ABSTRACT
BACKGROUND: In 2010, over 220 000 people attempted suicide in France, in other words up to one suicide attempt every 85s. Numerous risk factors are involved, including iatrogenic factors. Data from previous retrospective studies indicate, on average, 5.7 % of people treated with corticosteroids develop severe steroid-induced psychiatric disorders. Steroid-induced suicidal behavior is not explicitly specified in these studies, except for one recent descriptive study. Its prevalence remains unclear and is probably underestimated. CASE REPORT: We report the case of a 50-year-old woman treated by intravenous methylprednisolone for a relapsing-remitting multiple sclerosis relapse. Two weeks following a five-day intravenous treatment, she attempted suicide by prescription drug overdose at home. In the two months leading up to this event, she described symptoms of major depressive disorder which were left untreated. In retrospect, high doses of corticosteroids seem to have played a significant role in the occurrence of transient acute suicidal behavior. The patient improved significantly under antidepressant treatment and was discharged after three weeks of hospitalization. DISCUSSION: This clinical case points out that corticosteroids are likely to precipitate suicidal behavior in a patient with a premorbid undiagnosed depressive disorder. Early detection of psychiatric disorders before starting corticotherapy seems to be essential. However, management strategies are not explicit enough in the literature to be recommended. Treatment discontinuation should not be done systematically, but tapering should be considered in combination with an antidepressant drug. A recent longitudinal study by Fardet et al. on oral corticotherapy suggests a positive correlation between steroids treatment and suicidal behavior. These results may support our clinical observation. In addition, the neurobiologic correlates may give credit to the underlying pathophysiology proposed as a potential explanation to the patient's sudden suicidal behavior after corticotherapy. Physicians and patients must be aware of possible risks of increased suicidality when undergoing corticosteroid treatment in order to prevent fatal outcomes for the patient.
