I've been reducing from 20mg pred since November 2022, currently on 11mg. Since Christmas I have had episodes of extreme anxiety, depression, mood swings and tearfulness. My Rheumy this morning suggested swapping to Betamethasone which does not cross the blood/brain barrier. However, when I researched, it appears to have the same side effects as pred. Does anyone know anything about this?
Thank you as always for your support and advice.
All steroids have the same physical side effects, and reading the NHS handout they seem to acknowledge that the same applies for betamethasone including the mental health aspects. I would be interested to know where he found the information that betamethasone doesn't cross the BBB - all I can find state that corticosteroids cross the BBB, without any exceptions.
What concerns me more about using betamethasone is that tapering the dose is likely to be extremely difficult. 10mg prednisolone is the same equivalent dose as 1.2mg betamethasone and with pred you would usually taper the dosage 1mg at a time below 10mg. Exactly how does he intend achieving that? It is one thing if he is intending leaving you at about 9mg long term - that would be 1mg betamethasone - but usually they are going hell for leather to zero!
FleetRose, sad to say I am in the same boat as you, as we are in the group of people where prednisone causes the anxiety and depression side effects. Truly for us it's a deal with the devil, because in my case I couldn't stand the excruciating pain of PMR, and nothing but prednisone worked, but the depression and anxiety is also debilitating, not mention the mental anguish it causes. As for me, at the higher doses, without elaborating, I had some very dark days indeed. It has been alleviated quit a bit as I am on the lower doses, currently at 6.5 mgs, and my rhuemy told me that by 5 mgs and under most of the side effects go away. As for the Betamethasone, as PMRpro said it's still a steroid, and one that's much stronger too boot! Like PMRpro also said it would be nearly impossible to taper properly on this drug, as PMR requires a totally different tapering regime. Also, it may, or may not be for you, but my doctor prescribed anti depressants to help out with the side effects.
I have been struggling with trying to figure out why some of us get the extreme anxiety and depression from Prednisone, and others only get the weight gain and moon face. Some of it is probably caused by a genetic predisposition to it. And on the one hand there is much understanding that steroids cause the adrenals to shut down, but there is much more to it than just the adrenals. It effects the what they call the HPA axis: which is the hippocampus, pituitary, and adrenal glands. These work together, and when one is effected so are the others. They need to be in balance and this balance is most probably out of sync when we are on prednisone. It could be that we are more susceptible when this axis is out of balance. It's just speculation on my part, though.
Anyway, be assured you are not alone.
Thank you for your very thoughtful reply. It’s really helpful to know of others having the same problems with prednisolone and anxiety and I too have had some very tough days. It would seem that betamethasone is not the answer. I have had Hashimotos (auto-immune hypothyroidism) and low adrenal function for many years and I’m sure you are right in suspecting involvement of the HPA axis. Science (and medics) have a lot of catching up to do! My GP has arranged some mental health support and I will consider anti-depressants though am reluctant to take yet more pills… Thank you again for your thoughts.
Very interesting thoughts micpenn. I too have had dark days on prednisolone with anxiety and depression. I never wanted to take more pills but the insomnia and anxiety became too much after six months or so and I have been prescribed a course of Mirtazapine. This has helped a lot and as I taper down from the high doses of steroids things continue to improve. I hope you get the support you need FleetRose.
GP is refusing to prescribe enteric coated Prednislone
Anxiety side effects 
Anxiety
Cortisol levels and anti anxiety medication 
