This is the story of Jane. A healthy, stable woman in her twenties who, only weeks after moving from a rural town in Wisconsin landed the job of her dreams in the Big Apple, otherwise known as the city that never sleeps. I mention that, because it runs parallel to Jane’s initial experiences in New York: for the first couple of weeks after her uprooting, Jane wasn’t sleeping either. Not only that, Jane was facing a dangerous depression. A meloncholoy that got worse and worse every day, to the the point she found herself spending her days on the couch, immobile to the point she could not even muster up the emotional strength to answer the phone. It wasn’t long before Jane became suicidal and found herself in a hospital after spending an hour or so on the ledge of her building, ready to jump and end it all.

IT DOESN’T MAKE SENSE

Of course, the big question here is why. Why would a woman who had already undergone the stress of moving from a little town to the most threatening city of them all and on top of that, land her dream job in a well-known advertising company want to end her life? There is one notable glitch: since the move, Jane had developed asthma, an extrememly common occurence among transplants to an urban environment with poor air quality. After multiple attempts at treating her new breathing ailment with inhalers all of which proved ineffective, her doctor prescribed an oral steroid – et voila! it worked.

But that’s when the weird stuff started happening. Just a week or two after beginning the medication, Jane woke up one morning to a sudden rush of overwhelming and heavy sadness – nothing, she explained, like she had ever encountered before. She could not think of anything that would explain this very sudden and very intense despair. Within a day, the funk got bluer. She sat on the couch and didn’t move, and when it was time to go to bed, she couldn’t sleep and therefore resumed her intitial position on the couch. Jane stopped eating and drinking, cried uncontrollably and remained there in a catatonic state, and by the next day, the suicidal thoughts came creeping in. While the idea was a surprise to normal Jane, to depressed Jane, it seemed awfully alluring and relieving. Depressed Jane won over, and before she knew it, she found herself teeterng on the edge of her window sill deciding whether or not to take the plunge. Thankfully, in a sudden state of terror, Jane pulled herself back into her apartment and called 911.

PUTTING THE PIECES TOGETHER

When confronted with Jane’s story, the doctor in the ER was perplexed. Most suicide attempts, as you can imagine, are usually triggered by traumatic events such as a bad break-up, a death in the family, and so on. But in Jane’s case, just the opposite was true. While Jane’s doctor first thought of bi-polar disorder or some type of mania, the diagnosis didn’t seem to fit her case. Although she descried herself as feeling “euphoric” prior to the depressive episode, the euphoria was mild and not accompanied by the disorganized thoughts and behavior that go hand-in-hand with such a diagnosis. Further, her functioning was normal up to the episode, and she had no history of psychiatric illness at all. Jane was then asked what type of medications she’d been on, to which she replied “none”. She explained that she had been prescribed asthma medication but that she was “done with it”. Because asthma is a chronic condition, Jane’s doctor thought her answer to be a little off the mark. With a little more research including a call to her pharmacy, it was discovered that she had in fact been prescribed a high dose of oral steroids for a week along with a second prescription for a tapering dose of the same medication – but Jane never picked up that second prescription.

The medication that Jane had been prescribed was a corticosteroid, alternately known simply as a steroid. Corticosteroids are very powerful hormones produced by our adrenal glands  and physicians are known to prescribe them as inti-inflammatory drugs, in this case to reduce the inflammation in Jane’s lungs that was happening due to her asthma. Steroids have an array of physiological effects, including regulating the immune system and metabolism. When a person is on steroids, her adrenal glands don’t function as diligently as they would were she not on them. The body recognizes these drugs and in response, cuts back on the amount of steroids it would normally produce. Sometimes, it stops producing these hormones altogether. If a person stops taking these steroids, the adrenal glands will wake up, but this waking up process is sort of like trying to get an adolescent out of bed – it takes time, and sometimes, lots of time. Most high-dose steroids need to be tapered over weeks or months to give the adrenal glands time to “get out of bed” and start functioning again. In the case of Jane, it’s safe to say that when she stopped taking her steroids, her adrenal glands got all wonky and needed way more time than was allowed to wake up.

THE POWER OF STEROIDS

Steroids are also known to alter mood and behavior, sometimes creating extreme happiness, other times creating severe depression – which is what happened to Jane. These medications are so powerful in fact, that they can even trigger psychosis, extreme anger – and yes, thoughts of suicide. It is more than likely that this is what happened to Jane. She had been on the medication long enough to supress her adrenal glands, and when she stopped taking them, the sudden and severe drop in her blood steroid levels was catastrophic enough to cause her to spiral into a deep dpression that led to suicidal behavior.

Jane was monitored by psychiatrists for a couple of days, and when they restarted her on the steroids, it was like night and day. The depressed, desheveled Jane that had been rolled into the ER after a suicide attempt had transformed into a cheerful (nonetheless unnerved), articulate woman who clearly did not belong on a psychiatric ward. She was discharged within a short period of time, after a slow steroid taper to allow her adrenal glands to start working on their own again.

The story of Jane ends here. It is a not only a clear illustration of how a quick analysis of her symptoms could have led to a misdiagnosis of a primary psychiatric disorder, but a lesson about  the danger of medication when not taken appropriately. There are lots of close calls when it comes to medications and their effects – but this one comes a little too close to the ledge.