From the Research
To manage anxiety as an adverse effect of cortisone injections, start with non-pharmacological approaches such as deep breathing exercises, progressive muscle relaxation, mindfulness meditation, and regular physical activity. These techniques help reduce the physiological stress response triggered by corticosteroids. Ensure adequate sleep and limit caffeine intake, as both can worsen anxiety symptoms. For timing-related strategies, if possible, schedule injections earlier in the day to minimize sleep disruption, as cortisone can cause temporary insomnia and heightened anxiety at night. If anxiety symptoms are severe or persistent, consult your healthcare provider about temporary use of anti-anxiety medications such as short-acting benzodiazepines like lorazepam (0.5-1mg as needed) or buspirone (5-10mg twice daily) 1. Beta-blockers like propranolol (10-20mg as needed) can help manage physical symptoms of anxiety such as racing heart and tremors. Corticosteroid-induced anxiety typically resolves within 1-3 days after injection as systemic levels decrease, though this varies based on the specific corticosteroid used and individual metabolism. The anxiety occurs because corticosteroids increase cortisol levels, affecting neurotransmitter systems including GABA, serotonin, and norepinephrine, which regulate mood and anxiety responses. It is essential to be aware of the potential systemic side effects of corticosteroid injections, including toxicity to articular cartilage and numerous systemic side effects such as increases in blood glucose levels, a reduction in immune function, and an increased risk of infections 2. Given the potential risks, the use of corticosteroids should be approached with caution, and patients should be informed of the possible adverse effects, including anxiety, to ensure informed decision-making 3.
Some key considerations for managing anxiety related to cortisone injections include:
- Monitoring for signs of anxiety and adjusting treatment plans as needed
- Using the lowest effective dose of corticosteroids to minimize systemic side effects
- Considering alternative treatments for joint pain, such as physical therapy or other medications, if anxiety symptoms are severe or persistent
- Ensuring patients are aware of the potential risks and benefits of corticosteroid injections to make informed decisions about their care 4.
Overall, managing anxiety as an adverse effect of cortisone injections requires a comprehensive approach that includes non-pharmacological techniques, careful medication management, and patient education.