illness or a medication. Our personalities are fairly well established by the time we reach early adulthood. The experience of coping with a chronic illness of sudden onset and all the adjustments we have to make can be difficult. How each person responds to that adjustment process is influenced by our personalities and established coping strategies. Sometimes a coping strategy can be very effective for one set of circumstances, such as a busy working, multi-tasking life, but doesn't transfer easily to a different set, such as being slowed down by PMR or GCA and unable to continue facing each day in that way. We have to acquire new ways of living each day whilst unwell and that can be a difficult process if slowing down is not what we are used to. That can lead to feeling frightened, miserable and frustrated, on top of being in pain and unable to sleep.
There are two aspects of prednisolone that can feel as if they might be a 'personality change'. One is feeling very short tempered. The other is that steroids can cause significant lowering of mood or feelings of being hyper-active or in severe cases having hallucinations that can be very distressing. In some people these can be extreme and require urgent professional psychiatric and medical help. Strictly speaking, these are drug effects, not personality changes, even if the person appears to have a changed personality."
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Do I have to go up to 60mg pred again?
Shall I change from Pred to Methotrexate?
Controlling what pred you have
I am off Pred since April, but do I still have PMR?
At what pred dose do adrenal glands awaken!
