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The Spokesman-Review Newspaper
Spokane, Washington  Est. May 19, 1883

People’s Pharmacy: Prednisone treatment can lead to depression

 (The Spokesman-Review)
By Joe Graedon, M.S., and Teresa Graedon, Ph.D. King Features Syndicate

Q. I took low-dose prednisone for a few years following immunotherapy for melanoma. I slipped into brain fog, black depression and insomnia. It never occurred to me that prednisone might be a factor.

Then I was switched from prednisone to hydrocortisone. The depression and brain fog lifted, and the insomnia lessened.

If anyone had suggested that prednisone could cause those debilitating problems, I would have asked for hydrocortisone immediately instead of spending years of my life in a dark fog wondering why I was still alive.

A. Psychiatric side effects are relatively common consequences of corticosteroid treatment (Psychiatry and Clinical Neurosciences, October 2011). Symptoms may include depression, mania, anxiety, insomnia, depersonalization, paranoia and panic. Both prednisone and hydrocortisone are corticosteroids, but prednisone is about four times more potent and lasts longer in the body.

Q. A number of years ago, my cardiologist prescribed a statin. After taking it for a while, I started having muscle aches and pains.

These were so severe that I went to the emergency room. However, extensive testing did not reveal the cause.

I asked the cardiologist if the statin might be responsible for the problem. He said probably not, as there was no reliable evidence that such side effects were related to statins. He agreed however, that I might try getting off the statin. Almost as soon as I stopped taking it, all the pains went away.

Years later, another doctor insisted that I needed a statin. I told him about my experience, but he also said statins don’t cause muscle pain.

He put me on rosuvastatin. Within a few days, I began having the same problems. When I stopped, the pains disappeared. Since then, I keep my blood cholesterol in an acceptable range without statins.

A. Surprisingly, cardiologists often disagree about statin side effects. In an editorial in JAMA Internal Medicine (Oct. 1, 2022), Dr. Rita Redberg and her colleagues suggest that “… in observational data, statin-associated muscle symptoms affect up to 1 in 10 individuals.” In a research paper published in the New England Journal of Medicine (April 13, 2023), Dr. Steve Nissen and colleagues wrote: “… 7% to 29% of patients report adverse musculoskeletal effects that prevent them from using statins …”

There are other ways besides statins to reduce the risk of heart disease. Dr. Nissen’s study of bempedoic acid (Nexletol) reveals one option. We have included many others, including non-drug approaches, in our “eGuide to Cholesterol Control & Heart Health.” This online resource can be found under the Health eGuides tab at www.PeoplesPharmacy.com.

Q. I have found that 500 milligrams of magnesium works like a charm against constipation. I take it in the morning along with my vitamins. One bottle I have seen even said “laxative” on the label. My doctor said it was fine.

A. It was smart to check with your doctor. Magnesium can have laxative properties, but 500 milligrams is above the Recommended Dietary Allowance for both men and women. The popular liquid laxative Phillips’ Milk of Magnesia contains 500 milligrams of magnesium per tablespoon. Too much magnesium may cause diarrhea.

People with poor kidney function should avoid using supplemental magnesium as a laxative. This could put undue strain on the kidneys.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”