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Another Voice: Powerful steroid may impair Trump’s mental state

Another Voice: Powerful steroid may impair Trump’s mental state

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In my second year of psychiatric residency at New York State Psychiatric Institute and Columbia Presbyterian Hospital in New York City, one of the junior faculty members was honored by being mentioned by Professor Laurence Kolb in his textbook on psychiatry.

Steroid drugs were in their infancy in their application to medical practice. This young faculty member, in his consultation work on medical wards of Presbyterian Hospital, came across several patients treated with hydrocortisone who had developed psychological disturbances, though they had no such problems before.

As steroids have been used more and more, their psychological effects have become well established.

Almost all recipients feel more energetic, ambitious and cheerful, some so much so that they become manic, anxiety occurs frequently and depression is also common. In most instances these effects are mild but on higher doses and in susceptible people they can be severe.

The Mayo Clinic says, “Psychiatric adverse effects during systemic corticosteroid therapy are common. ... Although disturbances of mood, cognition, sleep, and behavior as well as frank delirium or even psychosis are possible, the most common adverse effects of short-term corticosteroid therapy are euphoria and hypomania.”

It was well publicized that Trump was treated with dexamethasone during his siege with Covid-19 at Walter Reed National Military Medical Center.

Dexamethasone is a powerful steroid related to cortisone and hydrocortisone. Its use is not well established but there are many hospitals using it in selected cases with considerable success.

The details of President Trump’s Covid hospitalization are not available to us. We do know that he suffered from a disease known to produce mental impairment and that he was treated with a medication well known to produce psychiatric aberrations.

We also have watched his almost manic burst of energy after this illness and most of us have judged his performance in Washington, inciting a gigantic crowd to attack the Capitol building, as irrational, perhaps megalomanic.

All of this might be excused as symptomatic of the terrible illness Covid-19, which he has been fortunate to survive, though many others have not.

I do not presume an understanding of the particulars of Trump’s illness. But whether or not this heinous behavior was caused or promoted by this illness, many of us would be willing to give him the benefit of the doubt if he would quickly step aside, using temporary insanity as his cover.

Dr. Larry Beahan, of Amherst, is a retired psychiatrist.

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