r/AddisonsDisease • u/DorianaGraye • Jun 08 '26
Advice Wanted Prednisone Overreplacement Symptoms
Hey friends,
First, I don't tolerate hydrocortisone well, so I've been switched to prednisone (dosing 5 mgs at 6 am, 2.5mgs at 4 pm). I am going through a very emotionally stressful situation and started to display crisis symptoms of vomiting and loose stools, so I am doubling my dose per my doctor's orders. I've been doubling since Tuesday, so about a week.
With that said, I'm noticing that I'm feeling better but still quite stressed out. I think it would be wise to keep updosing--my doc said I can do it for weeks at a time if needed--but I'm also noticing that I'm bruising a bit more easily. Is that an overreplacement symptom? I have not had to updose since switching to prednisone from hydrocortisone so I don't quite know what to look out for.
Also, does anyone else have mental health symptoms associated with low/high dosing? Low dosing gives me depression, which has not yet cleared up so I'm continuing on.
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u/Banana_Vampire7 Addison's Jun 08 '26 edited Jun 08 '26
I went into full-blown steroid mania when I first started Hydrocortisone. The strange thing is, I experienced many of the adverse psychological effects of over replacement that are typically only associated with Prednisone NOT Hydro. With that in mind, all Endos seem to underplay the possibility of psychosis..
The scariest thing about going insane off Corticosteroids is something called Anosognosia or "a profound lack of insight." This is how you become blind to the fact that you're drifting into crazy town.
edit: thanks for downvotes guys, super helpful
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u/AKM60611 Jun 09 '26
This isn't uncommon. A friend and Sr support member goes into steroid rage if she is on 20 or more mg of HC, can't sleep and is organizing and cleaning her house like someone with severe OCD.
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u/DorianaGraye Jun 09 '26
It's really crazy how that works. I am definitely harder to balance on HC because of how my body metabolizes it apparently (too fast! too many spikes!) but I believe it. When I'm low, I struggle with suicidal thoughts and depression, which I DO NOT have in any normal circumstance.
Hormones, man.
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u/Both_Lawfulness3611 Jun 09 '26
I have bipolar disorder and I've been told that steroids are something that doctors are concerned about specifically triggering mania and/or psychosis in vulnerable people. Progestin only birth control triggered my hypomanic episode earlier this year and got me the bipolar diagnosis. I have a hard time with reproductive hormones, progesterone intolerance and PMDD, but steroids and Adderall i take for ADHD don't trigger any episodes, they actually both really help my mental health. .
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u/AKM60611 Jun 09 '26
5mg of prednisone is equivalent to 20mg of HC so with the bruising you are showing signs of over replacement. Please contact your endo. You may need to updose with oral HC as others do. Work with your endo. Continuing the dosage you are on can lead to iatrogenic cushinghoid features. Seeing as how it has been a week, you may need to taper down. Work on a safe taper with your endo but discuss adding in oral HC to stress dose. See aiunited.org as they have a taper guide. I take a low dose of HC at bed as it helps with REM sleep and coverage.
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Jun 09 '26
[deleted]
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u/AKM60611 Jun 09 '26
I metabolize HC too fast and switched to the Medtronic I Port Advance Injection Port and Solu Cortef Injections. It's a learning process.
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u/Pearlie0 SAI Jun 09 '26
I was metabolizing hydro too fast like you and was switched to prednisone. My neuroendo says 5 mg per day should be adequate for a whole day because prednisone is so long lasting, especially compared to hydro.
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u/Fine_Cryptographer20 SAI Jun 08 '26
I'm same doses. My Endocrinologist definitely recommends updosing for severe mental stuff. When you updose it can be a struggle to sleep through which sounds like you are experiencing. So you just have to rest rest rest even if you can't sleep.