Prednisone causing extreme panic disorder?

Hi, I am a 32 year old male, healthy firefighter/paramedic. Just 3 months ago I wasn't on any medications. Around the beginning of the New Year I came down with the flu which for some reason took a toll on me (even after having the almighty flu shot). I was prescribed Tamiflu and after a week or so I was feeling much better. Around January 15th I began having nose bleeds, blood blisters in my mouth and petechia. I was admitted to the hospital on the 20th of January with a blood count of 5 and only a real complaint of being fatigued. They ran all the tests which came back normal and after the platelet transfusion I was diagnosed with ITP, a result from the flu!!! In the hospital they gave me 2- IV solumedrol infusions at 1000mg, I believe. Platelet count at 170. I was then released with a high dose of dexamethasone to take for 4 days, so high the pharmacist called the doctor to confirm. The hematologist told me that the ITP might come back or my body could possibly stop destroying my platelets. Well, 2 weeks later my nose bleeds came back as well as the blood blisters. I am now being seen outpatient with a prescription of prednisone. Started out with 60mg for about 2 weeks and then 50mg for another 2 weeks. I am steroid responsive so the doctor is tapering me down and since I have been on 40mg I began having EXTREME panic attacks. I have had 9 panic attacks since the 3rd of March which I went to the ER on the first one because I have never had one before and thought I was dying. My hematologist doesn't think it is related but what I have been reading prednisone is a nasty drug with a long list of side effects. My primary care has prescribed me a benzo to help with the panic disorder but honestly I end up enduring the whole thing( 1-2 hours) until I finally get sleepy enough to pass out:(
I am just looking for answers if anyone has heard of this or has experienced it before. I'm wondering if it could just be the fact that the tapering down is too fast or if I have been on the prednisone too long? Any advice would help me so much!!! I am not a weak person, my job is running into burning buildings and saving people in their time of need but now I need help and I don't feel like I am getting any answers. Once again, I stress that I have never experienced these panic attacks before so it has to be related to the steroids.

Welcome to the discussion site. I'm glad you found us.

Prednisone is wicked, and yes, it can cause panic attacks. Having to deal with your body "betraying" you and losing control of your health can cause panic attacks, too. I hope you'll take some time to read some of the discussion threads here...you'll see we've all gone through the very stressful period of being diagnosed with ITP.

You do have to be careful about tapering prednisone, and everyone will react differently to a taper. One thing you don't want to do is stop cold turkey...that can be really dangerous. Hang in there and stick around with us...there are many kind people here who will help you understand what's happening.

Having a doctor that is familiar with ITP and is willing to take the time to explain what is going on can be a big help during this time. If you don't feel like you have that, it's time to consider a second opinion.

-Tamar

Tamar is right that either the prednisone or the tapering could be causing the panic attacks. However, you tolerated the MUCH higher doses without problems, and your 4 week taper from 60 mg to 40 mg does not seem unusually quick, especially since you were on the 60 mg. dose for only 2 weeks. Based on these things, I would expect you to be doing fine on 40 mg prednisone.

It is possible that prednisone, or the tapering of prednisone, is causing the panic attacks, but my gut feeling is that something else is going on, that either your thrombocytopenia and panic attacks are unrelated, or they are both being caused by some other condition. In either case, I suspect that something else is going on.

Can you better describe your panic attacks? Other conditions can cause the symptoms of panic attack or symptoms similar to panic attacks. For example, I had episodes of tachycardia (with a pulse of 180) which resulted from an undiagnosed underlying condition (an extra circuit in my heart) that was then triggered in a rare response to a new medication. Also hypoglycemia can cause symptoms similar to panic attack.

Are you taking any other medication, besides prednisone and a benzodiazepine? Over the counter? Natural remedies?

Any other symptoms?

Nine panic attacks in 6 or 7 days sounds absolutely miserable. I hope you find an answer soon.

Thank you so much for the reply. I am still figuring out how to use this site. I am not sure if I use the quick reply or just the reply. So you can add another panic attack to that long list and I am now just able to sit down and type. I am an anxious person for sure but I have never felt anything like this before. I really feel like I’m losing it (no thoughts of hurting myself or others)First off this has been a stressful year for me and my family and winding up in the hospital with ITP honestly didn't really affect me initially. It sounded like something that I could handle and that's one of my biggest downfalls is I hold things in, don’t reach out for help and don’t react like most would finding out they have an autoimmune condition.
To describe the panic attacks is difficult because first off I start off with feeling disconnected from my body, with the inability to control my thoughts. Then I feel the overwhelming sense of doom. I imagine abdominal pain or that my spleen might be about to rupture and then list goes on. My HR does increase, the highest was 150 with no other symptoms i.e. Color change, diaphoresis. Sometimes I start to hyperventilate but my wife usually helps me with that. I also get very negative thoughts that I am a bad father because I am unable to watch my daughter and can tell I’m stressing my newly pregnant wife out.
Other meds that I am taking are propranolol 60mg since my HR did increase with panic attacks but that was prescribed after about 6 of them. I have been taking lansoprazole for acid reflux from prednisone, vitamin C and D. I am also prescribed Adderall but trust me I haven’t touched that nor any caffeine.
I woke up this morning attempted to meditate, did an internet yoga video, and went to the gym trying to work these feelings out of me and mid-workout I received a return call from my doctor since I had called during the weekend from my 4 panic attacks. I asked her if I would be done having panic attacks as soon as I finished the prednisone and she said that I have possibly developed a panic disorder. Immediate panic attack occurred right then. I really believe that I haven’t faced what’s been going on with me over the last year including the ITP and I am dwelling on these repeated panic attacks which in turn create more. I still think that the prednisone makes me more anxious but I might need to try some therapy and support on here.
Thanks, Matt

Matt:

Prednisone caused a similar thing for me, but I wouldn't exactly call it a panic attack. I knew what was going on and why. Prednisone can cause blood pressure to rise, the heart to race, and blood sugar to rise. My hands shook a lot and I felt so wired I thought my head would blow off. My job was stressful too which didn't help, so I would go into the restroom when I felt crazy and cry for a few minutes. It helped to release the tension. Doing that might not be possible or helpful for you, but it helped me to get through the days. I also had weird thoughts, but I knew the drug was causing it so I tried to find the humor in it. One example: I always watched MASH reruns at bedtime, but when I was on Prednisone, I couldn't stand the sight of BJ and Hawkeye because of their necks. That went on for weeks. Ridiculous. I also couldn't stand the sound of my co-workers voices. They may as well have been hitting a gong near my ears. It was all the drug and that became my mantra.

Realistically, you do know that your spleen is not going to explode, right? If it's not enlarged (which it shouldn't be), your spleen is perfectly healthy.

Prednisone can also cause that disconnected feeling. I remember not caring about anyone but me. I was so focused on myself that I didn't even care when my sister's appendix almost burst. It felt like she was some stranger that I had no connection to. You have to keep telling yourself that it is just the drug. I told my Hemo what was going on and he said, "No one else on Prednisone feels that way". Well come to find out from this site that yes, many people do feel that way. I learned how to just breathe and ride it out. I felt like it was more of a 'wound too tight' feeling than an anxiety attack, but it seems as if they are close.

It will get better as you taper down. Fatigue usually occurs during the taper, so that is the next fun thing to conquer. You'll get through it...most of us have been there. Prednisone is a wicked drug as is Dex. By the way, Dex is prescribed at high doses for ITP, usually 40 mg's for 4 days. It can shoot counts up but they sometimes drop back down quickly after that.

You'll get lots of support here. Most of us have been through the gamut. It's also possible that Tamiflu triggered the ITP; that can sometimes occur with medications. Many people do recover from ITP within a few weeks or months after an illness, so that could happen to you. Only time will tell. In the meantime, just hang in there.

Hey Matt,

First of all a disclaimer, that diagnosing panic attacks is definitely out of my league. Panic attacks are a strange thing, because of the mind-body interaction. Is your mind causing your body to react, or vice versa? Or, are the two caught up in a feedback system, where anxiety causes physical symptoms causing more anxiety, resulting in a full-blown attack?

You wrote, "I am an anxious person for sure but I have never felt anything like this before." There is research that shows that some people are more vulnerable to the psychological effects of steroids. What surprises me, though, is that you did not have panic attacks at much higher doses of steroids.

You are a courageous man accustomed to confronting fear with action. But there is no fire to fight. This is a fear that you can't confront. But it is one you can endure. And in time you will figure this all out. Meanwhile, stick around, ask a lot of questions, become an expert on your condition.

To answer your other question: Quick reply and Reply have the same end result, but quick reply doesn't allow all of the formatting options. If you are replying to a specific comment, use the Reply button. If your reply is general, use the Reply topic button. This only makes a difference to someone reading in the Indented mode.

Matt..I'll bet it is the prednisolone it made me feel absolutely dreadful at high doses...interesting link from Rob regarding lansoprazole..I am taking Ranitidine along with my Pred and have had no problems with it
Cheers Anne

Prednisone can cause anxiety Matt - we had someone here, Tofer [Julie] who had more than anxiety caused by it - she thought her husband was trying to kill her, called the cops on him. So don't let anyone tell you that your prednisone did not or will not cause it. Also those who have not ever taken prednisone at a high dose do not know what it can do, does do, and how we feel when on it!

You will do just fine - don't let ITP define your life. You have a beautiful family and a new baby on the way! Hang in there!

Ha, I forgot all about Julie and her episode. Don't forget the one who wanted to eat dryer lint. Prednisone has made people want to do all sorts of nutty things.

I wouldn't say that prednisone probably didn't cause Matt's panic attacks, nor that it probably did. I would tell him that considering that he tolerated much higher doses of steroids without panic attacks, including 2- IV solumedrol infusions at 1000 mg and 4 days of 40 mg dexamethasone, and the panic attacks started ONLY AFTER he tapered gradually from 60 mg to 40 mg, then he should consider possibilities other than prednisone.

I've had high dose methylprednisolone (solumedrol) 1000mg x 3 and it is nothing like prednisone.

The taper from 60 to 40 mgs of prednisone means Matt was still getting 40mgs or more of pred for a period of time. Perhaps the 40mgs were the trigger.

In any event, there are several stressors in Matt's life right now, and removing some of them will make the picture clearer. Hence, even if the taper is a contributing factor to the panic attacks, if a doctor agrees, then the taper should continue.

Hang in there Matt, and you can vent here if you need to!

(Edited to say methyprednisolone)

tamar,

I am not doubting you, but I am surprised. 1000 mg solumedrol is supposed to be the same as 1000 mg of prednisone, which is 25 times what he is taking now, and the same as 150 mg dexamethasone, nearly 4 times the dose of a high-dose dexamethasone pulse, which so many people complain about. Can you offer any explanation of why the 40 mg dose is worse?

Rob, I can't tell you the difference. I've the the 1000mg x 3 solumedrol treatment twice to try to jump start recovery from optic neuritis.

My experience is the weeks-on-end prednisone experience is significantly tougher to deal with, even with just tapering down from 60mgs.

Guys, solumedrol is not prednisolone, it is methylprednisolone.

1000 mg methylpred is like 1250 mg pred and 187 mg dex.

Matt we are here for you - as Tamar said, you can vent here if you need to, most of us have been on prednisone & know that it is nasty, know how it makes one feel (a lot of us feel our doctors should have to take a high dose for a while so they know too ). You will do fine and we want you to let us know how you are doing!!

That's Ann - our steroid conversion expert! I still can't do it.

Come to think of it, I've had Solumed too. I don't know how much, it was during the Rituxan infusion. I had no side effects and actually felt great afterwards (and for days). I wouldn't have felt that way on 1250 mg's of Prednisone, that's for sure. It's obvious that you can't compare the side effects of the two.

Why isn't Solumed used instead of Dex then? It is an anti-inflammatory too Sandi, that could be why you felt good. I'd have to ask my new hematologist about it if she ever wanted to put me on dex.

Ann wrote: Guys, solumedrol is not prednisolone, it is methylprednisolone.

1000 mg methylpred is like 1250 mg pred and 187 mg dex.

Thanks, Ann, you're right! I edited my post above. When I had the solumedrol the last time, it did raise my platelets.

The first time I had it, I don't know if my platelets went up because when I asked the administering nurse if we could get a CBC to see if my platelets were affected, she said no, because "the count wouldn't be accurate". Newbie that I was, I let it go at that, and when I finally went for a platelet count ~10 days later my platelets had dropped to 11K.

Prednisone can cause psychosis.

I have a severe fear of spiders so much so that on occasion it has cause me to break out in hives and trigger Asthmatic attacks. While on Pred I thought my only friend was a spider and I cried when it was killed.

I did not realize Pred had affected my mood till one morning my kids asked me a question I lost it and both kids ran and hid in their rooms.



I have a question for you? Are you still working?


PS: good news is if prednisone has caused an increase in HR or BP when your off it there's a pretty good chance your issues will disappear! That said you may want to monitor your blood sugar because it can also raise that.

All glucocorticoids can have psychological side effects, including psychosis. I have read that dexamethasone more easily crosses the blood-brain barrier, so one would expect more side effects, but several people here have reported the opposite, so it seems individual differences prevail.

Melinda, I don't know why Solumed isn't used instead of Dex. Maybe it's processed in the body differently and isn't as effective or maybe it's just a very expensive way to get the same effect. I don't know. I know that I probably felt great afterwards because it's an anti inflammatory and I'm actually going to ask my Rheumatologist next week if I can treat with that instead of the other horrible drugs she suggests. One point....I respond great to steroids for ITP, but Solumed did nothing for my counts. I don't get that at all.