Abstract

Received March 6, 2002; accepted March 26, 2002. From the Department of Psychiatry, University of Chicago. Address correspondence and reprint requests to Dr. Goldman, Department of Psychiatry, University of Chicago, 5841 S. Maryland Ave., MC3077, Chicago, IL 60637; l-goldman{at}uchicago.edu (e-mail). Psychiatric consultants working in general medical settings are occasionally asked to assess and manage mood disturbances caused by corticosteroid treatment. This problem is seen in settings where corticosteroids, particularly in higher doses, are more commonly used, such as in transplantation, oncology, pulmonary, rheumatology, and gastroenterology practices. Patients may present with delirium or a schizophreniform psychosis, but mood disorders—including manic, depressed, and mixed states—are far more common. Most reports of the treatment of steroid-induced mood disorders have emphasized the use of typical antipsychotics, and we found only a single case report1 in which an atypical antipsychotic, olanzapine, was used. Olanzapine is an atypical antipsychotic with high affinity for serotonin subtype 2A (5-HT2A) and muscarinic subtype 1 (M1) receptors and less affinity for dopamine subtypes 1 and 2 (D1 and D2), histamine subtype 1 (H1), and adrenergic 1 receptors. In addition to being an effective antipsychotic, it has been approved for use as a treatment for acute mania and is